

Editor: Neil B. Gailmard, OD, MBA, FAAO → CONTACT




Patients per Day: Youâ€™re Seeing Fewer Than You Think

February 8, 2017


I have an interesting exercise for you and I’m sure the result will make you think about your practice in a different way. My hope is that if you measure this simple data point for your practice, you will be motivated to change some of your procedures. Try it; it might be a wakeup call for you.
Most optometrists have a general idea of how many exams they perform in a typical day and we form an opinion on the right number for our practice and our preference. If we try to gather this data in a fairly accurate way, you will have to decide if we should count all patient visits or just comprehensive exams. We also need to define a day. You probably have some long days and some half days of patient care. As long as you understand the data in your measurement, it does not really matter, but I’ll suggest a standard to follow so we can compare your results with what other ODs do.
Let’s agree to count comprehensive eye exams (you can define what this means, but I would take it to mean a complete eye health exam and a refraction). Let’s also agree to count a day as about eight hours of patient care, but we won’t get too picky about lunch breaks.
Exams per day metric
I’m going to give you some guidelines on how to collect and measure your exams per day, but before we do that, I’d like you to make a mental note of the number you think you see. Don’t use data at all for this. Just based on your experience, how many comprehensive exams do you perform on an average day?
Next, I’d like you to calculate this metric in the following way:
 Use a long time period, like all of 2016.
 Calculate the number of doctor days that occurred in 2016 by adding up all the days worked per week by all doctors. For example, if you worked the whole year and you usually work 3.5 days per week, use that number. Or, if you work about 28 hours per week on patient care, divide that by 40 hours to get your fulltime equivalent and multiply by five because we consider five full days per week as full time. 28/40 = .7 X 5 = 3.5 days per week.
 There are 52 weeks per year, but reduce that by whatever time you took off in 2016. For example, you have three weeks of vacation, one week of sick days, one week of holidays and two weeks of continuing education. So you worked 45 weeks out of the year.
 You had 3.5 X 45 = 157.5 doctor days in 2016.
 Do the same for any additional doctors who worked in your practice and add them up.
Now we need an accurate count of how many comprehensive exams were performed in your practice in 2016. The best way to do this is by running a report in your practice management software, but you can use any method that you know is accurate. If you run a report of all services and products sold in 2016, you may have to add up some subtotals like new patient and established patient. And you may have to add up several CPT codes like 92004, 92014, 99204, 99214, 99205, and 99215. Just think about what codes or services are used to describe a comprehensive eye exam in your office and include all of them and be sure to get the data for all doctors.
Divide the total number of comprehensive exams by the total number of doctor days and you have the true number of exams per day. For example, if you saw 1,250 comprehensive exams in 2016 and you had 157.5 doctor days, you saw 7.9 exams per day. Call it eight.
What do you think of your number?
In my experience, the vast majority of ODs overestimate the number of exams they think they perform. I asked you above to make a mental note of the number you think you see per day. How did that compare with your real number? Feel free to challenge the calculation and make it as accurate as possible, but numbers don’t lie.
Your production report may not show exams that are no charge, but I assume you don’t have too many comprehensive exams that are given away. We might have some office visits like contact lens checks that are covered in a fitting fee or eyeglass trouble visits that are no charge, but we used comprehensive exams to avoid that issue.
If your presumed number and true number are vastly different, use this aha moment to make some changes in your practice.
What to do
Here are a few ideas on how to increase your exams per day metric:
 Change the appointment template. If you have many appointments booked ahead, consider adding more slots per day.
 Delegate more. You can see more patients per day if you hire an additional technician and delegate more of the exam procedures. Or teach the tech to scribe.
 If you are not booked far ahead, it might make sense to reduce your number of doctor days per week so you are busier when you are in the clinic. Then you will have some days off or days to work on management without interruption.
 No shows and last minute cancellations can cause a significant reduction in productivity. This is especially common if you preappoint. You should review your confirmation procedure to be sure it is still happening the right way.
 Increase patient demand. If you need to fill your schedule, there are three big ways to do it: Increase wordofmouth referrals (improve your customer service), add vision plans and increase your marketing efforts.

