Optometry Coding & Billing Alert

Published on Thu Dec 08, 2016 PDF

6 ways to improve patient flow in your optometry practice.

How can your practice stay competitive amidst declining reimbursements? Make sure you manage the optometrist’s time with strategy and precision.

Most ODs don’t see as many patients during the day as the practice is capable of, says Neil Gailmard, OD, MBA, FAAO, who taught several classes at Vision Expo East earlier this year.

ODs should aim to see 20-25 patients per day — about one patient every 15 to 20 minutes, a mixture of comprehensive and shorter visits, Gailmard says.

If the idea of your doctor seeing 20-25 patients per day makes you gasp in disbelief, consider these tips to help you plan your doctor’s time wisely, and your clinical support staff’s time wisely. “Seeing 25 patients per day is not more work than seeing 15 per day,” says Gailmard, “as long as the doctor delegates well and has good staff.”

Tip #1: Make sure you know how long exams really take. Don’t assume your ballpark estimates are correct, warns Derek Preece of BSM Consulting, a frequent presenter at AAO. Track times using your practice’s EHR system, a low-tech tracking sheet, or even a temp you hire to record information over a week or so. Then, use the data to determine the percentage of the doctor’s schedule taken by each type of exam. Use the date to determine the percentage of the doctor’s schedule taken by each type of exam.

Tip #2: Base your schedule on how long the exam actually takes, not on how long you hope it will take. If there’s disconnect between your hopes and the reality, your patients will wind up waiting.

Tip #3: Make sure you have enough space to prevent backlogs in your clinic area. Make sure you have at least two exam rooms per doctor on duty, Gailmard advises.

House all of your expensive diagnostic equipment in a pre-test room, and train staff not to lollygag there so that it’s open for the next patient, Gailmard urges. Ban history taking in the pre-test room, he suggests. If the patients wants to go into HPI in pre-test, teach your staff to graciously redirect them.

Sample script: “Mary, I’m going to want to hear all about that when we get to the exam room, and first, let’s do these tests here.”

If you have two or more doctors in your practice and there’s frequent pre-test room bottleneck, consider investing in a second pre-test room.

Tip #4: Hire more staff. “I can’t afford more staff” is usually a false assumption, Gailmard warns. If you hire and train clinical staff well, you boost your own productivity and increase the number of patients you can see during the day. If you hire and train staff on excellent patient care and customer service, you may well make more on optical sales than you do now.

Bonus: Patients who spend time with high-quality staffers feel especially well cared for. Additional staff often end up paying for themselves and more, Gailmard adds.

As a rule of thumb, consider hiring one full-time equivalent (FTE) nonphysician employee per every $150,000 gross revenue your practice collects, Gailmard told his Vision Expo East class. About 23 percent of your collected gross revenue should go to staff payroll.

If you have part-timers in your practice, calculate your number of FTEs by adding all staff hours per week and dividing by 40, Gailmard counsels.

Tip #5: Delegate. Doctors who are control freaks need to get over it to benefit the practice. Anything that saves the doctor time is important. Some optometrists hesitate to delegate things that techs can do — like tonometry — because they reason it only takes a few minutes. But over the course of the day, those few minutes really add up, Gailmard says.

Tip #6: Consider using medical scribes in your practice. “EHR is causing all of us a huge strain on our time,” Gailmard says. “Paper is just faster.” Yes, the EHR companies should make their software more user-friendly, but in the meantime, try having your best techs scribe for the doctors to see how much time and energy it saves.

Gailmard recommends that optometry practices consider the “supertech” model, in which one clinical tech stays with the patient during the whole visit, scribes the encounter, and even has basic optician skills to get the patient started in optical.

The supertech model prevents the “assembly line” experience among patients who may feel like they’re being passed quickly from tech to tech in other models. When one staffer besides the doctor takes care of them, patients feel positive about your practice.

Bonus: The “supertech” model can boost capture rate for your retail optical. “We get very few prescription walkouts and that’s the reason why,” Gailmard says.