Stay profitable in the face of eye care appointment cancellations

The results are obvious–the higher the number of cancellations, the lower your monthly production. Not only do cancellations hurt the bottom line, but they are especially frustrating in busy months like July when many other patients are trying to get in. A filled clinic schedule at the beginning of the month can be a misleading indicator of your office’s success, because cancellations can leave gaping holes. True results come from the number of completed exams at the end of the month.

Actively working to fill cancellations will improve your bottom line, and it can also improve your level of service to your patients. For example, your office is booked out four weeks, which might be longer than some patients prefer to wait. However, on this day you receive word of three cancellations. By filling those cancellations with previously scheduled patients, you will get three patients into your chair tomorrow, and now your schedule has three open spots in the near future.

So how do you ensure that 25 appointment slots equal 25 patients who show up and complete an exam or encounter in a given day?

Ensure all appointment slots in a given day represent a completed exam.

  1. Train staff to put patients on the cancellation list. – All staff who schedule appointments by phone or online will need to be clear on how the office cancellation system works.
  2. Use software that allows your staff to communicate a new opening quickly and efficiently. We have chosen SolutionReach, but others also allow for this capability.
  3. Sync the cancellation list for all staff and locations, if applicable. – We use Ocuhub, which allows us to have synced folders (i.e., Dropbox). Unlike many folder-syncing software packages, Ocuhub is designed for optometry/ophthalmology and is 100 percent HIPAA compliant in protecting patient health information.
  4. Offer patients the opportunity to be contacted should an earlier appointment become available.
  5. Scheduling staff should listen for voice inflections or comments that indicate a patient is frustrated. Have them ask, “Would you like to be put on the cancellation list to get you in sooner?”
  6. Twitter allows the staff to tweet available appointments for the afternoon. @WichitaOptom
  7. Allow online scheduling.  Schedule with Dr. Fleming.

Take advantage of the many opportunities to fill your schedule with patients instead of cancellations. Having a successful system in place will help fill in the non-producing gaps that every CEO faces in reflecting the end-of-month numbers.

3 essential tools for optometric staff management

toolsThe phrase “work smarter, not harder,” certainly applies to successful CEOs of optometry practices. Since many of us are doctors first, we may not be the number one draft pick for leading a business. Working smarter is knowing how to find resources that others have used in successful businesses. This is the primary reason that OptometryCEO makes downloads available.

Here are three resources that can be downloaded from OptometyCEO:

  1. Employment Manual – This is not optional for an optometry owner. An employment manual is a working document that is available on your website for all staff to access. The employment manual can be used for defending a wrongful termination lawsuit, setting boundaries for cell phone and internet use, and explaining discounts for family members, among other things. The download can be edited to fit your needs. This helps the busy OD create a comprehensive employment manual without having to start from scratch.
  2. Policy Manual – A policy manual assists your staff in addressing difficult situations that come up in an optometry office. For instance, how does the office handle patients who don’t want to pay even a portion of the cost of their new glasses until they pick them up? How about the patient that no-shows three times in the last three weeks? Does that patient get to reschedule? What is the office policy regarding sales reps scheduling appointments with your staff?  Is any time of the day or week OK? Thinking through these situations and writing guidelines specific to your practice will help your staff make decisions that are consistent with the owners’ wishes.
  3. Job Description/Expectation – An optometry office can operate without staff members having written job descriptions, just like a football team can advance the ball without having set plays. The problem is, it doesn’t work all the time. To be consistently successful, systems that can repeat themselves need to be in place. All of your staff members need to know what is expected of them to consistently be successful.

The three resources above can be customized for your practice and will provide you with a comprehensive guide to successfully lead your staff.

Three reasons to offer health insurance to your optometric staff

The hottest topic for optometrists in the past few years has been health insurance and the Obama administration’s impact on ODs as providers.

But what about the optometrist and staff as patients? Should you as the employer offer health insurance for all of your staff members?

Peace of Mind wooden sign with a beach on backgroundIn our parents’ generation many employees working in optometric offices were married and covered under their spouses’ insurance policies. Today, the majority of employees are single and don’t have another source of health insurance. Through the new state exchanges, health insurance can be an affordable option for your staff and potential employees. However, I believe you as an employer are at a competitive disadvantage if you do not build health insurance into your compensation model at your office.

Most applicants are looking for positions that offer health insurance. It has become imperative that you structure your compensation model to include health insurance.

If you do not currently offer health insurance to your employees, here are some ways to include it.

  1. Controlled Benefit – As the CEO of your optometry practice, you choose how much money will be allotted for health insurance. For example, you may choose to put $250 per month for each employee who opts to have health insurance.
  2. Better Applicants – By offering insurance, you will immediately improve the quality and sheer number of qualified applicants for any position in your office. Applicants are concerned about hourly compensation, but they also want peace of mind. If you offer health insurance, whether fully or partially paid, you are offering peace of mind.
  3. Control Overhead Costs – Most of us are unwilling to include health insurance as a part of an employee’s compensation package because we are afraid of the increased overhead costs. Don’t worry. If you are adding health insurance, discuss the added benefit with your staff and explain the impact it will have on hourly wages. Most of your staff will be just fine with it because they are receiving the peace of mind of having health insurance. As the owner and operator of your practice, do the math backwards. If you usually pay 25 percent for staffing, include an amount towards insurance for each staff member and adjust other benefits so the re-allotment totals 25 percent of overhead. (Twenty-five percent is typically high for those of you wondering)

There are many good reasons to offer health insurance as a staff benefit. The most successful practices learn to adapt to what is important to employees and compensate accordingly. Remember, compensation alone is not the primary reason most employees leave their jobs. (Remarkable Leadership – Eikenberry)

Defining “Standard of Care” for your Optometrists

As the owner of a multi-doctor clinic, you must define the standard of care for your practice.

When optometry owners bring in an associate OD to work as a long-term associate or future owner, they often assume the new OD is familiar with the standards of care the existing doctors are using. This is usually not the case. Communicating boundaries and guidelines to your new optometrists will help the transition to your practice.

As the leading optometrist, you must decide if the standard guidelines published by the American Optometric Association, the American Academy of Ophthalmology and Wills Eye Manual are appropriate for your patient care. For instance, a rural optometrist may manage a retinal pathology a little longer than an optometrist in a city that has a retinologist two miles away.

Giving specific guidelines to your associate optometrists is a great way to help them practice with confidence and a good way for the practice to guard against liability.

Questions to define your practice’s “standard of care”

  1. Glaucoma Suspect
    • How many times should a visual field be done in a year?
    • Is a 30–2 appropriate every time or should 24-2 be done at least once a year with one 10-2 once a year?
    • OCT – Should this be done every 3 years or once a year?
    • Gonioscopy – Did you know some optometrists managing glaucoma have not done this since optometry school? Are you OK with that?
    • Serial Tonometry – Did you know some optometrists never do this? Are you OK as the owner if an associate OD chooses to never do serial tonometry?
  2. Vitreous Detachment
    • Is it OK to see the patient for the initial visit and not do a follow up?
    • Are you OK with a 3 month follow-up after an initial visit?
    • Is it OK if 3 doctors in the practice manage posterior vitreous detachment (PVD) in three different ways?
  3. Contact Lenses
    • Is it OK if an optometrist in your practice does not require that the contact lens be evaluated on the eye yearly to renew the contact lens prescription?
    • Is it acceptable for your associate OD to fit teenagers into 30-day continuous-wear contact lenses?

Guidelines published by our national associations are meant to be the minimum standard of care for all optometrists. Some doctors who have been practicing for a decade or two have eased off their once-stringent guidelines, and any associate optometrists working with them are getting no real-world guidance.

As the leader of the optometry practice, it is your responsibility to ensure that all doctors in your practice are delivering a defined standard of care. Ultimately, this not only protects from malpractice liabilities, but it also ensures that patients receive the level of care that the practice has a history of providing.

Build your Optometry Practice to Sell

hands-shakingHave you been thinking about retirement?
If you have graduated from optometry school and you currently own your practice, you should be. It’s never too early to begin the process of preparing your practice to sell. Many optometry practices do not sell for reasons that could have been prevented if the CEOs would have had the mindset that someday they would sell. If you plan to someday sell your optometry business, then avoid these four costly mistakes that have left many optometrists holding a business they cannot sell.

  1. Aging Technology – Some optometry practices still use outdated technology like the GDx. You might have a chance of selling your GDx in the United Kingdom, but you won’t get anyone to buy it in the United States. The standard optometry practice should have some form of Optical Coherence Tomography (OCT) technology.
  2. Paper Records – If you believe you will hold out on changing from paper to EMRs (Electronic Medical Records), then plan on holding out from selling your practice. Most of the optometrists who are in the market for buying a practice have not even performed an exam on paper. Also, as costs continue to mount for changing from paper to EMRs, the pool of investors who are interested in paper offices has shrunk. Investors do not want to spend thousands at the outset just to make the office current. If you remain on paper, the value of your practice is on the decline.
  3. Single Owner Doctor – What would happen if you stepped out of the practice? Is the success of the practice dependent upon one individual? The optometry practices that can remain profitable independent of a sole doctor are practices that carry the most value for potential buyers. Hiring an associate OD can be a difficult decision due to the up-front costs, but not selling your practice can be much more costly.
  4. Depending on vision benefit plans – If your practice cash flow is greater than 50 percent from vision benefit plans like VSP, Eyemed, & Superior, then selling your practice will be highly dependent upon the future of the segregation of vision and medical. As we move to an Accountable Care Organization (ACO) environment where fee for service becomes obsolete, practices must prepare for bundled payments and full capitation. To be profitable in this environment, the number of patients seen must increase as the reimbursements decrease. Optometry practices depending on “ramping up their schedules” can only ramp up so far until it starts costing the practice to see patients. Transitioning your practice to a medical model with complimentary vision benefits is a must for selling your practice.


Optometrists continue to make similar mistakes each generation. Building a practice that is salable is key to maximizing the potential profits of owning a practice. If doing this does not seem necessary nor desirable, it may be an indication that you are best fit for being an associate. If you currently own a practice, you will want to sell it someday. Making the above adjustments should be at the front of your list for working on the practice. An astute buyer will not pay much more than 55 percent of the last three years’ average gross collected, and many buyers will not even pay 55 percent. Take action now and build your optometry practice to sell.

Oh baby! Surviving an Associate OD’s maternity leave

The birth of a baby is one of the most exciting events a human can experience. When one of our associate ODs informed me she was pregnant, I was happy for her. As a CEO of our optometry practice, I also recognize scheduling her maternity leave will bring some challenges. Overcoming these hurdles and coming out stronger post-maternity leave is what all successful optometry practices do. The great management advantage of pregnancy and maternity leave is you most likely will be aware of it seven or eight months in advance, so you will have plenty of time for planning.

Here are a couple of tips for navigating a six-to-eight week span when an associate optometrist is out of the office.

  1. Staff time off – When you find out an associate OD will need maternity leave, you can encourage non-OD staff to plan vacations and time off. Many times your staff can and will arrange for time off when you will be without a doctor for an extended period of time. Your role is to communicate and encourage them to use that time.
  2. “Locum tenen” – The definition of locum tenens, roughly translated from Latin, means “to hold a place.” Locum tenens physicians fill in for other physicians on a temporary basis for a range of a few days to up to six months or more. When healthcare employers face temporary staffing shortages due to vacancies, illness, or other causes, they hire locum tenens physicians and other part-time clinicians to fill those vacancies and maintain patient care quality. (reference)
  3. Extended “to do” list – Plan for the office to do jobs that usually do not get done during the busy week. This may mean going through patient records and calling ones who have not been in for two years to see if they still consider your practice their eye care provider and then schedule an appointment. This may mean doing a deep clean of the office and equipment. Whatever it is, time is maximized by planning ahead.
  4. Adding appointment slots – This maybe the easiest way to address being short a doctor for an extended period of time. Depending on the size and how busy the practice is, an hour a day added to your schedule may be all that is needed.

The question still remains about how the practice is going to grow minus a doctor. The growth does not occur during the time the optometrist is out of the office. The growth is a product of what was done during the “off-season”  With any sport, the success of the season is highly dependent upon what is done during the “off-season” Being intentional about making your “off-season” productive will grow the practice when it is back to running full speed. And whatever you do, don’t lose sight of the big picture. Family growth and prosperity far outweigh practice growth.

The #1 way to avoid paying unemployment

Laying off

A bad hire can can damage office morale. Sometimes employees don’t work out and need to be terminated. However, you might hesitate before you fire them because you don’t want a lawsuit for wrongful termination, and you certainly want to avoid paying unemployment.

Here is the number one way to avoid unemployment costs:

Quit and Document
When employees quit voluntarily, they will have a harder time receiving unemployment pay, so quitting is the best-case scenario. Of course, many times poor employees refuse to see they are the problem so you may have to fire them.

However, when a problem employee does quit, make sure you document extensively what led up to the resignation. Then when you receive a notice that your former employee is filing for unemployment, you can submit your documentation for an appeal. This can and has worked for optometry employers. The key is to document all threats that the employee made to quit, and also to document that neither you nor your staff encouraged the individual to quit.

One last word of advice: In your employment manual, make sure that you use the term “at will employment” for referencing staff employment. An employment attorney is an important part of your team and can be instrumental in leading you the optometrist to make these key human resource adjustments.

How to stick it to your NO SHOWS

When patients cancel or or forget their appointments, a highly productive day can turn into a day that’s only slightly better than just staying at home. Because frequent cancellations and “no shows” are costly, some optometry practices try to punish patients by charging them a “no show” fee. However, I think they end up losing in the long run.

Is there a way to stick it to the schedule busters?

Maybe, or maybe not. First, you need to consider these three things:

    1. Is your appointment reminder system efficient and effective for the patients you serve? SolutionReach has been effective for us. DemandForce and WebSystems3 also have good ones.
    2. Does your EHR track the number of N/S (No Shows) a patient has? Once patients hit two or three, schedule them in slower times of the day or double-book them at the end of the day.
    3. Find the source of the problem. If it is an entire family, fire the family. There are times when the relationship needs to be ended. For more information of this topic, check out Dr. Henry Cloud’s book Necessary Endings. Also, look closely for trends. Maybe your unreliable patients tend to be ones that have a certain type of insurance. If so, maybe it’s time to stop carrying that particular insurance.

Patients generally do not like paying for appointments they didn’t attend, so I would highly recommend that you do not charge for no shows. I believe far more damage is done than the small amount of money collected. Instead, use the above suggestions to minimize the number of cancellations and no shows, and decrease the negative effect on your practice.

Dialing for dollars: How to reduce costs

Photo of a telephone and dollars over a white background

In the past several years, staying profitable in an optometric business has become a battle. Reimbursements continue to decline while cost of goods and general optometry practice bills increase. Expenses will quickly eat up profits if you don’t proactively control your costs.

The bite that hit our practice recently was the corporate “family plan” for our mobile phone and device costs. I was amazed how the plans had changed, without even a courtesy call to inform us of the rate increases. One phone call this morning saved us $100 per month ($1,200/year) in data usage.

To be proactive in keeping your costs as low as possible, make the following a yearly habit:

4 steps every optometry CEO should take yearly

1. Collect all reoccurring bills into one folder.

2. Review the costs of the bills and what services are included.

  • Examples – mobile/device, telephone system, internet, trash, general insurance, electric, cleaning, lawn services, snow removal, IT company, data storage, shredding of hard drives, service agreements, software, website company, etc.

3. Highlight all the numbers that represent each company.

4. Call each business, asking the following questions:

  • Is the office currently receiving the best rate for the services that we receive?
  • If we were to switch to a different company, should we expect to receive the same offer coming back to you?
  • What other services do you offer that could potentially save us money?
  • Would we receive a better rate if we committed for a period of time?

Many variables impact the rate that each company gives you. One thing is for sure, all companies have different rate plans and those plans change to adapt to their competitors.

For example, we have been with SolutionReach for three years and the agreement includes a no-rate increase as long as we continue with them. This loyalty benefit allows us to control costs as the practice grows.

Many optometrists say the time required to do this is not worth the savings involved. I respectfully disagree, as they are usually the ones who wonder why their practice net continues to slowly erode. Don’t be surprised if the yearly exercise saves you between $1,200 to $6,000 per year.

Tattoos – Practical application to staff non-compliance

When a staff member is not following office guidelines, as the CEO and staff manager, I believe having protocols in place for consistently and fairly restating expectations is important.
Businessman in a suit with no sleeves and tattoo on his arms

For example, we have a staff tattoo policy that addresses how tattoos can (or can’t) be displayed for patients. Neither I nor Dr. Yarrow, the other owner, have any issues with tattoos. However, we know many of our patients may view tattoos as unprofessional. Based on this, we have implemented a policy that all tattoos should be covered during office hours when patients are present. I have been surprised at how positive the staff have been about this policy, and how much they have appreciated the guidelines.

So what happens when some staff members consistently forget to cover their tattoos?

Action Plan

As the staff managers we cannot assume the worst of our staff, we must assume that a staff member who does not have his or her tattoos covered is probably busy working and simply forgot. To easily solve this, open up your employment manual and export the page that references tattoos.  Then communicate to your staff member with a kind email stating:

  • “As I have observed you working so very hard at the front desk taking care of patients, I would have to assume that your efforts in complying with office guidelines is just a mental slip up. For your review, I have attached a page from the employment manual for your review. Thank you in advance for reviewing.”
  • Attach the exported page from the employment manual and send it to the staff member with the above message.

For the majority of staff this simple piece of communication should resolve the problem for a while. Staff members are human and they will probably forget again at a later date. If the later date is months down the road don’t worry, this is part of managing people. Send another reminder.

If the staff member continues with non-compliance, there may be a bigger issue that requires a face-to-face discussion. You then need to have that Crucial Confrontation.