Practice owners are always looking for ways to make their businesses more profitable. The first thing most owners pursue is more promotions or marketing to attract more patients, but a worthy alternative to this strategy is to improve clinical efficiency.
Saving time for technicians and doctors can produce more profit in the following ways:
• Time is money. If we reduce the time spent with each patient, it allows us to see more patients per day or to do other productive tasks.
• If we save time by dropping mundane and less productive tasks, the doctors and staff have more time to recommend and educate patients about various treatment modalities and optical products.
• Employee payroll costs are strangling the profit in many practices today. If we increase staff efficiency we can reduce that expense or at least hold the line on it.
• In addition to profit, being more efficient can improve the patient experience because people have busy lives and they don’t really want to spend over an hour and possibly close to two hours at the eye doctor’s office. We need to be easier to do business with.
Tips for changing your process
There is often debate in corporate board rooms about implementing change. Some leaders prefer smaller “incremental” changes while other situations may call for reinventing the organization with “transformational” change. Here is a list of possible changes for you to consider in your clinical process; some are big and some small.
While still providing a thorough, high-quality examination, how can we save technician time and doctor time?
• Eliminate double entry work. Many offices still use a fair amount of paper forms along with their EHR system. These work-arounds can serve a good purpose during the early stages of EHR integration, but see if you can eliminate some paper forms and printing of previous exam records for internal use.
• Prepare tomorrow’s files today. This applies to front desk staff and clinical technicians: have employees use their downtime to prepare charts and forms for patients who have appointments tomorrow. This increases efficiency during the patient’s visit.
• Perform some routine tests on new patients only, like color vision and stereopsis. Of course, the doctor can still order them as needed.
• Stop doing automated visual field screening as a pretest and do confrontations instead (performed by tech or doctor).
• Consider technician refraction. Always observe applicable laws, but doing a refraction is not the same as prescribing. Refraction is data collection and it can be performed under a doctor’s supervision.
• Consider pre-dilating with tropicamide or Paremyd. This can be more complicated than you might think and you might have to write a protocol so techs can determine which patients can be pre-dilated, but the goal is to reduce the number of patients who must see the optometrist twice: once before dilation and again after. The walking and waiting destroys efficiency.
• Our techs have developed a bad habit over many years of taking a very long time to read and review a patient’s previous exam record before calling the patient in. I understand that it is helpful to know some aspects of the patient’s visual status before starting the pretests, but 10 minutes of reading is way out of hand. We are working on changing this.
• Having scribes waiting in the hallway for doctors to become available is a time waster that adds up. We are changing the routine to have the technician work with a patient in an exam room and the doctor just walks in and takes over whenever he/she is ready.
• Instead of relying on a handoff to an optician, consider using super-techs (scribes who are also opticians). This eliminates the wait for an optician to become available and the tech can walk the patient out to optical and back into an exam room for the dilated fundus exam.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.