Experts spend hours looking at past trends to anticipate the future and recommend ways to exploit the changes that are predicted to occur. In the profession of optometry many are speculating on the change in the health care model and the impact the Affordable Care Organizations (ACO) will have on the reimbursement model for medicine. As optometrists we must preserve our current reimbursement model while anticipating the future payment model. One way to approach the future is to remain independent but act as a group when it comes to discussing payer models. The main focus is who will you team up with to present ACOs with a model that they can commit all their covered lives to that will represent all aspects of eye care.
Large Eye Care Corporations – These are corporations that typically have 20-80 ODs that practice throughout the region and refer to the specialty ophthalmologists. They are under one name as they are a group that works to provide all levels and types of eye care to the general public. If a patient is referred into a practice like this they are typically referred internally. This model will have a competitive advantage when an ACO considers partnering with a group that can provide all the eye care needed for their covered lives.
OD-OMD network – This is a corporation (group) of multiple independent practices that come together under one umbrella. They benefit by being a large group but remain independent in individual office decisions. This group is typically made up of 20-150 optometrists of multiple small independent practices, referral centers that represent retinology, glaucoma specialty and cataract surgeons. This model allows an optometry practice to remain independent but still compete with larger groups.
Health Care Groups – This is a large regional multidisciplinary group that represents all and is positioned under one group name. It is different than the “large eye care corporations” since it is a multidisciplinary group. This type of group usually involves a hospital and has a competitive advantage with ACO alignment since it can offer all services to the ACO covered lives. Typically, the eye care is a carve out and the health care groups do not include all aspects of eye services.
If you are in a practice with one to five doctors that has always operated independently, please take notice that to not be a part of a larger body of providers may mean that in January 2016 when most health care plans change in industry, you may find you are no longer a provider for XYZ company. Assuming that you can continue to survive on only vision care plans is taking more risk than the average owner should be willing to take. Positioning yourself for the future includes being a part of an OD-OMD network. This will allow you to continue to remain independent but think and act as a group.
When patients have conditions that are difficult to diagnose or treat, an optometrist might want to send them to an ophthalmology referral center or to another optometrist at a different clinic. However, the fear of not receiving the patient back may keep the optometrist from making the referral. This becomes a lose-lose for all parties, most importantly the patient. So when is referring to another OD a good idea?
Refer patients when you need:
A second opinion – this seems counter-intuitive because we all view ourselves on equal diagnostic fields. In reality, we are not. If you are in your first years of practice, don’t be worried that you don’t know everything–you never will. Many of your referrals in the first couple of years will most likely be due to lack of experience rather than a true pathological active problem. Finding an OD that you can trust to refer these unknowns to will not only be best for patient care, but will guide the perception in ophthalmology that optometry should be THE primary eye care providers.
Access to technology – many optometry clinics do not have the tools to manage medical eye care. The optometrist does not lack the competency but only the equipment to properly manage medical eye conditions. There are optometry practices in your area that have all the equipment. Be proactive and see what optometrist would be open to allowing you to send patients for testing only. The facility would bill a per click fee to you and you would bill insurance.
Specialty contact lens fits – you may be guilty of telling patients “there are no other options” when there are many contact lenses that may work in the specialty lens area like scleral contact lenses. The most successful eye doctors give patients all the options even when an option results in referring the patient to another OD.
Controlling parents ultimately lose the relationship with their children that they are trying so hard to control. The same can happen with the doctor-patient relationship. However, if you are always doing what is best for the patient you will win in the end. Optometrists who regularly refer to other optometrists end up winning the trust and loyalty of their patients in the end and most ODs who receive a referral from an OD are more likely to refer their own patients to another OD.
One of the key benchmarks for evaluating the health of your optometry practice can be determined by measuring the revenue generated per patient. Because the medical care revolution has placed diminishing emphasis on comprehensive exams, the benchmark is perhaps not as illuminating as in the past. Still, as an owner I find the “revenue per patient” benchmark a good reference in charting the health of my practice.
The formula is simple
Doctor production (collected dollars) / # of comprehensive (full) exams (92004, 92014, 92002 92012) = Revenue per patient
Comparison with the respected MBA statistics
Here are 3 ways to increase revenue per patient
Diagnose and manage diseases before they are moderate to severe – Most patients do not complain unless their eyes are bothering them most of the time. People in general don’t want to be complainers, and some patients in act as though complaining about their eyes is a sign of weakness. The astute optometrist asks the right questions to diagnose slight abnormalities before they become problems. This leads to better patient care. Proactive management not only solves patient eye problems early, but also builds the practice and thus increases revenue per patient.
Prescribe specific ophthalmic lenses/coatings and contact lenses – As an optician and now as an optometrist, I had always been taught to “recommend” products. Through experience and observation it has become apparent that patients should be “prescribed” medications, ophthalmic lenses, ophthalmic coatings, and contact lenses. With a prescription, patients are far more likely to follow through and purchase the products they need.
Invest in marketing your practice to generate new patient growth – As a general rule, most new patients to the practice generate more dollars initially than returning patients. The new patient is ready for a change or seeks services for an immediate problem, and that is most likely why they have searched for your services. The best way to generate new patients is from within. Talk to your existing patients and ask for referrals. Some of the most successful optometrists have grown their practice by respectfully asking patients for a referral. Outside of internal growth, the leading external growth modality is online dominance. Having the best online company that is optometry specific will significantly impact your revenue per patient. I’m biased with iMatrix because they have grown our practice with their product and they are a partner of OptometryCEO.
As the CEO of your optometry practice, it is extremely important to monitor the health of your practice. Of the many tools that can be used, in my opinion, revenue per patient remains a gauge that allows me to answer the question, “Am I working harder or smarter for the return on my time and money?”
The title of this post probably made some of you bristle. You don’t want to have anything to do with sales. In fact, you went into optometry for the sole purpose of making a good living without having to sell anything to anyone.
Despite your aversion to selling, you and your staff are selling to your patients every day, and not just new frames in the optical department. How is this possible?
In basic terms, selling is persuading someone to your way of thinking. This happens all the time in the clinic. For example, you don’t want a patient who has signs of glaucoma to go blind from the disease, so you convince her through education and instruction that medicating her eyes with nightly eye drops is the solution. Compliance is the responsibility of the patient, but many times compliance can be improved by having a good sales person during the exam. You, the optometrist, are selling the plan to improve the patient’s vision.
Success is measured by action that patients take to improve their vision and eye health.
So why do we get so worked up about sales? Over the years, sales people have gotten a bad reputation for being pushy, self-serving, dishonest, and downright rude if you don’t buy their product. However, if sales people are highly skilled, you don’t view them as a nuisance, you view them as partners in your business.
Selling is a skill that the most successful optometrists have embraced and use to get positive results, like more patients using needed medications, ophthalmic lenses, lens coatings, surgical options, and specialty referrals. When selling with the highest integrity the result is a win-win for the patient and the practice.
It begins with you changing your mindset (which, by the way, is a great book) about what you do and how you do it. Success is measured by action that patients take to improve their vision and eye health.
When his little brother knocks over his Legos, my five-year-old is inclined to feel sorry for himself and give up. I encourage him to see this negative situation as an opportunity to build something bigger and better.
This principle is definitely true when leading your staff. Sometimes unhealthy cultures and frustrated staff can present you, the CEO, with an opportunity to knock the walls down and build back bigger and better.
Starting the rebuilding process begins with knowing what the heart of your practice is, the core values. All successful business leaders have core values on which they center their leadership. Successful optometry owners may find themselves using the core values in a motivational speech or as a teaching tool for growing immature staff members.
Here are some examples of core values that you could use. Remember that you must live the core values yourself, otherwise they are meaningless.
The patient always comes first
Assume the best in all circumstances
The most successful optometry offices are committed to core values which lead to continued improvement in patient care. Online search engine rankings, competitive insurance plans, and social media accounts are all tools that can enhance a growing practice, however, the secret to optometry practices that are robust and remain that way for decades is the commitment to patient care. This begins with a solid message and a set of core values that is lived out in the owners all the way to the newest staff hire.
For more core values, google “core values” and you will find endless examples.
How well do you pay your staff? Studies have shown that job satisfaction is key to keeping staff in your optometry practice, but money is a close second. Successful optometrists who are also the CEOs of their practice know the importance of compensating staff fairly and equitably for their market while continuing to be a profitable practice.
The averages below are national averages of hourly rates that can assist you in analyzing how well you pay your staff and show you if increases are appropriate. It is also important to remember that smaller practices tend to pay 10 percent less. Based on MBA Key Metrics for 2015, these are the averages for each respective position:
Average hourly rate 2015
Contact Lens Technician
Of course, each practice may have its own variables. For instance, our practice is a large practice, so with the amount of production any mistakes in filing insurance can be exponentially costly to the bottom line. Therefore, we believe that an insurance administrator is extremely important for accurate billing and claims and feel that the above compensation guidelines are low in the area of insurance administrator. Each optometry practice will vary, but use this as guide to evaluate the competitiveness of your compensation.
Some people love change–it’s part of their DNA and makes them who they are. Some people easily tire of the stress and frustrations that come along with change. If you are the latter, you may be ready for retirement. If you are an optometrist and CEO of your practice, you must embrace change–whether you love it or not–and constantly try to improve if you want to be successful.
One area of change that makes many optometrists leery is online scheduling. Professions like cosmetology and massage have made this a norm for their clients, whereas healthcare professionals tend to be protective of their schedules and stick to the old “call the office” routine. Fortunately for those who are ready for change this will be the next evolution of patient convenience and practice success (and it isn’t as uncontrolled as you might think). For a business of any kind to grow and thrive it must change to meet the demands of consumers (or in our case, patients). Online scheduling is one of those conveniences that patients want. How do I know this? More and more patients are contacting our office electronically to schedule instead of calling the office.
Put yourself in your patients’ shoes:
Old way–Scheduling an appointment when it is convenient for the OFFICE.
Make sure the office is open.
Call a phone number.
Wait through the phone tree.
Be transferred to scheduling.
Answer a bunch of questions that you don’t have time for because you are late for your daughter’s soccer game.
Ask if you can go online to fill out the questions they are asking.
Phone call ends with you frustrated because you still have things to do to complete the appointment process.
New way–Scheduling an appointment when it is convenient for YOU.
The old “call the office” model revolves around you and your staff. When a company can design its processes and systems to revolve around the customer, the company wins and so does the customer/patient. Practicing optometry is difficult during this time when change occurs weekly and the office must constantly defer to consumers. However, if one ignores the changing patterns of society then one ends up wondering how some optometry offices have thrived while some have barely survived.
What do you do with an employee who has a post through two sections of her ear and a quarter-sized gauge in her earlobe?
The younger generation of staff members are more likely to have body piercings that may or may not be suitable for a healthcare facility, and, more specifically, your optometry practice. Unfortunately, many optometrists who own their practices are reactive instead of proactive. These individuals wait until a new hire shows up with a piercing before deciding it is time for a policy. At that point, the offending person will likely feel singled out and picked on.
That’s why all owners should be proactive and address piercings in their policy manual. Here is an example of a policy that you can copy and paste today. With a “body piercings” policy, you are setting an office-wide standard, and you may even avoid the unpleasant task of having to ask staff members to remove their piercings.
All visible body piercings should be filled with a clear post or stud. The exception is piercings that are in the ear. The preference of (Your Practice) would be for all staff to keep visible body piercings free of any type of post or stud, again excluding the ear.
If you believe body piercings are unrelated to the professional image you desire your practice to reflect, then most likely you can move on without such a policy. However, if you have not thought about this because someone has not asked or reported to work with one, it is time to be proactive and make a policy. It is always much easier to explain policies up front than to make them as you go along.
When a doctor needs to take an extended leave from work, the remaining doctors in the practice may try to take on the additional patients among themselves. However, the level of patient care may suffer as they work longer hours or add an extra day each week. Under the increased workload they can become stressed and on the path to burnout. To protect all of the optometrists’ quality of life, a better solution needs to be found.
Hire a locum tenen for an extended period of time. Locum tenens is a Latin phrase that means “to hold the place of,” or, “to substitute for.” Hiring a fill-in doctor takes planning, but if done correctly can be a win-win for all parties involved.
Finding a locum tenen – If you live within an hour or two from a big city, you can most likely ask an optometrist working at a commercial establishment to substitute in your practice a day or two. Online companies provide fill-in optometrists. Part-time optometrists across the city or in another town may want some extra hours.
Prepare patients – If the doctor leaving is already booked during the time he or she will be gone, use this as an opportunity to allow patients to keep their yearly appointments with a different doctor, and promise they can return to their original doctor for following visits. A month before, have staff notify patients that Dr. Extended Leave will be gone the day of their appointments, but another doctor will be filling in.
Malpractice coverage – It is important to visit with your malpractice carrier about terms of coverage. We were pleased to discover that our locum tenen is conveniently covered under Dr. Extended Leave’s policy for a 60-day period. Please check with your malpractice carrier.
Insurance – If the Locum Tenen practices in the same state, he or she is already on most of the insurance panels. If not, planning ahead will allow your insurance staff plenty of time to get them on the panel. Medical insurances make this extremely easy whereas the vision benefit companies (VSP, Eyemed, Superior, etc) make it more difficult.
Prepare staff – Staff appreciate being part of the decision-making process, and they and respond best when they know of changes in advance, so it’s important to communicate through this process and show them why this will be best for patient care. Explain they may not get many hours to work when Dr. Extended Leave is out, and they will warm up to the idea of a locum tenen quickly.
Doctors find it easier to take time away and actually let go of the office stress when patients are being cared for. The locum tenen solution allows for the new mother to enjoy a couple of months with her baby, or the compassionate doctor to serve for a term internationally giving of the gift of sight. It also may give a father extended time with his family before all the children are grown and gone. Whatever the need for an extended leave, a locum tenen for a replacement is a good option.
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.
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.
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.
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.
Offer patients the opportunity to be contacted should an earlier appointment become available.
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?”
Twitter allows the staff to tweet available appointments for the afternoon. @WichitaOptom
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.