Practice Management

Re-Engineer Your Work Flow to Add 20 Patients a Day

By Peter J. Cass, OD

May 3, 2017

More patients per day means more revenue coming in, and a greater opportunity to care for patients, and grow your practice. Over the last few years, small changes–the addition of one support staff member and a streamlined workflow–have allowed me to double the number of patients I see each day.

I typically see 40-50 patient per day, with 24-28 comprehensive exams. This number is a significant increase from the approximately 20 patients that I saw (like most ODs) just three years ago. Things changed for me after my full-time associate moved with her husband who had taken a job in another city. Unable to immediately fill her position, I was forced to see her patient load in addition to my own. I hired a tech to assist me and it worked out well. My staff and I developed processes and efficiencies to improve workflow and reduce the amount of time that I spent gathering data.

According to the Management & Business Academy (MBA), the average revenue per exam is $306. So, one extra exam per day would be: $306/day x 20 days/month = $6,120/month or $73,440 per year.

Dr. Cass uses this PowerPoint slide to illustrate for other doctors the gains his practice has seen by adding more patients per day through effective delegation of data gathering, and an improved work flow.

More Patients Mean Lower Chair Cost
A key factor in profitability with insurance plans is chair cost. Generally, the lower the chair cost, the more profitable your practice will be. One way to lower chair cost is to see more patients. Chair cost per exam is calculated by dividing total practice expenses/cost-of-goods and OD compensation/retained profit divided by the number of complete exams performed. According to the MBA, the median chair cost for independent ODs is $121.

For example:
Total Expenses    $1,000,000
less COGS             $300,000
less OD income   $200,000
less Profit              $100,000
= Fixed Expenses $400,000
divided by complete exams $ 3,300
= Chair Cost   $121

The Difference One Additional Support Staff Member Makes
I hired an additional staff member, streamlined office procedures, and utilized technology, to reduce the amount of time required by me to see patients. To really boost efficiency requires hiring additional staff, but I was able to almost double the number of exams I see by only hiring one additional staff member. So, “additional” can mean as little as one more to make a huge difference.

Examine Work Flow & Delegate Data Gathering|
Many optometrists spend too much time data gathering, and think of that as quality time with the patient – it isn’t. In my opinion, it actually reduces the patient’s perception of you as a doctor, and anything you can pay a technician to do, you should. It would be crazy to pay an optometric assistant $61.33 per hour to work up patients, but optometrists who do their own work-ups (or a portion thereof) are doing just that (the average salary/hour of an OD according the AOA income survey).

I spend about eight minutes with each patient (more for complicated exams and less for simple exams), but it is quality time, and includes very little data gathering.

Dr. Cass notes to other ODs how his office has streamlined the average patient visit, so that no more than 15 minutes is spent on each part of the experience.

Workflow is one of the key areas to optimize. In our office we worked with our technician to reduce the time it took her to enter exam data by customizing our EHR, arranging the pre-test room in an efficient way, and linking instruments directly to the EHR. We also moved our special testing instruments into a separate room to reduce bottlenecks in the workup flow. I handed off many tasks to my assistant including:
•    External Photos
•    Internal Photos
•    Topography
•    VF
•    OCT
•    Pachymetry
•    Specular Microscopy
•    Dilation
•    Walking the patient to optical (we use a special form for handoffs)
•    Patient education (for example LipiFlow)
•    Soft CL I&R, and initial assessment
•    RGP I&R
•    Sample meds and coupons
•    Referral letters
•    Reports
•    Patient forms
•    Insurance forms
•    Pharmacy calls
•    Patient calls
•    Scheduling reps

The routing slips Dr. Cass says simplify the process of moving patients through his office. His optical staff is able to see on the sheet exactly what he prescribed, making reinforcement of the prescription in the handoff easier.

We train our staff thoroughly, and require certification through either the AOA, ABO or JCAHPO. My staff knows to ask me if they ever have any questions. They also know if it doesn’t look normal, like we trained them, or if they are not sure, to make a note and let me know. I double-check anything I have concerns about, and always take the opportunity to teach when a good example presents itself.

To look for further areas for improvement, I plan to set aside a day to follow patients through the office while they are seen by one of my associates, so I can scrutinize the entire process, not just the doctor piece of the process.

Simplify Process for Patient
We have patients fill out their history online through our secure portal before they arrive, and my staff thoroughly reviews the history with the patient.

We have found that less is more, as I don’t think that patients like a hard sell. We have a simple, one-page, lens recommendation tear sheet on which I check off options, and briefly go over with the patient, as I hand them off to my assistant, who walks them to the optical. The sale is easy for my opticians because they just reiterate what is on the recommendation sheet. It works well, and it’s very efficient.

 

Peter J. Cass, OD, is the owner of Beaumont Family Eye Care in Beaumont, Texas, and president of the Texas Optometric Association. To contact: pcassod@gmail.com

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