By Daniel Epshtein, OD, FAAO
July 25, 2018
With health-care changes leading to shrinking reimbursements and higher operating costs, the need for increased patient volume has never been more important. But high volume will only build your practice if you are able to maintain high quality, and ensure that patients get adequate face-to-face time with their doctor.
The goal is to promote both high-quality exams and efficiency, so that patients don’t get frustrated by wait times, and have at least 20 minutes to shop in the optical. We strive to have patients in the office for no more than an hour.
The following are essential clinical components of a high-quality exam, along with processes that efficiently move the patient through our office. In our practice, multiple exams rooms per OD, scribes, efficient data entry and continual improvement measures are paying off in patient satisfaction and profits.
Every comprehensive exam must completely assess the patient’s visual and ocular health, including a dilated view of the anterior and posterior segment. I explain to patients that doing an eye exam without a dilation is like doing a physical without blood work, as you’re missing one of the most important components. I require a dilated exam at least yearly for the vast majority of my patients. Ultra-widefield imaging with systems such as the ZEISS CLARUS and Optos Daytona, can be additive to your exam, but medically and legally, cannot be substitutes for a dilated fundus exam. I have used ultra-widefield imaging to improve the efficiency of my exam by reviewing images before I examine a patient to help guide my assessment, and as a powerful education tool at the end of my exam.
Provide Time for Thorough Patient Education
At the end of my evaluation, I always leave time for face-to-face discussion. Though patients may have a sight-threatening disease, their presenting complaint may be unrelated, and much more benign. For example, many of my patients present complaining of bilateral mild irritation, which is longstanding and stable. The fact that they have diabetic retinopathy, which can be vision-threatening, is often a secondary thought to them. They may continue to be preoccupied with their initial complaint of mild dryness, which to us seems less important.
For this reason, I finish every exam by making sure I address the patient’s chief complaint in addition to any other issues that I may find. I make sure to address any secondary issues that arise during our discussion, and then ask the patient what questions they have. By asking an open-ended question such as “what questions do you have for me?,” patients feel more comfortable asking for clarification, which helps improve the doctor-patient bond and the management of their health.
Delegate Data Entry & Auxiliary Testing
Data entry is a huge time drain during the exam. Meticulous record keeping is not only extremely important for the management of our patients, but is also required by law. The entry of the medical history, family history, allergies, and other information, should be delegated to trained personnel. The optometrist can then review this data for accuracy at the beginning of the exam.
Cleaning equipment, checking entering acuity, autorefraction and lensometry are all things that can be delegated to support staff. Once the exam begins, the presence of a scribe can significantly decrease time spent per patient. By decreasing the doctor’s time glued to the computer, one can have more face time with the patient, which is greatly appreciated in an increasingly impersonal world.
Auxiliary testing such as OCT or fundus photography should be completed by technicians while the optometrist examines another patient, and then displayed in the exam room, so it can be reviewed by the doctor and shown to the patient if necessary. When patients return for follow-ups and auxiliary testing, it should be completed before the patient is seen by the doctor to minimize movement and waiting time for both the patient and doctor.
If Possible, Try Two Exam Rooms Plus a Scribe
Having two exam rooms with a scribe/technician accompanying the doctor is one of the most efficient set ups in an optometry office. The technician can call the patient into the room and have them situated, saving several minutes of “dead time” per patient. The doctor can be in the other room finishing up with a patient, or reviewing the patient’s chart before starting the exam. As the doctor-technician relationship develops, the technician will begin to learn the doctor’s habits and can begin taking the patient history, which the doctor can then review and add to.
Survey Patients to Enable Continuous Improvement
Surveys are a great way to measure the patient experience because it is important to understand how patients perceive our office and examination. My current practice recently initiated a survey which grades front desk staff interaction, support staff interaction, doctor interaction, wait time and appointment-creation experience. We have generally received good reviews, but we always strive to improve the patient experience, which, in turn, improves my experience as their doctor.
Daniel Epshtein, OD, FAAO, currently practices at Mount Sinai St. Luke’s and a private practice in New York City. Previously, he worked at a high volume multi-specialty practice where he provided refractive,medical, and perioperative care. He combines his research experience with the latest clinical practices to detect sight threatening disorders early and provide the best treatment options available for his patients. To contact him: firstname.lastname@example.org