March 10, 2010
3 min read

How can ophthalmologists make their offices more efficient in anticipation of increased patient loads?

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No easy answer

Samuel Masket, MD
Samuel Masket

Increasing efficiency in practice is a complex subject, and there are no easy answers. But it is clear that we see a potential for decline in our workforce at the same time that we are going to have a massive increase in the needs of our population. As well, we don’t know what health care reform will look like, so we don’t know how reimbursements will be handled. Doctors are going to have to figure out how to take care of patients for less money per patient, but do so in a large volume.

In terms of adding efficiency to our practices, benchmarking is a good place to start. The American Academy of Ophthalmic Executives and the American Society of Ophthalmic Administrators can provide information for practitioners, practice executives and administrators to look upon what are considered model practices to consider how they function, what their patient throughput is, etc.

Division of labor is also going to be important. The turf war between ophthalmology and optometry should and will need to go away so that each profession can take part of patient care in the manner most prescribed by their training, by their experience and by their scope of practice. We need to have greater cooperation of the two practices.

The expected surge in the patient population may also signal a need to reconsider practice dynamics. The solo practitioner, as an example, really needs to consider whether he or she is better off working alone or working with other practitioners, particularly subspecialists. The physical design of the ophthalmologist’s office and the use of automated devices are other areas that may be able to increase patient throughput.

We just won’t have the number of MD ophthalmologists available, so a combination of technicians, paramedical personnel, working with optometry, use of automated devices, group practices, and working with subspecialists will be important. The ability is out there to make our practices more efficient, and the challenge to us is to find the best way to do it.

Samuel Masket, MD, is a clinical professor of ophthalmology at the Jules Stein Eye Institute, UCLA Center for Health Sciences.


Efficiency can be a financial incentive

John B. Pinto
John B. Pinto

Doctors who have some nominal control over how many patients they can see and access to such patients are going to be in a much better fiscal position than those doctors who feel they have topped out in patient throughput terms. It used to be quite conventional to transit 350 to 400 patients per month; today, among my clients, the average visit volume for doctors working full time and trying hard is about 550 to 600 patients per month, and I have some clients who routinely see 800 to 1,000 patients per month. We are just beginning to learn the upper limits of throughput and, thus, the potential to mitigate falling fees or at least fears of falling fees.

In some markets, limitations to throughput are going to be volumetrically based rather than capacity based. In San Francisco, Boston and similar over-doctored markets, we have a much higher density of ophthalmologists relative to the population base. So even if you are a super-efficient doctor, you might never have enough patients to see. For such providers, efficiency has to be of a different type: Rather than figuring out how to see 80 patients in a day, their mandate is to figure out how to bring the cost of seeing an individual patient to the lowest possible level.

Profit enhancement, though, is most often a matter of revenue enhancement rather than cost containment. The typical ophthalmology practice seeing an average number of patients and wanting to boost profits by $100,000 per year can do so by terminating three staff members, or they could see just three more patient visits per day. For smaller practices, the prospect of cutting staff members may threaten viability; however, it is easy to contemplate seeing just three additional patient visits per day.

Resource utilization should be monitored closely. The typical general ophthalmology practice needs about 0.8 or 0.9 tech payroll hours per patient visit. (This is 1.1 in refractive, 1.3 in retina.) If you are seeing patients with more tech coverage than that, you are financially ineffective, and if you are using far fewer tech equivalents to see patients, chances are you are running ragged personally as a provider, or else you may not be providing much supplemental testing and so your revenue yield per patient is down. You may feel that you are really an efficient doctor because you don’t have a lot of support staff, and yet paradoxically, your net profitability per hour of your time is much lower than your colleague who has a normative level of tech coverage.

John B. Pinto is OSN Practice Management Section Editor.