Staff Management

Delegation Dos and Don’ts

By Robert L. Bass, OD, FAAO

March 9, 2016

SYNOPSIS

Free up revenue-producing doctor time by delegating key tasks—but know when to hand-off and when to be hands-on.

ACTION POINTS

PERSONALLY OVERSEE. Delegate tasks, but the ultimate responsibility for patient care rests with the doctor. The doctor will be held responsible for oversights in patient care.

NOTE SIGNS IT’S WORKING. Patients should have all their questions answered by pre-testers, and inventory should be well maintained.

TRAIN THOROUGHLY. Have staff shadow a more experienced employee before turning over responsibility for a task. Then, have the experienced staff member observe the employee do the task.

As practice owner and doctor, you only have so much time in each day. You don’t want to give your patients short shrift, but you also don’t want to neglect overseeing your practice’s operations. Learn what to delegate, and what to do yourself, to save valuable time and enable a smoother-running office.

Each staff person needs to function at their highest level of perfomance. It doesn’t make financial sense to have a doctor do an activity that can be handled by an employee making $15-20/hour. I can’t answer definitively how much time is freed up, but I am delegating to $15-$200-an-hour staff members, which gives me more time to bill $100-400 an hour for my own time. The total amount of time gained I don’t know, but I do know is that my return on investment in staff pay is higher with delegation.

Editor’s Note: According to Management & Business Academy Key Metrics, the average optometrist is generating revenue of $337 an hour based on 1.1 exams an hour at $306 revenues generated per exam.

I am a solo OD with a staff of five, including an office manager. Each staff person wears several hats, each with responsibilities I have delegated to them.

The page on Dr. Bass’s practice web site highlighting his staff members. Dr. Bass says delegating to staff is a key way to not only stay efficient, but to ensure the most beneficial, profitable use is being made of the doctor’s time.

Decide Who Does What

Do myself: All financials (checkbook, dealing with the CPA: payroll, payables) except making the daily deposit, but the results of the daily deposit go on my desk; refraction and eye health exam; coding of exams and letters to other doctors, which only takes a few seconds, with my EHR.

Personally oversee: Everything! Ears are always listening for how the phone is answered and patients are greeted. I sit in occasionally with sales reps and check the lab for outdated products, late orders. It is my money being wasted or my unhappy patient waiting on a product. When I do a contact lens follow-up, I ask the patient how they were treated while being taught insertion and removal, and if they have any questions for me. The fewer the questions, the better my staff did.

Support Staff: Open and close office; take deposits to the bank; screen calls; meet with sales reps; assist in exam room; train contact lens wears; order contact lenses; order frames and lenses, check in completed glasses; do inventory of products; learn insurance processing; reconcile insurance checks; (the one who files a particular insurance, does not reconcile that check); pre-test and other equipment: visual fields, pachymetry, OCT, GDX, keratometry, non contact IOP, Retinal photos; go over medical hx, medication hx, family hx, eye hx, record and verify what the presenting wearing Rx is, why they came in today.

Front Desk: Divided among three staff members, who also have other responsibilities, in addition to meeting and greeting, checking patients in and out, and other traditional front-desk duties:

Betty: Ninety percent front desk, in addition to handling deposits, reconciling lab invoices, and, if needed, calling in lab orders.

Angie: Ten percent front desk, along with submitting medical insurance claims and helping with pre-testing.

Crystal: Fifty percent front desk, in addition to pre-testing, contact lens insertion and removal training; optical orders and contact lens orders; and, if needed, helps adjusting glasses.

Sheryl (my wife): VSP check reconcile, recall patients; interface with insurance companies, adjusts glasses, modifies rigid contact lenses, repairs and adjusts glasses.

Opticians: Tony and Kelly are able to do all the above, plus run the optical: inventory, meet reps, make and order glasses, repair and adjust glasses, again everything including computer updates.

What Makes a Responsibility Good to Delegate?

Do Delegate: Anything and everything a doctor feels comfortable delegating, because it is still 100 percent their responsibility. “My tech did that…” is no excuse in court!

Don’t delegate: Money because too many practice owners have been embezzled from; medical evaluations and decision-making; and refractions.

Signs that You’re Delegating Improperly & Additional Training Is Needed

Training may be done by myself or another staff member. You have to make sure the employee, whom you are newly delegating to, knows the end result you are looking for. I do not micro-manage. We demonstrate to the end result, and then expect staff to have their own polite, efficient style to get to the same end result. We coach the employee and watch before they are left to their own devices.

I think of it this way: I have a pile of bricks I want stacked a certain way; this is how I do it; you may do it any way you want, as long as the stack ends up looking the way I want it to look. We demonstrate the end result look of all of our processes, our way of doing it, and if your way is better, or equal in efficiency, then that’s OK with me because all we care about is achieving the end result we need.

Pre-Testing: The information your technicians are passing along from pre-testing doesn’t make sense to you, and/or the technicians are not able to adequately explain the results to patients.

Patient complaints: Patients complaining that their questions about pre-testing were not answered, or the wrong information was given to them.

Inventory out of balance: Missing contact lens trials and popular frames should have been re-ordered. Asking too often if something has been done yet. You want frames to be current (no more than 90 days old), total inventory value at a set amount and frames boards that are clean and organized.

Handle Finances Yourself

I feel it is dangerous not to be involved in financial management. I know 4-5 doctors who trusted office managers to do all of their financial management only to be bankrupted. I know several whose spouses, husbands and wives, have bankrupted the practicing partner. So, I have total oversight and responsibility for my practice’s finances. I use QuickBooks, only on my own PC, for deposits, payables and payroll.

My practice management system reports are reviewed by me and/or my associate OD for accuracy. Once an insurance check is deposited, and discrepancies have been investigated, we also review the results. It takes me 20-30 minutes, 1-2 times per week, to make sure I get paid for the work I have done. I always find a mistake that makes me money, or rather, keeps me from losing money. It is always worth my time. I am not perfect, my staff is not perfect, and for dog gone sure, insurance companies are not perfect. If you do not make time to check your financials, you are just giving away your hard earned money!

Robert L. Bass, OD, FAAO, is the owner of Optometric Associates, PC, in Manassas, Va. To contact: idr.bass@verizon.net

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