Part 2: Secrets of…

The second part of how to embrace professional strategies that large, successful practices utilize

By Allan Barker, OD, and Greg Stockbridge, OD, MBA

Do large, successful practices differ from their smaller counterparts in the way they conduct business? Last month, we addressed retail strategies for success. But what about the professional side of the practice? Here are professional strategies and concepts that the most successful practices live by—and that smaller, less successful practices sometimes fail to embrace.

HARNESS MANAGED CARE

Large practices realize that managed care is an opportunity rather than an annuity. Managed care plans can give you patient access plus the ability to make money. They represent opportunity.

You cannot, however, afford to sit back like a robot and accept a plan and not work it to your benefit. If you elect to play in the managed care arena, you need to realize that your work is just beginning. The opportunity starts when the plan helps you fill up an otherwise empty exam chair. It expands when you reward that patient with the best eyecare available anywhere.

Sometimes that may entail a return visit utilizing a major medical carrier to help diagnose and/or treat an existing medical condition. Often the patient was unaware of the condition, and thanks to their coming in for a basic vision exam, you have upgraded their care with measures that can be sight- or even life-saving.

Material benefits provide another opportunity. Large practices recognize the importance of maximizing the profitability of every patient encounter by promoting upgrades, multiple-pair sales, and discounts on second and third pairs of glasses. Staffs are well trained and incentivized to make such upgrades and multiple sales. These benefits not only increase sales and make managed care an opportunity rather than a burden, they also provide higher quality care.

Managed care glasses patients without upgrades or multiple-pair sales can represent a financial loser. The same goes for managed care contact lens patients who leave without purchasing annual supplies.

MONITOR INSTRUMENTATION

Large practices don't just purchase instrumentation and hope for utilization. They monitor its use and act accordingly.

■ WHO'S INVESTED? Doctors who invest their own hard-earned money into an instrument will surely utilize it—and make sure they correctly code and bill for it. Time and time again, the same doctor who brags about certain instrumentation's positive effect on patient care and profits will, when asked about their associates' use of the product, give a far different response. They will almost invariably say, "I just can't get my young associates to use the product like I do." That's because the associate has no investment at risk.

■ TRACKING WITH EMR. Large practices don't just buy and hope. They generally acquire and monitor. Thanks to electronic medical records and practice management software, a well-run practice has the capability to track instrumentation usage and associated billing and collections. If a doctor is not billing for the services delivered by a certain instrument, the successful practices will follow up and determine why and what needs to be done to improve utilization.

■ ANALYZING THE DATA. Instrumentation utilization or lack thereof will speak volumes about the quality of care delivered in one's practice. It also identifies doctors who may be slighting patients via underutilization of state-of-the-art diagnostic equipment.

UTILIZE SCRIBES

With the integration of electronic medical records into large practices, the doctor-patient relationship can be challenged and impersonalized.

Too often, the doctor's eye contact and thought process transfers from the patient to the computer screen. No patient wants a doctor who is focused on a computer instead of them. A scribe allows the doctor to focus 100 percent on the patient, something that is generally not even possible with written charts.

Instead of worrying about computer entries, the doctor can spend time discussing not only refractive and medical care but also the finer points such as the importance of computer, driving, and sports eyeglasses as well as annual supplies of contact lenses.

Obviously, a practice with limited patient flow does not need a dedicated scribe. However, even a smaller practice can utilize a cross-trained scribe who handles various other functions in the practice.

Large practices with heavy patient volumes often utilize dedicated scribes who only handle the scribe duties. However, even large practices are exploring the efficiency of having a dedicated technician for each patient.

The dedicated technician is with the patient throughout the visit. They screen the patient, take a history, scribe, escort the patient to the optical, and execute the hand off to the optician with doctor instructions.

Some scribes even remain for the entire process, including frame selection. Ophthalmology has been using scribes for quite awhile. Scribe use is relatively new for optometry.

Busy doctors have reported a significant increase in production using scribes. There is a cost involved; therefore, productivity must be enhanced to offset the additional salary and benefits required for the scribe. That means the doctor needs to see more patients while refocusing on the patients and their needs and making recommendations.

TAKE INSURANCE SERIOUSLY

The most important ingredient for financial success of any health care practice in the 21st century is proper billing and coding of insurance claims. You simply can't afford the bill, file, and pray method.

Large practices constantly train their staff to follow up on denied claims and re-file when necessary. They also learn from their mistakes and don't just correct them; they get to the root of the problem and train other staff members on how to avoid such mistakes in the future.

These practices generally maintain their own insurance filing department. This way they are not as dependent on one person to file and monitor claims. They know how important insurance claims are to their bottom line and insist on the utilization of sound business principles in this critical area.

EMBRACE TECHNOLOGY

Large practices embrace rather than avoid technology. They see systems as a key to success and technology as a means of harnessing these systems to their advantage. These practices see value in electronic medical records, quality assurance reporting, and state-of-the-art instrumentation.

They also see value in extensive analysis of practice numbers. They can tell you not only revenue figures, but also information on eye examinations, selected clinical procedures, inventory turnover, and insurance receivables.

Large practices embrace technology, associated data collection, and the power that properly collected information provides.

There are many things done by large practices that translate into a better bottom line without compromising patient care. Hopefully, the concepts presented here will help smaller practices understand and embrace the fundamentals of large practice concepts so that they, too, can be rewarded financially and professionally for their hard work. EB