Practice Management

What to Outsource & How To Do It

By Dave Anderson, OD

Nov. 27, 2019

There are many things your practice does well, and then are office functions that you don’t do as well, or which take an undue amount of time. The inability to do those things well can signal the need for help from an outsource partner.

Here’s how my practice, which has 3.5 full-time-equivalent doctors and 18 support staff members, has decided the tasks that should be outsourced, and how we ensure our outsource partners do exactly what we need to have done.

Assess What Takes the Most Time
We have chosen to outsource several things that required significant staff time, and it has paid big dividends in many ways.
One of the first things we chose to outsource was payroll. It was not difficult to tackle payroll for a small staff, but the burden of doing this nearly 30 times a year became tiring. It was nice to eliminate dealing with new employees and adding them to the system, making sure the 401K deferrals were handled correctly, and that the work hours were accurate for each staff member.

The overall time spent doing payroll in a year added up to around 130 hours. My office now has Paychex manage this all, and my staff now clocks in directly to their system, can look at their vacation days left or sick days used, and the burden of accuracy is now on Paychex. The work that Paychex is doing for us is equal to about 10 hours a month, and an additional 10 hours dealing with W2s at the end of the year. At $22/hour, the staff savings is $3,000 per year, plus benefits.

Another area we quickly chose to outsource was recalls and reminders. We started with Solutionreach, and use it to this day. We liked the reminder ability, which happens through text, e-mail and automated phone call. We use the system to send a message when glasses and contacts arrive, and are ready to pick up, to remind patients of scheduled appointments, and to send recalls when patients are due for their exams. This amounts to nearly five hours per day, or $60 per day, of savings. Added over a year, we save nearly $20,000 in staff time.

The great thing that happened when we started recalling patients via e-mail and text was the ability to not only send the yearly recall reminder, but the ability to send another reminder at 18, 24 or 30 months out. This has helped keep our office busy with nearly full schedules well over two weeks out.

Another advantage: Digital recall has decreased the money spent on postage to mail recall postcards, and decreased needed staff time.

Accounts Receivable
The most recent area that my office has outsourced is our accounts receivable. We use RevCycle to manage our reconciling of payments received from insurers, and to follow-up with insurers after denial or non-payment, and to help appeal when necessary.

When we outsourced revenue cycle management, we saw a decrease of over $20,000 in our out-standing accounts receivable. The other great advantage was elimination of the time it took to reconcile the vision explanation of payments. It would take a full day for one staff member to manage this, and it would need to be done 3-4 times a month. This amounts to three hours per day, and around $45 per day in savings, and around $15,000 saved annually.

Now, that staff member works more meaningfully on patient accounts receivable, making personal phone calls before the debt is sent to collections. On average, our staff member collects $600 from patient accounts that were about to be sent to collections.

ROI of Outsourcing
Each area that we have outsourced has a cost, but these are all things that we would have had to do ourselves, and that would have costed us too, in time. The big difference is that each time outsourcing occurs, staff becomes more available to help patients, or to work on things that can’t be outsourced.

For example, it used to take two staff members nearly all day, in between checking patients in, to call the next day’s book of patients to remind them of their upcoming appointment. As soon as we outsourced the reminder call, we gained another pre-tester, and this allowed us to add two extra exams a day. This more than made up for the $499 we pay to Solutionreach each month, not to mention the added benefit of Solutionreach automatically sending patient surveys after each visit, which then get automatically posted to Google Reviews and other online review sites.

When my office stopped handling payroll, I was quickly able to devote more time to staff training and developing more effective staff meetings. The cost of using Paychex is around $100 per pay period, but can vary greatly depending on the services an office chooses.

When we began outsourcing our revenue and accountants receivable, we quickly decreased our out-standing accounts receivable by over $20,000 in a matter of months. The cost of RevCycle is 4 percent of medical billing, and 7 percent of vision plan billing, but this is based on received payments, which holds RevCycle accountable to continue to go after the money we should be paid.

Vet Potential Outsource Partners
The best way to vet a company is to know the details about it, and the services it provides. Know exactly what you are getting, understand the contract, and whether there is a penalty for terminating service early. The biggest thing is to ask a lot of questions upfront.

For demos of each company’s services, ask it to give you the names of other eyecare practices that use its service, so you can get a feel what others think of it.

Finally, ask if there is a trial period, and if you can exit without penalty within a certain time frame if you are not happy. Most of the companies have contracts that could be 1-2 years, but these often can be negotiated, and often can include a 30-90 day trial period that would allow you to walk away without any penalties.

You also can easily do research online to see reviews posted by other companies that use these vendors’ services.

Have a Point Person at Outsource Partner & In Your Office
A specific staff member should be assigned to work directly with each outsource partner, with that employee, along with the practice owner, having direct and easy access to a vendor representative.

The best outsourcing companies have periodic check-ins either with the key staff member or the doctor, mostly to make sure any new updates to its services are communicated, and to make sure all aspects of the service are being optimized by the practice.

For each outsourced service, we have a quarterly meeting with the key staff member in our office to ensure we are happy with the service, and if any issues are present, that they are addressed. We have our account with the outsource partner pulled up online during the meeting, and we go through it fully to ensure everything is working as it should, and that we are getting the best service for our money spent. If we see something out of order, or not working, we reach out promptly and to a specific person at the vendor.

Outsourcing companies typically have an on-boarding system in place to train practice staff, set up the outsourcing system specifically for your office, and coordinate with the office processes you already have in place.

Expect a few concerns from staff, namely, they may wonder if their job is going away. Be sure to let them know their value to you and your office, make clear the new role they will be performing, and ask them to give you feedback about the potential challenges of outsourcing.

The other issue staff may be concerned with is potential extra work for them, as well as poor feedback from patients, which they worry they will have to respond to. Spend time going over why the change is needed, but also go over the timeline to implement the outsourcing, and take your staff feedback to your outsource company rep to see what they have to say, as the vendor may already have a great way to deal with staff or patient push-back.


Dave Anderson, OD, is a partner with Miamisburg Vision Carein Miamisburg, Ohio, and a partner with wEyes Guys. To

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