Practice Management

4 Ways to Boost Your Practice’s Profitability by Raising Productivity

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By Thomas Castillo, DO, MBA

 The formula for practice profitability is simple: volume × receipts  expenses. With expenses continuing to go up while reimbursements go down, the only variable we can control is volume. A lot of physicians are asking themselves, “How can we see more people, provide high-quality care, and enjoy our jobs at the same time?” 

My partner and I are the only 2 ophthalmologists in our county, offering a full range of services to a patient base of about 80,000 people. Like any private practice, we’re seeing reimbursements decline to a point that is not consistent with the quality of work and results that we’re able to produce. Medicare reimbursements go down, and private insurers follow suit. Unlike other businesses, we cannot raise our prices. We certainly cannot cut staff. What we have been able to do is to raise our productivity, relying on four major strategies that do not require us to rush patients along or work longer hours.

 1) Incorporate Advanced Technologies
Technology is an investment, but it saves time and in some cases can generate additional revenues. We recently purchased a fully digital SLT-YAG system (Digital Duet, Lumenis), which saves us time and increases productivity by documenting data and delivering it directly to the electronic health record (EHR). We can capture digital images, video and voice, automatically track data such as the number of laser shots used, and create a procedure report. SLT procedures are very efficient with this platform. Our staff preps the patient, and then I put a lens on the eye, do the laser treatment, and sign off in about 5 minutes. The integrated camera allows us to efficiently document pathology with external photography—a new revenue stream in our practice. For example, I recently imaged an abnormal lid lesion with much greater detail and quality than I could get with a handheld camera or cell phone camera, and I will continue to monitor if it grows and affects vision. 

Our practice began using non-mydriatic ultra-widefield imaging (California, Optos) to quickly obtain fundus photos with an undilated pupil. Unlike traditional fundus cameras, this technology does not require a skilled ophthalmic photographer, so any one of our technicians can capture quality images. When patients have flashes and floaters, technicians can identify and document a retinal tear or detachment before confirmation with a dilated fundus exam. Another recent addition was our combination autorefractor, autokeratometer, corneal topographer, and wavefront aberrometer (OPD-Scan III, Marco), which saves time by enabling staff to get multiple measurements in the same chair.

 2) Optimize Clinical Staff
I can see more patients when I focus on my expertise and rely on well-trained staff. At the same time, our investments in technology have reduced the time they require for testing and manual input. 

Before patients come in, they fill out pre-visit forms about their past medical history, medications, and allergies. In the practice, our staff gathers essential data, including a history of the chief complaint, and performs visual acuity testing, autorefraction, autokeratometry, wavefront analysis, and lensometry. They check the anterior chamber depth through the slit lamp and test intraocular pressure. For cataract patients, staff can obtain ocular biometry and axial length as ordered. They also may do other testing if needed, including Amsler grids, confrontation visual fields, or color vision checks. When testing is complete, they dilate the patient per our practice guidelines. 

As a result of my staff’s work, I can go into the exam and focus on looking at tissue and talking with the patient, rather than collecting data. Our practice tries to hire people who enjoy helping others and have good language skills and math ability (for optics and refraction), and we’ve had excellent success. 

3) Embrace the Indispensable Scribe
Even with devices that automatically transfer data to the EHR, scribes are essential to a physician’s productivity and a positive patient experience. Most of our ophthalmic technicians are certified COTs and COAs, and they are also trained to scribe during the exam, so I can focus on being fully engaged with the patient, rather than typing on a laptop. I think patients feel like we spend quality time together and they’re getting the best care. Throughout the exam, I talk about what I’m finding, and the scribe documents it. When we’re done, I sign off on the entry and move on to the next patient. 

This approach completes 3 tasks simultaneously: examination, education, and documentation. The scribe also serves as a chaperone and documented witness to the discussion. 

Example: During a routine visit, I sit at the slit lamp examining the cornea, conjunctiva, sclera, anterior chamber, iris, and lens. I tell the patient what I see in patient terms, normal and abnormal, and point out other specifics. If I see a +2 nuclear cataract with a small posterior subcapsular cataract that’s interfering with the patient’s activities, we talk about surgery and go over the advantages, disadvantages, risks, and complications of the proposed procedure. The scribe records everything in medical terminology. At the same time, the scribe gathers all the materials I mention, such as consent or other forms, a prescription, or educational literature.

While I move on to the next patient, the scribe may obtain any other tests I have ordered, assist the patient into a coat or wheelchair, and escort the patient to the checkout area, surgical coordinator, or optician, conveying any necessary information at the hand-off. 

 4) Stay Open to Efficient New Revenue Streams
Part of boosting productivity is offering procedures that help our patients and are less time-intensive for the practitioner. I mentioned the imaging we’re billing with the Digital Duet. In addition, I recently learned to implant sustained-release bimatoprost (Durysta, Allergan), a very beneficial treatment option for patients with glaucoma that can be done in the office with patients at the slit lamp or in a supine position. We can bill this in-office procedure and cut down on unbillable time spent on medication pre-authorizations, prescriptions, and pharmacy call-backs. 

It’s the Little Things, Too
These 4 strategies are the big ones in our practice, but there are others. Patient portals save staff time, so they can focus on higher-level tasks. When a telehealth visit is appropriate, it saves time for staff and doctors alike. 

Video education boosts productivity as well. We dilate our patients in an exam lane, and while they sit, they watch a video related to their primary complaint. They get a background education without the staff or doctor present, and I can start the conversation about their pathology at a higher level. If a patient presents with a potential retina problem and sees the video, I hear a sigh of relief when I tell them, “There are no tears, holes, or retinal detachments. You have a vitreous detachment, and we’ll keep an eye on that.” Watching our informed consent video for cataract surgery helps to condense the surgical discussion to specifics with a simple “…like you saw in the video…” and “Do you have any other questions?”

Once all of these strategies, large and small, are in place and working smoothly, patients can spend less time in the practice without feeling that they’re getting rushed through it. We care about our patients, and we want them to know that and feel it; the way for us to do that and remain viable is to find the right balance and provide the best care with greater efficiency. 

Thomas Castillo, DO, MBA, is in practice at Vita Park Eye Associates, Beaver Dam, Wisconsin.
Contact: [email protected]
Disclosures: Consultant for Lumenis