Article Date: 7/1/2011

Create a High-Efficiency Practice
practice management

Create a High-Efficiency Practice

Follow these six tips to maximize your patient flow and increase your profitability.

Rob Murphy, Contributing Editor

It's an old yet all-too familiar story: While practice operating costs continue to rise, an optometrist's income—much of which is derived from managed care reimbursement—stays fairly flat.

In hopes of achieving a profitable end to this story, optometric, among other healthcare practices, have sought to expand their patient volume. Yet all healthcare practices have limited capacity. The trick, then, is to create a high-efficiency practice and to do so without sacrificing quality of care.

Here, optometric practice management experts provide six tips on how you can accomplish this.

1 When it comes to administration, think “e”

Think of the time your staff spends on administrative tasks. For example, “in a busy practice, it wouldn't be uncommon for a front-office employee to spend a couple hours a day taking appointments,” says Richard S. Kattouf, O.D., a Warren, Ohio practice management consultant who writes OM's monthly column “Fix This Practice.”

You can reduce these hours by automating the scheduling process—that is, by offering “e-scheduling.”

“By offering appointment scheduling through your practice's website, you can potentially cut that down to 45 minutes a day, freeing these employees to tackle other in-office tasks that could improve efficiency,” says Dr. Kattouf.

A review of other time-intensive administrative tasks may lead your practice to other significant “e” time savings. For example, enabling the patient to fill out the case history form via your practice website reduces staff time and office paper while potentially improving accuracy, as handwriting does not have to be interpreted. Patients who are Internet savvy may also appreciate the ability to fill out forms at their convenience.

Once electronic, consider integrating as many tasks as possible into your practice management software system and if available in your practice, an EHR system.

2 Utilize high-tech equipment

State-of-the-art diagnostic equipment typically performs tests and provides results faster than earlier generations of equipment, thus “creating” time for you and your practice. A prime example is computerized refraction systems, which contain technology that allows the technician to perform the subjective refraction. (Also see “Is It Time to Stop Refracting”). This, in turn, enables you to schedule more patients without sacrificing the quality of care, says Neil B. Gailmard, O.D., who practices privately in Munster, Ind., runs Gailmard Consulting and writes OM's “Management Tip of the Week.”

“These systems actually coach the technician with scripts and can be programmed to make the proper chart selection. You can fine-tune the prescription if needed,” he says. “This doesn't take nearly as long as performing the entire refraction yourself. Further, computerized refraction systems, by virtue of their technology, present the tests a lot faster than the manual refraction systems, also enabling the scheduling of more patients without sacrificing quality of care.”

Dr. Gailmard adds that some of these systems include built-in wavefront analysis and corneal topography, which enhance the subjective refraction and provide additional data about the eye's optical system, such as the aberrations within the optical pathway and on the surface of the eye. “These features enable you to produce a more accurate lens prescription in a short period of time,” he says.

3 Delegate

When you consider delegation, take a holistic view of all the tests and services offered by your practice. Gary Gerber, O.D., of The Power Practice, a practice management consultancy located in Franklin Lakes, N.J., says to reach peak efficiency, delegate all duties that don't involve “high-level” clinical decision-making.

“A well-trained staff can successfully perform pupillary testing; visual fields; retinal photography; corneal topography (with pachymetry); A-scan ultrasonography; dilation; anterior chamber angle evaluation; subjective refraction; contact lens-related procedures (e.g. insertion, removal, locating the proper trial lens, obtaining visual acuity with lenses, etc.); and certain aspects of patient education, such as how to use lid scrubs and instill drops,” he says.

John Scibal, O.D., who recently retired from more than 20 years of private practice in Morehead City, N.C. to start Blackwell & Scibal Consulting, in Morehead City, N.C., says that while the O.D. plays the pivotal role in educating patients, having staff provide patient education is integral to creating a high-efficiency practice.

“All staff members should be ready to answer basic questions,” he says. “For instance, if the patient needs to undergo cataract surgery, staff should be able to explain where they'll go for it and how long it will take, while the doctor addresses the nuts and bolts of the actual procedure. Having a staff member address these issues may not seem like much of a time saver, but it does add up.”

4 Provide staff training

Without providing staff training on equipment and in other areas of the practice, you won't be able to delegate or operate at peak efficiency, say those interviewed.

Take advantage of ophthalmic device companys' training programs, and consider creating your own, says Dr. Kattouf.

“I wanted to ensure my staff was well-trained, but obviously I don't have the time to individually train each and every one, so I hired a professional videographer and made 36 DVDs on how to perform everything from retinal photography to glucometry,” he says. “It took three months, but it was worth it to have all my staff on the same page, and it's enabled me to focus more on my patients, which is where a doctor's main focus should be.” Dr. Kattouf adds that each staff member is required to learn and undergo testing on each lesson.

“A staff's abilities are a direct reflection on the doctor's abilities in the mind of the patient,” he says. “So, if you want a high-efficiency practice that approaches maximum capacity, you have to create a well-trained staff.”

Dr. Scibal suggests you set aside a specific day or days for staff training. “Sometimes, it makes sense to close up shop, lock the doors and get away for a staff retreat,” he says. “This way, you have no phones ringing and no patients coming in and out, allowing you and your staff to focus solely on training.” Dr. Scibal says he divided these retreats into segments: clinical procedures, practice management and a discussion of strengths, weaknesses and opportunities.

“For clinical procedures training, for instance, I would say to one of my technicians, ‘Okay, you're going to train everybody on how to do pachymetry today.’ And everybody would practice on everybody else,” he says.

Dr. Scibal adds that he's found that putting certain staff members in charge of training can be beneficial. “To achieve a high-efficiency practice, the O.D. simply doesn't have time to train every single staff member on every single thing in the office,” he says. “So not only does doing this reduce doctor burnout from micro-managing, it also is much more engaging for the staff to learn from one another.”

One caveat: Although one staff person may know how to operate all the devices well, don't over delegate to that person, Dr. Scibal days. “Staff can burnout too, and you don't want to lose a smart and capable employee,” he says.

5 Schedule weekly staff meetings

Dr. Kattouf recommends you schedule weekly staff meetings at which discussions on how to refine individual responsibilities are discussed to create and maintain a high-efficiency practice.

“I carry a notepad and pen with me every day, and I jot down jobs well done, those that could have been better and those that were completely botched,” he explains. “Then, I take this notepad with me to the weekly staff meeting, reward those who did a job well done with a small gift, such as movie tickets, and turn the discussion to the noted transgressions, not naming any names, and what we as a staff can do to improve these transgressions.”

6 Value your time and the patient's

Understanding that “time is money” may help to create hours for you, the optometrist/practice owner. Here's why:

Optometrists are known as a personable bunch, says Dr. Kattouf. It's the reason that patients return. That said, in a high-efficiency practice, you must manage the amount of time you spend with patients, he says.

“There are two ways to accomplish this: The first is to designate yourself as the diagnostician—delegate the data gathering so that you're not with the patient as long. The less you're with the patient, the less of an opportunity there is to socialize,” he says. “Second, have a posture. Once you start to socialize—and there should be some socialization, as it fosters patient loyalty—sit in the exam room's chair, and meet eye-to-eye with the patient. To end the conversation, politely stand up, and say: “Alice, I've reserved an appointment for you next year,” and hand the patient her pre-appointed visit card. Standing sends a message that the conversation is over. Meanwhile, pre-appointing further helps to create a high-efficiency practice, as it saves your front-office staff the time it takes to interact with the patient regarding scheduling.” Dr. Kattouf adds that pre-appointing has also been shown to decrease the number of cancelled appointments, which will help your bottom line as well.

So, how much socialization is too much?

“In a managed care environment, in which optometrists are getting paid roughly $70 for an exam, you shouldn't be spending any more than 30 minutes with a patient,” Dr. Kattouf says.

A final note

We offer these tips as a starting point and invite you to share the other strategies and tactics that have created high-level efficiencies in your practice. We welcome you to submit your tips to for consideration of future publication in Optometric Management. OM

Mr. Murphy is a freelance writer based in the Philadelphia area. He has spent several years reporting on the eyecare field. E-mail him at Or send comments to

Optometric Management, Issue: July 2011