Article Date: 6/1/2002

Delegating
Delegate Your Way to Higher Profits
Let your staff wear many hats and you can work magic at your practice.
BY WALT WEST, O.D., Brentwood, Tenn.

Think about your last visit to your physician. Did your doctor measure your blood pressure, weight and temperature? Prick your finger for a blood sample? Take your case history? More likely, a nurse or medical technologist performed these data-collection tasks, and your doctor analyzed the information, did any critical physical examination and provided a plan of care.

 PHOTO BY PAT SIMIONE

I've long been a proponent of delegating within an optometric practice. If you look at healthcare providers in general, or at other professionals such as certified public accountants, optometry is one of the last bastions where providers typically do minimal delegation. The only healthcare providers who delegate less are psychologists, for obvious reasons.

This month, I'll explain why you should delegate and how to go about it.

Crunching the numbers

Let's do some number crunching in reverse. Dr. Smith decides he wants to net \$150,000 next year. He has a net/gross of 25%. Half of his gross revenue comes from optical sales.

Table 1 shows us that Dr. Smith needs to generate \$300,000 in professional fees and \$300,000 in optical sales next year to reach his net goal of \$150,000. For purposes of illustration, we'll keep his net/gross ratio stable at 25% and his optical sales stable at 50%.

Table 2 shows the professional fees needed per unit of doctor time worked to meet that goal. If Dr. Smith works 40 hours per week and takes no vacation, he'll need to generate \$144.23 per hour, or \$36.05 per 15-minute unit of time.

If Dr. Smith books full exams every 30 minutes (fairly typical), charges \$72 per exam (typical), stays fully booked at 16 exams per day (atypical), has no no-shows (doubt it) and never takes a day off, he'll reach his goal of \$300,00 in professional fees. But he'll burn out fast with no time off and from the stress of keeping his appointment book full.

 Table 1 \$150,000 /.25 Net/Gross = \$600,000 gross revenue needed\$600,000/2 = \$300,000 from professional fees, \$300,000 from optical sales needed

Another pair of hands

I'm being simplistic, for illustrative purposes. More realistically, let's assume that Dr. Smith also generates fees in addition to his exam fee, from special testing such as visual fields, contact lens evaluation and fitting, co-management fees, etc. Let's also assume that, while booking patients every 30 minutes for full exams, he's booking them in 15-minute intervals for medical visits such as intraocular pressure monitoring, red eyes, punctal plugs and repeat fields.

Let's further assume that Dr. Smith wants to take vacation and time off for continuing education. If he takes 4 weeks of vacation and 1 week for continuing education, he'll need to generate an additional \$3.84 per 15-minute unit to reach his goal of \$300,000 in professional fees.

What's the best way for Dr. Smith to increase his revenue from professional fees? Bear several things in mind:

• Most practices experience fluctuations in scheduling, sometimes being overbooked and others being lightly scheduled.
• Half of Dr. Smith's plan is based on optical revenue, so while he's developing a plan to increase professional revenue, a good deal of that must come from spectacle-purchasing patients. In other words, he can't build it on anticipated co-management fees alone.
• In most practices, a significant percentage of patients, because of managed care reimbursement, generate less than a full exam fee.
• The net/gross will fluctuate depending on many different factors. For illustrative purposes, I'll keep it stable at 25%.

Dr. Smith could still make his plan work by billing two full exams per hour and an incremental \$15.34 from a separate procedure. However, when he considers the four points above, he decides to make some changes in how he structures his patient care and fee generation.

He realizes that if he could see more full exams, he would generate more professional fees and optical sales. He doesn't, however, want to hire an associate doctor. Dr. Smith decides that his best source of "another pair of hands" lies within his own staff.

 TABLE 2 Doctor weeks-hours worked Prof. fees needed/hour Prof. fees per unit (20 min.) Prof. fees per unit (15 min.) 52 wks = 2080 hrs \$144.23 \$48.07 \$36.05 50 wks = 2000 hrs \$150.00 \$50.00 \$37.50 49 wks = 1960 hrs \$153.06 \$51.02 \$38.26 48 wks = 1920 hrs \$156.25 \$52.08 \$39.06 47 wks = 1880 hrs \$159.57 \$53.19 \$39.89

The source

We can divide patient care into two categories: data collection and data analysis. Put your ancillary staff in charge of data collection and take care of data analysis and subsequent plan of care yourself.

While in many practices delegation is a way of life, far more could benefit from placing those data-collection tasks squarely in the hands of the staff. Your time is at a much higher premium than that of your staff. Freeing you to do more data-analysis and case planning will increase the profitability of your practice.

In Dr. Smith's case, his staff consists of the following:

• A receptionist who schedules and greets patients and performs data entry.
• A billing clerk who handles receivables and third-party claims.
• An optician who's responsible for all lab work, frame ordering and dispensing, and contact lens inventory and ordering.
• An assistant who escorts patients to the exam room and performs autorefractions and visual fields.

In addition to his "doctor" duties, Dr. Smith handles the bookkeeping and professional correspondence.

In considering where to institute changes, Dr. Smith first had each of his staff members list all of the duties she regularly performed. Dr. Smith did the same. Then he compared the lists and evaluated ways of repositioning the duties.

He decided first to broaden his assistant's knowledge base. Over the next month, Dr. Smith set aside one morning per week to train his assistant and also gave her some home-learning materials. She learned how to perform a thorough case history; external exam, including pupils and motilities; corneal topography; and applanation tonometry. The billing clerk sat in on much of the training as well to provide back-up help to the assistant.

One at a time

Dr. Smith added one new duty at a time to his assistant's roster. Every 2 weeks, she was expected to efficiently perform the new skill for patients, freeing Dr. Smith's time to do a more thorough job of patient counseling.

It soon became apparent to Dr. Smith that while his time was being better managed, his assistant was busier with patients and needed help herself. Dr. Smith had the billing clerk, who had also received the skill training, help escort patients to the exam area and perform visual fields and other automated testing.

Referring back to Table 2, if Dr. Smith can generate \$53.19 every 20 minutes, or \$39.89 every 15 minutes, he can attain his goal and work just 47 weeks. If his schedule stays reasonably full, he'll attain his goal and even exceed it with the newly found help within his own staff.

What could you delegate?

You may be thinking that this sounds too good to be true, or too easy or too optimistic. Some practices have a high turnover rate, and maintaining an adequately trained staff is difficult at best. How can you combat this problem? Well, as they say, the best defense is a good offense.

The best tactics to ward off staff turnover aren't unique to optometry. Employees value personal appreciation, regard for their family/personal time, good pay and the opportunity for growth -- nearly exactly the same things you value.

The best reasons to maintain a highly trained, consistent staff are also not unique to our profession. When you consider establishments you visit, you probably value competent personnel who have a history with the company -- for instance, the same travel agent or banker can make your life a lot easier! Your patients recognize that your staff -- the same optician, contact lens tech and receptionist -- over years add consistency and efficiency to their visits. The patient feels his time is valued and not wasted "breaking in" new staff.

Also, consistent employees tend to have much greater job satisfaction and thus do a better job. In turn, they should be consistently rewarded through higher pay and the opportunity to grow within the practice.

Getting their cooperation

Dr. Smith's assistant has taken over most data-gathering duties, with some help from the billing clerk. The billing clerk has greatly enhanced her value to the practice by expanding her skill set. Next, the receptionist will need to learn some of the billing clerk's job so that she can help when needed and also expand her skill set.

The optician seems to have more than enough duties to keep busy, yet he still needs some degree of cross-training. The other staff should receive cross-training in the optical and contact lens areas as well, so that they can perform functions such as contact lens training and ordering, frame adjustments and repairs and pinch-hitting with frame selection when the optician is backed up or absent.

Many of you think your staff would quit if you "dumped" that much more responsibility on them. How can you combat this problem? Again, the best defense is a good offense.

Tactics for warding off staff turnover aren't unique to optometry. Consider the following:

Recognition. Staff members value consistent personal recognition and appreciation (verbal and written). Provide staff with encouraging words in private and recognition in front of patients and other staff members.

More pay than they could make elsewhere doing the same job. We pay our staff a generous base salary and a bonus based on their production over the previous year.

Growth opportunities. Growth opportunities will become apparent as you train your staff. When I started co-managing laser-assisted in situ keratomileusis (LASIK), I spent a great deal of time counseling interested patients. When I realized how much time I was spending, I trained a key assistant to provide some of the counseling. When it became obvious that the LASIK market was huge and that I could provide a valued service to my patients (with potential for high revenues), I sought a new staff member for the counseling role.

I hired a highly organized person who possessed terrific people skills and a background in working with patients concerned about their vision. She was a registered evoked potential technologist who performed tasks such as monitoring nerve impulses during brain surgery.

Adding higher-level staff to your practice shows that you're committed to excellence and will continue to establish roles for their future growth.

Dr. Smith provided the opportunity for growth with his new plan to delegate data-gathering and cross-training his staff. He's become a master trainer and delegator. He's now adding the role of Trainer to his assistant's duties. With training materials available from industry, she'll be able to both expand her knowledge base and teach new staff members.

You can work the same magic in your own practice.

A few dollars more

Because he's delegated more responsibility to his staff, Dr. Smith can easily generate the additional revenue needed to reach his goal of earning \$150,000 and working 47 weeks. By breaking the numbers into small increments for analysis, such as 15-minute units, he saw that grossing just a few more dollars per hour would allow him to reach his goal. He shared his numbers, goals and vision with the staff so they could see the overall picture and work together to achieve it. The staff also set personal goals, such as levels of training they would like reach.

The overall picture

This sort of analysis and planning is crucial to a successful practice. If you only look at the overall picture, you can become overwhelmed by the scope of the effort needed to reach your goal. It's like the old saying, "How do you eat an elephant? One bite at a time." By crunching the numbers and tasks into small, realistically achievable elements, the seemingly overwhelming tasks become relatively easy.

Likewise, when you're implementing or expanding a program of active delegation, your staff might view it as an overwhelming amount of training or material to digest. But they'll respond enthusiastically when you adopt an incremental approach, while showing them the long-range, overall plan up front.

The keys to effective delegation are sharing the vision, focused skill training, cross-training to other jobs, opportunity for employee growth within the practice and compensation reflective of the employee's increasing value. The reasons for delegation will become apparent in your bottom line.

Dr. West is the senior partner of Primary Eyecare Group, a practice providing optometric and ophthalmological services to middle Tennessee, southern Kentucky and northern Alabama.

Optometric Management, Issue: June 2002