THE EFFICIENT OPHTHALMOLOGIST

Break old habits, earn from new ones

These cost saving, revenue producing measures work for us; they can work for you.

By Steven M. Silverstein MD, FACS

Happy new year! Each new fiscal year, I challenge our administrator, department managers and physicians to focus on new areas of cost savings, overhead reductions, and additive and complementary sources of revenue. Many fixed, variable and recurring expenses often stem from old habits, antiquated technology and unchanged office culture paradigms.

Try the following. They’ll fall directly to your bottom line and into your pocket.

ELIMINATE ANSWERING SERVICES

Many physicians are not aware that answering services typically charge both a monthly fee and per-call fee, which can seriously add up. Most office phone systems, even those 10 to 15 years old, can be programmed to receive after-hours calls. They forward the call to the on-call doctor’s home or cell phone automatically.

Eliminating answering services in our office has saved the practice nearly $10,000 annually. Our after-hours message informs the patient to call 911 for a life-threatening emergency; to call the office during normal business hours for prescription refills; or to remain on the line to be connected with the doctor on-call.

It only takes the secretary a few seconds at the end of the day or first thing in the morning to activate or de-activate this after-hours protocol.

BRING TRANSCRIPTION IN-HOUSE

Often a technician familiar with our medical nomenclature is delighted to earn extra income (fixed fee per dictation) as a transcriptionist, usually at about $1 per page compared to about $2 per page for an outside service. Or, you could assign a salaried employee, so no additional expenditure is realized (unless this requires you to hire another staff member).

In our office, we have enjoyed further savings by creating templates for frequently dictated letters, such as those for patients with diabetes or patients being treated with high-risk medications. We give our clinic manager/tech supervisor time during the regular workday to transcribe dictations; it also makes the employee happy not to bring this work home.

Further, we send PDF files directly to the physician or referring optometrist’s email, or by efax from her computer. Compared to mailing via the post office, this saves the postage cost and the employee time to address, stamp and mail the letter.

BUDGET FOR A WORKSTATION

Workstations can significantly decrease patient work-up time and the time necessary to move patients, especially those dependent on walkers and wheelchairs, from technology to technology. By saving this time, you can reduce your technician pool by 1/2 to one FTE or eliminate the need to hire an additional staff member as your volume demand increases.

REVIEW AND RENEGOTIATE SERVICE CONTRACTS

Service-based providers do not typically send us notifications when rates improve or when better pricing is available at the end of a contract period. These include landline and cell phone companies, copy machine maintenance contracts, cable and internet services, IT contracts, HR and payroll companies, company car leases, malpractice, practice “slip and fall” policies, key man insurance and especially healthcare/dental insurers. These policies often self-renew for another year or more. However, due to improved technologies or increased competition, fees often can be reduced substantially. For example, one call to our cable and internet service saved us more than $200 per month.

Also, I recommend setting reminders for when the end of the contracts are near to avoid automatic renewals and allowing you an opportunity to renegotiate or shop for a better deal.

REMOVE MEDICAL RECORDS FROM PAID STORAGE

The fees charged for paper record storage and retrieval are outrageous. Even requesting a stored file typically costs $15 per record and a monthly fee. Shred inactive files older than seven to 10 years (the required time may vary), and scan and store the rest in your EMR system, which is simple to retrieve during your patient encounter. Once we did this, we saved $152 per month.

RENEGOTIATE YOUR LEASE

Landlords love physician tenants because we are reliable and often do not move. We are considered “anchor tenants,” but this gives us a strong position in finding an appropriate win-win. I needn’t tell you this is an expensive, fixed-overhead line item.

Within 12-18 months of the end of your lease, survey fair market value of office space within a five-mile radius, and renegotiate your lease price and terms. If the market has either added equal or better medical office suite inventory, or the cost per square foot has significantly declined, you can save many thousands of dollars.

For example, if you are willing to renew your lease prior to its scheduled term and perhaps extend from a five-year contract to a seven-year contract, the landlord might lower the price per square foot; lower or freeze escalating common area maintenance fees; and/or provide a lease-hold improvement allowance as an incentive, such as several months’ free rent.

Last year, we renegotiated and extended our lease, which gave the landlord tremendous credibility when applying for bank loans or lines of credit. In addition to lowering and staggering our lease rate over the next decade, we received three months free rent, which we used to finance upgrades to our physical office space. OM

Steven M. Silverstein, MD, FACS, is a cornea-trained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. He invites comments. His email is ssilverstein@silversteineyecenters.com.