Management Essentials

Widen Your Range of Services

By Farrell "Toby" Tyson, MD, FACS

The field of ophthalmology is constantly in a state of flux. In order to keep up with the changing financial realities of maintaining a practice as well as looming healthcare changes, you should consider investing time and effort into researching complementary services to add to your practice.

Widening Your Focus

When I started practicing ophthalmology, our practice was primarily a cataract/glaucoma comprehensive ophthalmology practice. This narrow focus allowed us to be very good at what we did, but left us vulnerable to changes in the market or to regulation. Our practice had missed the LASIK bandwagon early on and the price for admission into that market was prohibitive.

With the onset of presbyopia-correcting lenses, our practice made a concerted effort to be at the forefront. This also played to our strengths of being a premium cataract practice. Initially, we were converting about 15% of our patients to premium cataract procedures. After three years and the increase in premium products, we were seeing 60% of our patients paying out-of-pocket for cataract surgery. This premium addition allowed for better outcomes and provided extra revenue for practice investment in staff, equipment and other lines of service.

If You Build it…

Since we already had a great rapport with our patients, our focus became how could we better serve them. First, we looked at what we did and didn't offer in the ophthalmology arena. At the time, we were referring all of our oculoplastics and retina patients to other practices. We knew we couldn't afford a full-time oculoplastic or retina specialist. We were able to bring in one of the local oculoplastic surgeons part time to see our patients in our clinic and use our ASC. We quickly discovered that having an "in-house" oculoplastic surgeon led to more oculoplastic consults and procedures than anticipated. This was due to the fact that patients were now requesting to have oculoplastic consults once they realized that we had a specialist on staff.

Once successfully integrating part-time oculoplastics into our practice, we decided to tackle retina. This required a larger capital investment and therefore greater risk. We initially started with one day a week of retina, which grew to two days after a year. Retina allowed us to bring in a totally different cash flow than cataract surgery. By scheduling retina days when the cataract surgeon was at a satellite or in the OR, we were able to lower our overhead significantly.

At this point, we were finding that we were becoming a premium cataract practice with benefits. By bringing specialties in-house, we were able to control the environment and the experience our patients had. This led to increased patient satisfaction and word-of-mouth referrals.

As most of our patients in southwest Florida are retirees, we felt our market was underserved in the field of audiology so we decided to bring audiology in house.

We hired a doctor of audiology full time instead of a hearing aid specialist, which cost us a little more in salary, but in return we got the expertise that our patients had come to expect. In addition, having a doctor of audiology allows the practice to bill the insurance companies for the hearing and balance evaluations, thus eliminating the need for hard-sell tactics on hearing aids. Not only do we offer a new line of service to our existing patients, now we are seeing new patients self-referring from audiology to ophthalmology!

We continue to look at what is successful and not successful at other practices. Several ophthalmology practices have brought in dermatology and even family practice. Others with ASCs have looked into pain management, podiatry and GI. Though some promote a "boutique" practice setting catering to the few, I feel in this economy diversification allows better protection in the storm — especially when you treat every patient like a king or a queen for the day. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.