Co-Management

OD-MD Expense Sharing: Cost-Saver, Practice-Builder

By Crystal Brimer, OD, FAAO

SYNOPSIS

Sharing office space and expenses with an MD can be a practice-builder and a financial boon to an OD.

ACTION PLAN

SAVE ON SPACE & STAFF COSTS. Reduce overhead.

INCREASE PER-PATIENT REVENUE. Higher-paying patients visit co-managed practices.

DO INTERNAL MESSAGING. Make patients aware of your presence inside office.

My independent practice was housed in its own office for years, but last year I decided to move my practice into an ophthalmology office to benefit from a high-end office setting while sharing overhead expenses. The move has paid off handsomely in cost savings on staff and proven to be a practice-builder in providing a steady stream of patients. I retain my independent practice, simply sharing office space and rent with an ophthalmologist. Being within the same office space benefits me in eye exams generated and patients developed over time. And it benefits the MD, in that I contribute toward costly expenses of a major medical center. It is a win-win, and has to be for it to work.

We share an approximately 2,800 to 3,000 square foot office space including three exam lanes. The rent I pay contributes to the upkeep of those three exam lanes, along with the use of a front desk employee and two technicians. The only employee that I pay for on my own is a billing specialist who just handles my patients.

I estimate that I now pay 10-15 percent less in overhead expenses than I paid when my practice was housed in its own office space.

Another benefit: We are able to easily refer patients between us. For example, I can attend to long-term monitoring of conditions such as dry eye, macular degeneration and glaucoma, and can even do pre- and post-op management of my cataract patients, while the MD can attend to all patients requiring surgery.

The downstairs entrance hall of the office building Dr. Brimer shares with an ophthalmologist.

Many ophthalmologists are busy with surgical patients and have little interest in performing primary eyecare exams. But patients have primary eyecare needs–which they prefer to have met at one location. This surgery-only strategy is challenged when they encounter resistance from their patients. Unless patients are referred by an optometrist, they are adamant about continuing their care with the MD. It can then become uncomfortable to turn patients away or refer them elsewhere for their routine eyecare. By managing the routine exam load in the office, an independent OD can be a great asset to the ophthalmologist, and build her own practice at the same time.

SHARING SPACE & STAFF = COST SAVINGS

MDs often have spacious and well-appointed offices with plenty of staff members. Ideally, the rent paid by the optometrist covers the services of at least a few staff members, in addition to the lanes and office space. In a smaller MD practice, it may only be feasible to work a schedule opposite of the MD to avoid competing for space and staff members. Even so, this is often a workable arrangement because the MD has OR time each week and may not maintain a five-day clinic schedule. This is perfect for a part-time OD or someone who wants to work between multiple offices but maintain practice ownership. In larger offices, there may be a couple lanes that can be committed to the OD in a full-time capacity.

When you look at what you receive regarding the space, staff experience, office environment and patient base, you can sometimes get much more from your rent dollars verses a similar arrangement in a commercial setting. This type of arrangement often requires paying the established practice a percentage of net collections. This is ideal when starting out because the rent is not overwhelming during the initial growth phase of the practice. Of course, some ODs choose to negotiate a flat rate, which may be more desirable in the long run.

The reception area in Dr. Brimer’s shared office space.

In our arrangement, I pay a percentage of net collections for the month, which must exceed a minimum amount that we’ve agreed upon. This equates to substantial savings compared to the expenses I would incur up-fitting and maintaining an entire office. It also saves me significant time that would have to be invested in management tasks.

Share Emergency Calls
Another benefit to the OD and MD is having the option to share after-hours emergency calls. We may underestimate the value of this to a solo ophthalmologist, but sometimes a weekend free from the “beeper” carries a lot of weight. In the same respect, it is a great relief to the part-time OD to work in an office that runs at full force all week long. It means not having to put out fires when you return.
This does not necessarily help grow your patient base because they are already patients of the practice. However, you might collect more in after hour fees than an OD in a more traditional setting. In an ophthalmology setting, a large percentage of the practice is medical based. In my practice, more than 75 percent of my patients have some sort of medical ocular diagnosis.

Establish at Outset Whether You Want an Optical Dispensary
The ophthalmologist I share space with gave me the option of having an optical shop in the office, but I declined. We made a conscious decision for this to be a medically based office. If the MD does not already have an optical, there may be resistance to add one in fear that it could have a negative effect on area OD referrals. So, if this is a primary goal, it is important to negotiate those terms from the beginning. But keep in mind that an ophthalmology setting is the perfect environment to establish a medically based practice, able to thrive despite the absence of an optical or through challenging economic times.

More of the shared space’s extensive waiting area.

Though I prescribe and dispense contact lenses, I chose not to have an optical onsite for multiple reasons. Including an optical requires significant investment in capital, staff, management and location, and it complicates the arrangement to some degree. The absence of an optical has not hindered patients from coming in for their routine exams. In fact, they trust my advice even more now because they know I am not benefiting financially from the recommendation of a particular lens or treatment. I don’t refer all my patients to one specific optical, but discuss which one might be a better fit for their needs.

INCREASE PER-PATIENT REVENUE

Many MD offices are in professional buildings and boast a beautiful clinic space. This environment can influence the type of patients and insurances you may see. These patients are not usually out seeking the cheapest eye exam in town. And in turn for higher professional fees, they have high expectations for the service they will receive. When I started in my current location, patients were accustomed to paying more than $200  for a complete eye exam, which is comparatively high.

Because of the fees and the resultant expectations, my business model is different than the majority of ODs. Instead of seeing 25+ patients per day, our full schedule allows for a maximum of 16 patients. We see fewer patients, but charge more.

This enables us to deliver the ultimate eyecare experience without compromising the bottom line. There are few environments that allow for this, but expense sharing with the right MD can certainly empower you. We see patients through lunch, but close at 4 pm every day. The staff appreciates getting out early and is willing to alternate break times in order to finish the day early.

INVEST IN NEEDED PROMOTION

We have considered using newsletters, local magazines, local Rx bags, postcards and Facebook to get the word out. Each of these marketing endeavors can cost $1,500 to $3,000, so it is important to time your efforts and track their success in your market. On the upside, since advertising can serve dual purposes, it may be another expense that can be shared by the MD.

Related ROB Articles

Medical Eyecare Opportunity in Optometric Practice

Managing Medical Eyecare

Making the Co-Management Network Work

Crystal Brimer, OD, FAAO, owns Crystal Brimer, OD, FAAO, in  Wilmington, NC. To contact her: drbrimer@crystalvisionservices.com

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