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Improve efficiency and patient satisfaction using simple techniques


Today ophthalmologists are facing decreasing reimbursement rates and increasing costs. John R. Fitz, MD points out that ophthalmology is a high fixed-overhead business, and to be successful a practice first needs to reach the break even point. Some strategies for increasing profits include cutting a staff member and increasing patient volume. To increase patients he suggests adding IOLs, increasing the amount of patients seen, and making the experience better for the patient. Dr. Fitz also suggests being diligent about filling out paperwork.

Key Points

The problems facing most ophthalmology practices today are that reimbursement rates are going down, costs are going up, and most of the "low hanging fruit" has already been exploited.

John R. Fitz, MD, an ophthalmologist with Precision Eye Care Inc. of Farmington, MO, addressed the American Society of Ophthalmic Administrators on the topic, "Improve Efficiency and Patient Satisfaction Without Driving Doctors and Staff Crazy." He pointed out that ophthalmology is a high fixed-overhead business.

"You run the treadmill really hard to the break even point," Dr. Fitz said, adding that after that point profits can climb. "But you've got to hit that break even point to make that work."

Dr. Fitz offered two strategies for increasing profits–cut costs by cutting a staff member and increase patient volume.

Cutting a staff member may mean adding another $26,000 annually back into the practice, but it can leave the rest of the staff running on empty as they absorb the extra work. Small details can be missed, and staff dissatisfaction can increase.

Another strategy to increase profits is to increase the number of patients seen in a practice by 4.2 patients per week. By contracting with other specialists to share the costs, practices also can raise alternative income through new services, such as a surgery center.

"You can do it as a contract employee where you're splitting every dollar, or do a rental agreement," he said. In the case of the rental agreement, the turnkey approach gives the specialist access to an operating room, schedulers, and billing. In return, the specialist pays the overhead for using the office that day, what Dr. Fitz calls a "fair market approach."

There are pros and cons to this arrangement. On the plus side, the practice can bring in income from referred patients, and office space can be freed up to see other patients. On the down side, the practice needs to build in enough capacity to fill in the gaps, and should have enough business to keep the doctors busy. The staff also has to deal with another doctor and another personality, which can be challenging.


One option for increasing traffic into a practice is offering implantable contact lenses, or IOLs. This requires having a patient education system in place, which includes patient counselors, software, and scripts for the physician and counselors. To be able to offer IOLs, a practice's current cataract surgery rates must be good with low complication rates.

The patient education component is steep. Plan for two visits to handle these patients. The first visit includes the exam and initial consultation on the IOL procedure. The second preoperative visit includes more education and explanations about expectations and reality following the procedure.

"Tell them what they are candidates for and get them thinking along those lines once they go to the counselor," Dr. Fitz said. "First get them to understand the concept of what you're trying to do for them. Defer the pricing question."

The second preoperative visit is when the implant system is chosen for the patient. But, Dr. Fitz said, in most cases, patients don't want a lot of details.

"They want us to pick for them; we tell them what they should have," he said.

Patient satisfaction

Another way to increase the number of patients in a practice is simple–give them a better experience. Dr. Fitz recommends looking for patients at risk and suggesting they have their family members checked.

"That worked with primary care doctors–screening for high-risk groups," he said. "A big way to get a pay raise without really working is to follow standards of care for care.

"Make the experience of your patients truly special," he said. "You want to knock their socks off."

Dr. Fitz said he personally calls his surgical patients to check on their progress. He also smiles and introduces himself to each patient.

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