Special section sponsored by Marco

Down With Down Time

Reduce waiting and testing times to improve capacity.

By Dan D. Chambers, MBA, COE

Several years ago, I began speaking around the country about the coming economic realities for ophthalmic practices. I told audiences that declining reimbursements and the rising costs of labor and supplies would cause profits to drop two to four times faster than in the past. That meant the average practice could see 10% less revenue, requiring a nearly 20-30% boost in patient volume to maintain the physician’s income. I followed this sobering reality with some basic advice — think about efficiency in terms of major change, not minor change — as well as practical steps to make those changes and, ultimately, see more patients each day by thinking technologically smarter, not working harder.

Today, the discussion is the same, but it’s gained a new urgency as the situation has become more acute. Medicare reduced cataract reimbursement about 13%. In January, sequestration added a 2% cut for all Medicare fee-for-service reimbursements on April 1, and a number of private insurers have mirrored the fee-for-service reductions. The future we talked about a few years ago is now the present, especially with new accountable care organization discussions throughout the country. Some practices were prepared. Those who weren’t are hastily working to make the necessary changes.

You can start now. To see more patients each day, you need to systematically shorten patient visits and streamline testing time. At Key-Whitman Eye Center, these strategies enabled us to increase our capacity by about 15-20% over the last year negating the adverse effect on productivity that resulted from implementation of our electronic medical records (EMR).

Finding Time

Do your patients think you’re a good doctor? Do patients think your practice is a welcoming, successful, well-run business? While pausing to answer these questions, you’ll need to consider many factors — from your success in diagnosing and treating pathologies to your billing manager’s deftness at dealing with myriad insurers. But these questions don’t ask how well the doctors and staff are doing; they ask how well your patients perceive what you’re doing. What do they see and think?

Forget all those other factors for a minute. The number one quality issue for most patients is wait time and duration of the entire office visit. They directly associate waiting with quality. Simply put, patients see a practice that keeps them waiting as a poor-quality practice. They won’t recommend your practice, and they may not return.

This may sound unfair — shouldn’t patients look at quality based on visual outcomes? But before you get frustrated that an outside-the-exam-room factor is so influential, consider the advantage. You now have the power to improve patient perception simply by decreasing wait time.

To see more patients in the same time allotment without overworking you and your staff, each patient must spend less cycle time in the practice. Your examination time won’t be shorter — you’ll just cut the time patients spend waiting and growing dissatisfied.

There are several ways to measure how long your patients are waiting and where. (See “What’s the Wait?”) Once you analyze wait times, you can work on reducing them. And if, for example, you can cut work-up wait time 10 minutes per patient in a 50-patient-per-day practice, you’ll add 500 minutes a day to see more patients.

We’ve decreased our wait and work time significantly. As we’ve done that, we’ve also analyzed our electronic patient satisfaction surveys each month and found a dramatic improvement in satisfaction in direct correlation to declining wait times.

EPIC Success

While cutting work-up time and wait time is one way to find time, another is to streamline your testing process. We accomplished this with Marco’s EPIC workstation, which performs many standard tests simultaneously without moving the patient. This means no waiting or moving between routine tests. EPIC’s clinical results and efficiencies have encouraged us to add another EPIC system in the last year, bringing the total to six systems in three locations. The EPIC combines an autorefractor/keratometer, a chart projector, an electronic refractor, an auto lensmeter and a topography OPD. Patients sit at the EPIC station for six or 12 tests in about 15 minutes, cutting total evaluation time up to 50% for some of our more proficient technicians. All the data can be sent straight to our EMR.

The EPIC also gives physicians the accurate and consistent results they need. Techs can perform more thorough evaluations for cataract refractive procedures while still keeping the time manageable. We began by assigning some of our least skilled technicians to the EPIC, but we’ve had a rather interesting transformation in the last 6 months. Our most skilled staff members have been using the EPIC with even greater speed and reliability. Technicians don’t need a high skill set for the EPIC, but it may be desirable to achieve higher quality and productivity levels.

Our Results

The combined result of cutting wait time and streamlining testing has increased capacity at Key-Whitman 15% to 20% without adding more staff. We’re now adding more services to our daily schedule to fill that capacity and increase revenue. Our physicians are excited about the prospects this presents. They can see more patients, and we’re increasing our non-covered services, such as upgraded cataract surgeries with premium intraocular lenses and a femtosecond laser approach.

We’re also launching a full-scale dry eye program. Just a few years ago, our physicians simply didn’t have the time to take this on. Now they do. Technology changes have impacted our practices in a profound way.

Dan D. Chambers, MBA, COE, is the chief administrative officer at the Key-Whitman Eye Center in Dallas.