No easy answer
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 dont know what health care reform
will look like, so we dont 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
ophthalmologists office and the use of automated devices are other areas
that may be able to increase patient throughput.
We just wont 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
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 dont 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
John B. Pinto is OSN Practice Management Section Editor.