4 WAYS to Increase your Retina Practice Efficiency
The goals: less downtime, less paperwork and more time with patients.
EDDIE F. KADRMAS, M.D., PH.D.

Retina practices are burdened with mounting paperwork. Documentation has been driven to the extreme for billing, HIPAA compliance, and to prevent legal problems. And although reimbursements are declining, we see more patients in less time. Nevertheless, we keep striving to give our patients the high level of care that is rightfully expected. Efficiency has never been so important.

Here, I share four practice management strategies that have helped me cope with these challenges. All of them may not work for your practice, but most should help you navigate more efficiently through our current healthcare environment, while maintaining the high quality of care that you provide.

Hire an Office Writer

If you don't have a trained scribe or writer, I strongly suggest you hire one or train a staff member. The time you save in chart writing and patient movement more than pays for a writer's salary, especially considering the potential increase in patient volume.

I personally prefer two writers and at least two dedicated retina rooms. While one writer stays with me in 1 room for assisting and scribing, the other moves the patient to the second room or laser suite and carries over chart information needed for documentation. When I'm finished, the writer reviews any instructions and counsels the patient. If the patient requires surgery, surgical counselors take over and make the appropriate arrangements.

When you add up the time that's saved in a busy day or week, the economy of scale is remarkable. I can now spend more time with more of my patients than I did when I saw fewer patients per hour. A well-trained writer can also field your phone calls and perform routine callbacks to patients and pharmacies. Electronic medical records (EMR) may in the future play a timesaving role, but I haven't yet found an EMR system that meets the needs of a busy retina practice.

Develop Quick-Response Report Forms

I've also reduced required paperwork to a minimum. A few years ago I implemented the use of fluorescein angiogram and OCT report forms using a "circle the appropriate response" or "fill in the blank" format. This type of form saves both time and dictation costs. Other testing can be reported in the same way.

Examination report forms can also be useful timesavers. When I first started to practice, I wrote detailed letters to each PCP who referred a patient to me. In talking to some of them, I found they too were busy with the paperwork shuffle and rarely had time to read the letters I so carefully constructed. What they wanted was "the meat" and a direction. So I developed a circle-response/fill-in-the-blank form that could be filled out immediately after a patient's examination and faxed to the PCP. The PCPs get what they want the same day, patients are happy with the efficient communication, and I save time and dictation costs -- a win-win situation.

Brief follow-up notes to the PCPs on how their patients are doing can be added. Some may say this kind of communication is impersonal. But, the feedback I've received is overwhelmingly positive, especially when you take the time to add a brief handwritten thank-you note, and many PCPs are now doing the same thing.

Have a Well-Trained Technical Staff

A well-trained staff of technicians is essential. Certified technicians can take the patient history; check vision, pupils motility, confrontation visual fields, and tensions; refract; and perform most of the external and anterior segment examinations.

Carefully constructed examination sheets with "check-the-box" responses make it easier and quicker for the technicians to provide documentation and for your practice to accurately code and bill for services. A brief check by the retinal physician is all that's needed in most cases.

Consider a Surgicenter Setting

The most important decision a retina specialist has to make is whether or not to practice in a surgicenter setting. In previous issues of Ophthalmology Management (March 2001, December 2002), I wrote about the many advantages of operating in this environment.

The ideal set-up is to have your surgical facility adjacent to your clinic. Then there's no downtime as you move from one aspect of your practice to another. I often see emergency patients while the OR staff manages case turnaround. I can see patients in clinic right up to the time of surgery, or I can see patients in clinic immediately following surgery, which is the most efficient use of my time.

In the OR, a professional, trained team that knows retina surgery is crucial. When each team member is good at his or her job, cases can flow like a well-orchestrated piece of music. With the advent of 25-gauge-transconjuctival vitrectomy, retina cases can be handled even more efficiently in this type of environment.

Finally, in our practice, "batching" nonurgent lasers, PDTs, fluoresceins, and other testing and procedures has helped to improve patient flow and overall efficiency.

Dr. Kadrmas is a vitreoretinal surgeon in private practice in Plymouth and Dartmouth, Mass. He is an instructor in ophthalmology at Harvard Medical School and a member of the editorial boards of Ophthalmology Management and Retinal Physician.