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 By Neil B. Gailmard, OD, MBA, FAAO, Editor November 5, 2008 - Tip #353 
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How do you know if your practice is exceptional?


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I think most eye care practitioners (ECPs) are proud of their practices and think they are doing a great job, but frankly, we are probably not objective. Unless we look at outside indicators, we really can't be totally objective because we are too close to the practice. It's hard to see it the way patients see it.

Gaining a true read on how the practice is perceived by patients, the general public and staff can guide the ECP/owner to make adjustments in policies and procedures which can lead the practice to greater success. Here are five factors that will help you be objective.

The patient survey card

A patient satisfaction survey, offered to every patient seen, is the best way to gauge how the practice is doing. The procedure I use for this was described in tip #17 and if you aren't currently monitoring the patient experience, I recommend you start doing so now. I'm shocked at how few practices use a survey system on a continuous basis. Perhaps it's viewed as an expense that doesn't return much value, but I would strongly disagree with that. There are many nuances to conducting the survey process effectively, so I'll cover that in another tip article in the near future.

Survey cards provide very valuable information over time about how the practice is perceived by the most important person in the office: the patient. I look for an overwhelmingly high percentage of positive comments and ratings of excellent. Complaints and poor marks should be very rare and should be analyzed closely for possible ways to improve.

Spectacle and CL Rx retention rate

The percentage of patients who purchase contact lenses and eyeglasses from the practice is a strong statement about their general satisfaction. The first step is to design a system that accurately tracks the data. It's fairly easy to count how many Rxs leave the office each month (see tips #28 and 29), but to arrive at a percentage one also needs the total number of candidates for an Rx. If you use comprehensive eye exams or refractions as the dividing number, your resulting percentage is not really accurate because many refractions do not result in an Rx or an Rx change.

There is no standard for this data; we just need to understand where the numbers come from. Some practices use the number of refractions as the divisor, even knowing that it's not completely accurate, but it is an exact number that's easy to come up with. You could also compare the number of Rxs to go with the number that you actually process per month and use that percentage. As long as you are consistent with the data analysis within your practice, the Rx walkout rate is a useful tool to monitor over time.

A desirable Rx retention rate will vary widely among practices based on the type of practice and its goals, but the typical general optometric practice should achieve a very high percentage. I would look for a figure in the 90% range.

Gross revenue per patient

This statistic is possibly the most valuable of all management data to me. I track it every month for the practice as a whole and for each doctor in the practice. Here is how to measure it: the gross collected income for the month (this is the true gross or what is actually deposited in the bank, not the fees that are written up and will be adjusted heavily by insurance plans) is divided by the number of comprehensive eye exams performed that month. Again, using total eye exams could be argued as not representing every patient type (it ignores shorter office visits), but it provides a consistent accurate number that can be compared to national norms and can be tracked over time within the practice.

The optimum gross revenue per exam figure will vary widely from practice to practice, based on the marketing strategy in place, fee levels and local economic factors, but a recent study of hundreds of successful optometric practices found the median to be around $300. An advanced practice with high fees could easily exceed that number; I've seen several in the $500 range. Once you start tracking your gross revenue per patient you can set your own goals and work toward increasing the number. The truly exceptional practice has a high number that increases over time.

Recall success rate

Many practice management computer systems offer a success rate percentage based on the number of recall notices due for a given month and then analyzing the number still due for that month after the recall effort. Some systems will monitor appointments that are scheduled from the recall group. How long of a time period before the analysis is a variable that will affect the rate. If we analyzed the number of appointments scheduled within one week of recall notices being sent out we would get a lower number than if we looked at that two months later or six months later. For this reason it's hard to compare recall rates from one practice to another, but you should still determine the rate for your practice and track it over time. I've seen recall success rates in eye care quoted from 5% to 80%.

A high recall success rate is obviously a strong indicator of a well-managed practice.

General patient demeanor

This factor is qualitative and does not have a measurable statistic, but much can be learned by paying attention to the patient's demeanor throughout their visit and especially at the check out process. If the vast majority of patients served are happy and congenial in their interaction with staff (taking into account that some people have received unpleasant news about their eye condition) we can conclude that the practice is doing a good job with customer service. Even patients who have significant eye problems are often grateful for the care they received in spite of hearing bad news. Observe the attitude of your patients when they are with your staff and you'll learn a great deal about your practice.


Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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