Slow Season: You Can Lose It Or Use It
Experts offer tips for preventing a regular dip in volume or putting the time to good use.
By Louis Pilla, Contributing Editor

M aybe your practice is one of the lucky ones, running at a consistent, satisfying, and productive level of patient volume in spring, summer, winter, and fall. But, if your practice is like many, you experience dips in patient volume, probably at about the same time each year.

If that's the case, you can search for ways to either lessen the dip in patient volume or make the most productive use of staff time if you do hit a lull. In this article, you'll find practical tips and techniques for both mitigating "slow season" and dealing with it if it occurs. First, though, let's take a look at when you might experience slow season.

Slow season: no one time

No one slow season occurs in practices across the country; your slow season may well differ from others. Slow season depends on practice type and location, according to consultant John Pinto, J. Pinto and Associates, San Diego, Calif.

For instance, he says, practices in Florida and South Texas obviously have busy, but opposite, "snowbird" seasons from practices in Ohio and Maine. Practices in temperate climates such as Southern California have fewer weather-related changes in volume.

What's more, geriatric patients might delay eye care during the year's first quarter as they hold back before being hit with deductible payments. On the flip side, refractive surgery tends to peak in the first month or two of the year when medical savings accounts become available, during spring, and again in the fall, according to Pinto.

Some physicians, especially refractive surgeons, might experience a "self-inflicted" slowdown during summer months, according to William B. Rabourn, Jr., Medical Consulting Group, Springfield, Mo. That's because the surgeons tend to take vacation, for instance, when their kids are out of school. It's typical for patient volumes for geriatric and LASIK practices to drop 20% to 40% during the middle of summer, Pinto suggests.

Preventing the slowdown

Although some slowing in activity might be inevitable, you may want to question why you're experiencing downtime in the first place. "The key thing is to really analyze if you're having a slow period, why you think you're having a slow period," says Rabourn. Is it, for instance, because the doctor takes a vacation at that time of the year, or because the practice has consistently failed to market during that time?

One solution to avoiding downtime involves diversifying your services, according to consultant Michael D. Brown, Health Care Economics, Indianapolis, Ind. If, for instance, you face "snowbird flight" from northern to southern states, make sure you add services like refractive surgery and ancillary testing instead of focusing only on cataract surgery. Some ophthalmologists, he notes, set up practice in a snowbird state for the winter months to follow the market.

Sales consultant Susan Villamena, S&R Associates, New York City and White Plains, N.Y., asserts that a lack of consistent marketing might be the culprit for your slowdown. Rabourn agrees, recommending that slow season represents just as good a time to advertise as busy times and that you not reduce your advertising efforts. Failing to build consistency by turning ads off and on represents one of the biggest problems he sees.

Instead, he recommends that you establish and stick to an annual advertising plan and budget; such consistency will help alleviate slower times, he says. Of course, you may want to tweak the plan, using radio instead of TV advertising during warmer months when people are less likely to be watching the tube.

Other experts offer different views on whether to continue advertising during slow times. If you ramp up advertising during your practice's lull times, you'll only waste marketing dollars, Pinto suggests. If, for instance, you experience a 30% dip in patient volume in your LASIK practice in the summer, he recommends you take a "proportional dip" and spend 30% below your average on advertising. This even extends to parts of the week: If you have lulls on Friday, then advertise more in the first half of the week, he says.

Varying ad frequency is the course of action at Hollingshead Eye Center in Boise, Idaho, which specializes in LASIK and cataract surgery. Although the practice still "makes a presence" with ads, it lessens advertising during slow times, according to administrator Jodi Jones. The first 6 months of the year are the practice's strongest time, she says.

Marketing matters

Besides advertising, other marketing activities can help you either limit or make the best use of slow season. Hollingshead's Jones offers the following tips from her experience:

• If you anticipate a traditional slow time, hold workshops or similar events a month or two before that time to build patient interest and volume.
• During slow season, have your practice's marketing director visit corporations in the area to describe your services. Her practice promotes corporate discounts for LASIK.
• Have your optometrist take other area O.D.s to lunch.
• Consider having staff members visit nursing homes and high schools. They can educate high school students about eyecare issues such as LASIK; at nursing homes, they can do health screenings and discuss cataracts and glaucoma.
• Ramp up recall efforts, suggests Pinto. Your appointments should be scheduled up to a full year out. If your practice is especially seasonal (for example, experiencing a regular lull in January), spend time in the late fall reviewing charts of patients that haven't been seen for 2 to 4 years and contact them for a January appointment. Of course, this takes discipline at a time of year when your practice may be bursting at the seams, Pinto notes.

You can also adjust your recall system, suggests consultant Arthur De Gennaro, Arthur De Gennaro & Associates, Lexington, S.C. Because most practices have busier months in April and May than June or July, it makes sense to extend the recall dates of some routine patients who would normally be recalled in April and May of next year until May or June.

Regardless what is happening in your market, you should always be doing five separate activities geared to increasing business, asserts Villamena. (See "Five Ways to Keep Your Practice Strong".)

Staff time

Staffing represents the largest cost for every practice, says Pinto. With that in mind, try these techniques to make the most effective use of staff time during slow time:

• Have staff take vacation at the same time as doctors, suggests consultant Jeffrey J. Denning, Practice Performance Group, Long Beach, Calif. This pertains especially to staffers involved with the physicians in patient care -- medical assistants, technicians, optometrists, and surgery schedulers. Asking staff to take half of their vacation time at a time when the doctors are off is standard operating procedure in at least two-thirds of the practices in the country, either by written mandate, or by informal common agreement, says Pinto.
• Cross-train workers, suggests Denning. Use slow periods to have staff teach each other to backstop jobs. Having a second person who can pay the bills, prepare the payroll, or back up the computer isn't a luxury, it's prudent, he notes. Staff can also use this time for self-study and in-services, notes Jones.
• Update CPR and OSHA training. Besides complying with the law, this sends the message to all who work in the practice that a safe workplace represents a priority, Denning says.
• In sharply seasonal practices, use a core and contingency staff, says Pinto, so that you're not permanently staffed for peak times. In one Florida practice he knew, perhaps a third of the total workforce of 18 to 20 people worked full time; everyone else had a range of 8 to 20 hours per week, ramped up during busy season. A secondary gain involved the practice not having to pay benefits to the contingency staff.

You can also use part-timers, or two part-timers in a job-sharing arrangement instead of hiring a full-time employee. Realize, however, that this "puts some onus on leadership skills for the managers and doctors," says Pinto, because people will feel less attached to the practice.

Plan, purge, and clean

Besides marketing and staffing activities, your practice can put the slow season time to good use in additional ways:

• Do strategic planning. One 2-day session invested in strategic planning can set the practice's direction for up to 6 months, according to De Gennaro.
• Purge records. Send inactive patient records to your archives, says Denning. That includes not only patient charts but also business and financial records. And use the records purge as an opportunity to reactivate patients, perhaps by sending out a short note.
• Update contract references. Too many practices, says Denning, accept discounted payments based solely on the plausibility of the explanation of benefits attached to the check. Find all your HMO, IPA and PPO contracts and compile what you've agreed to accept, then hold them to the deal.
• Do a coding review. Pull 10 charts for each physician and copy the visit notes and operative report. Then compare them with the coded claim to see if the chart record supports the billed services. This can help reveal charting shortcuts.
• Clean house. Although cleaning should be an ongoing activity, use downtime to do a deep cleaning. A messy office can wear on the mind and detract from professionalism in the eyes of those who work there and visitors alike, says Denning. Get every worker to ruthlessly police his or her desk area.
• Update your policy and procedures manual, as Jones does in her practice.
• Have surgery staff do inventories of supplies, Jones says. It's also a good time to restock exam rooms, the operating room, and all the offices.

You may not be able to completely prevent a slow season. But using these tips, you can make sure that downtime doesn't mean unproductive time.

Pilla is a healthcare journalist based near Philadelphia, Pa.