Article Date: 4/1/2004

Are they hearing what you're saying?
Communication is the keystone of a successful practice. Try these six ways to improve yours.
By Owen Owens

It's hard to measure how well we communicate ... until there's a problem. Was a patient notified that his appointment time was changed? Did you treat a patient and then find out that you don't accept her insurance? Has a patient arrived from one of your comanagement partners without any information relating to previous treatment?

These things happen -- we're only human, after all. But if they happen repeatedly, they can undermine your relationships with patients, staff and others as well as impact your bottom line. Improve your practice's performance by taking a look at your communication in these six important areas.


You've probably read a lot about referral networks and comanagement. It's possible for all parties to benefit from these relationships, but relationships don't just materialize. How do you as a new practitioner make the right comanagement connections?

In a word: Networking. Take every opportunity to meet other practitioners in your area, learn about their reputations and discuss the possibility of building comanagement relationships.

One way to start networking is to join the medical staff of a local hospital or agency. As a member of one of these organizations, you'll have opportunities to communicate with local physicians, and you can begin establishing mutual referrals. Not only will this help you grow your network and practice, but it's also a great way to stay abreast of what's going on in your local area outside the scope of optometry.

You probably already have a good foundation for your referral network among your instructors in optometry school, as well as O.D.s and M.D.s you've met at eyecare meetings. Ask these professionals for the additional contacts you need. It's essential to include physicians in your referral network; not only will you build revenue from routine eye care, but you'll also be well-positioned to handle pre- and post-op care of cataract and refractive surgery patients.

Once you identify comanagement partners, you'll need to iron out some specific communication issues. Start by defining your expectations from a comanaging physician. When a patient transitions from the physician's office to yours, what information do you want to receive? What form should it take? How should you send information to the physician's office? You must ensure that you and the comanaging physician meets all your patients' needs efficiently.


As the scope of optometry expands, so does the risk of malpractice, particularly in cases related to retinal detachment, glaucoma and tumors. How can communication help you alleviate the threat of malpractice? It starts with your communication with patients and staff.

The Risk Management Foundation at Harvard Medical Institutions found that a strong professional relationship between doctor and patient is the most effective shield against malpractice lawsuits. Not surprisingly, research shows faulty or inadequate communication is the main reason patients sue their doctors.

The solution to reducing your risk is to speak clearly and openly to patients about their symptoms and needs, the examination, your diagnosis and the patients' treatment options. By understanding patients' needs and explaining their options, you'll help them make better choices for their eye health. When in doubt, ask the patient if he understands what you've discussed. In difficult cases, you might also request a consult with a colleague.

Simply put, your excellent skills coupled with effective communication will make malpractice a non-issue.


Your staff plays an essential role in establishing good communication with patients. They have the first contact with your patients when scheduling appointments and checking in. They're also the ones who discuss financial responsibility with patients, verify whether patients are eligible for various services through their insurers and collect patients' copayments.

In all these areas, good communication is vital. Patients need to feel they're in good hands from the moment they call your office. Communication should be friendly and efficient, helping patients move from check-in to filling out forms, going to the exam room, picking up prescriptions, scheduling additional appointments and handling payment.

Another way your staff can help you communicate with patients is to make your patients aware of the importance of continued eye exams, as well as when they should schedule an exam. Your staff can handle appointment reminder postcards and phone calls, both of which will help you decrease no-shows. You can make scheduling and reminders easier for your staff by having established schedules for each practitioner. This way, the staff won't need to call patients for scheduling changes.


Many insurers require you to submit extensive credentialing applications to ensure that their members get appropriate care and a certain level of quality from their providers. You need to communicate with the insurers to fully understand how they define the services for which you're credentialed, and how they perceive your responsibility to the patient.

If an insurer needs to credential both you and your practice, be sure this is finalized before you begin seeing patients with the plan. And remember, if you see a patient without being credentialed for his or her plan, you probably won't be reimbursed for the services.


When you can't collect your fees, you're left with two options: Write it off, or pay someone to collect your fee for you. Both are costly options. To make sure this doesn't happen, establish effective billing and collections practices early.

Billing and collections begin the moment a member of your staff asks about a patient's insurer. At this stage of the communication, your staff needs to verify that you take the patient's insurance or that the patient will pay for services. If your practice doesn't have a billing and collections department, it's best to collect all fees at the time of the patient's visit, especially if the patient is paying out-of-pocket.

When you join a new vision plan, your staff might find the paperwork difficult to manage. The new plan can increase patient volume, but it may seem impossible to collect your fees. The result is diminishing cash flow. After a few months, the uncollected fees can accumulate enough to become a problem. The solution is to ensure that you and your staff understand the protocol required for reimbursement. Then make sure patients understand their role in the process.

Another simple way to improve billing is to clearly communicate a patient's services to your billing staff. Write clearly and legibly when completing the patient's chart and fee sheet.




Winning Referrals From M.D.s by Richard Hom, O.D., F.A.A.O. Optometric Management.

A New Referral Relationship by Walter D. West, O.D., F.A.A.O Optometric Management.

Triggers for Malpractice Suits by Jerome Sherman, O.D., F.A.A.O. Optometric Management.

Relationship Between Malpractice Claims and Adverse Events Due to Negligence: Results of the Harvard Medical Practice Study III. New England Journal of Medicine, 325 (1991).

A Survey of Physician Training Programs in Risk Management and Communication Skills for Malpractice Prevention by F. Lefevre. Journal of Law, Medicine and Ethics (fall 2000).


Marketing is the communication backbone of your practice. It's how you reach out to both potential and established patients. When you design your marketing plan, think in terms of an overall message that you want patients to get in marketing materials and inside your practice.

For example, if you pride yourself on a caring approach, you might advertise that you'll "be there" for your patients. Of course, you need to follow up by offering flexible hours so you can be available when patients need you. Your patients will expect you to practice what you preach.

Be sure to communicate your marketing efforts within the practice. For example, if you decide to increase optical sales with a buy-one-get-one-free promotion on select frames, you must discuss the promotion fully with the optician. If not, patients could catch the optician unaware, and the optician might even dispense costly frames that aren't intended for the promotion. Depending on how long this continued, the loss could range from a few hundred to several thousand dollars.

At regular staff meetings, discuss any promotions in detail, including the start and end dates, what the promotion includes, whether a vendor is supporting the promotion and any free services involved. It's useful for all your staff to be aware of this information because your patients might ask them questions about the promotion.


You'll find that good communication spreads. As you improve each of these areas, the results will spill over into other parts of your work. Discussions with staff become more open, talking to insurers becomes routine and conversations with patients increase in depth and effectiveness. As a result, you'll improve your practice's overall efficiency and profitability, and increase patient satisfaction -- all of which have a positive impact on your practice success.

As an analyst with Medical Management Resource Group in Phoenix, Ariz., Owen Owens helps optometry and ophthalmology practices reach their goals.


Optometric Management, Issue: April 2004