Keep Your Business in Focus
Assess the health of your practice without sacrificing patient care.
JASON R. MILLER, O.D., M.B.A., F.A.A.O., POWELL, OHIO, WALTER WHITLEY, O.D., M.B.A., F.A.A.O., NORFOLK, VA.
Primary eyecare providers play two roles: healthcare provider and business owner. To prepare your practice for 2014, you must focus on your role as business owner.
But, how can you do this when your role as healthcare provider takes up so much of your time? The answer is office efficiency.
Increasing efficiency enables you to work with the office manager to evaluate areas that need improvement to enhance the patient experience. Also, it gives you more time to work with bookkeepers, advisors and consultants to ensure you are meeting your monthly, quarterly and yearly benchmarks. In addition, you’ll have more time to network and market your practice.
Follow these six steps to improve office efficiency, so you can focus on your business:
1. “Fly full”
Operational excellence, which focuses on improving the efficiency of manufacturing, can be applicable to efficiency in an optometry practice.
For example, “fly full” refers to the importance of filling the appointment book. To accomplish this, make one person responsible for this, while allowing many staff members to make calls and send mailings to fill every available spot, including cancellations.
Additionally, evaluate your daily clinic schedule to ensure your clinic time is maximized. If the schedule has multiple gaps, consider adjustments to your schedule to allow more time to work on the business side of your practice.
2. Identify bottlenecks.
Look for bottlenecks within your practice, and consider ways to address them. One idea is to implement a 10-minute rule in which the patient starts the pre-test process within 10 minutes of being checked in.
Also, you could award bonuses based on your staff’s ability to consistently meet this goal.
With the responsibility of office efficiency being shared by all, this will help to maximize patient flow and patient satisfaction — no patient enjoys waiting.
3. Use the “one-time” system.
Make a concerted effort to enter the exam room only one time after all testing is complete. If you go into the exam room multiple times, this essentially takes time that can be used on other tasks.
4. Delegate to staff.
Delegation allows you to maximize “doctor time” by performing tasks only you can do.
Develop a process to delegate your nonessential duties. Start by writing the many steps of the eye exam process on notecards, then separate those notecards into “critical tasks” and “not-so-critical tasks.”
Teach staff members how to perform the “not-so-critical tasks” by providing the tools to do their work, along with proper guidance and training, and empower them to perform these tasks when indicated. Examples of such tasks: contact lens insertion and removal, tonometry, refractions and visual fields.
Delegating to staff allows you to focus on performing eye exams, interpreting the results and educating your patients.
By enabling staff to perform multiple steps during each patient encounter, they will understand their critical role within the practice.
Through proper training and meetings, you and your office manager can help staff see how everyone’s role integrates into the eyecare experience.
5. Strengthen your IT foundation.
Implementing electronic health records (EHR) further improves office efficiency in many aspects, including patient care, scheduling, recalls and billing procedures. In addition, ophthalmic data management systems can integrate images and reports directly into the EHR, which saves you and your staff time as well.
Analyze and focus on your information technology foundation. With government programs, such as meaningful use, the physician quality reporting system and EHR are integral to this foundation to improve patient care, clinical outcomes and practice efficiency.
If you have not implemented an integrated EHR system, make it a priority. If you have an integrated system and are unhappy with its performance, consider a different EHR system.
6. Code correctly.
Strengthen your medical record, and you will strengthen your business.
Take courses in billing and coding, utilizing Current Procedural Terminology (CPT) and International Classification of Disease, 9th Ed. (ICD-9) as your resource. Practice proper documentation of chief complaint, history, examination and medical decision-making to ensure proper patient care, and prepare to defend your practice in an audit. Remember: Only perform tests based on medical necessity.
Also, proper medical record keeping helps prepare your practice for the upcoming adoption of International Classification of Diseases, 10th Ed. (ICD-10), which will replace ICD-9 for reporting medical conditions in patient records and insurance claims in the U.S. starting Oct. 1, 2014.
Many practitioners are familiar with ICD-9, but ICD-10 is completely different, so do your homework. ICD-10 offers more than 70,000 potential choices for coding diagnoses, causes of medical conditions, etc., compared with roughly 17,000 choices in ICD-9.
Many EHR systems will likely have ICD-10 capability built into the EHR, automatically choosing (or recommending) ICD-10 codes just as they currently recommend choices of ICD-9 codes based on the content of the patient’s record for the day. The choice of ICD-10 code will be an automatic, single-entry system, converting the words of the diagnoses into ICD-10 codes. That said, you are ultimately responsible for coding and billing, so you shouldn’t rely on these systems.
With changes occurring within the healthcare environment, many of which are out of our control we must learn to adapt to ensure future success.
The best resource available to gain an understanding of ICD-10 is the CMS website (
Looking to the future
Although your primary focus is on providing an excellent patient experience, your practice is a business. As a result, making time to address the health of your business is essential to the long-term success of your practice.
The aforementioned six steps will enable you to ready your practice for strategic planning — an essential element for practice sustainability and growth. (See page 12.) OM
Dr. Miller is a partner of EyeCare Professionals Inc. E-mail him at firstname.lastname@example.org.
Dr. Whitley is the director of optometric services at Virginia Eye. E-mail him at email@example.com, or send comments to firstname.lastname@example.org.