BEST PRACTICES

Satisfying increased patient demand

You might need to integrate — but think, plan, develop before you do.

By Maureen Waddle

I cannot find an ophthalmologist for my practice and I cannot keep up with [patient] demand.’” So say and write panicked practice administrators in phone calls and e-mails on a regular basis. “’What do I do?’” they plead.

Those nervous administrators are articulating what the data show in Figure 1. Practices are feeling the effects of the ever-widening gap between demands of an aging patient population who need vital ophthalmic services and the static number of ophthalmic professionals who can’t keep pace. A recent report indicates there will be a 14% increase in office visits over the next 10 years.¹

Figure 1. Ophthalmologist trends

While there aren’t enough ophthalmologists — new or already in practice — out there who can meet current and future demands, there’s no need to panic.

INTEGRATE AND DELEGATE

Ophthalmologists, short on help who face long days with scheduled patients, must find ways to more effectively use their time — just like PCPs and other specialties have been forced to do.

Primary care physicians, for example, have found success with nurse practitioners and physician assistants to meet increasing patient demands. This success plays out in a 2004 JAMA paper, which found that “Medical settings in which physicians and non-physician professionals work together as teams can demonstrate improved patient outcomes.”²

For eye exams, optometrists are the most natural extender of the ophthalmologist. Many ophthalmic practices have been working in an integrated optometric/ophthalmic eye care model for years; others are new to it. (See related story in the January issue of Ophthalmology Management, http://tinyurl.com/jceubda)

But an optometrist isn’t your only choice. What follows are critical steps for successfully integrating physician extenders.

STRATEGIZE FIRST

Define your practice model and your long-term vision. Doing so will help you segment the roles and responsibilities of the eye-care professionals needed to meet those goals. For example, a surgically oriented practice might consider a physician assistant (PA), while a practice more oriented toward comprehensive care with vision services might be better served by an optometrist. Clarifying the practice’s vision will help you with the next steps.

DEVELOP A MULTI-STEPPED SELECTION PROCESS

Setting realistic expectations at the beginning of the recruiting process will require establishing clear direction on your part. Practices should take these steps to ensure they build a sound selection process:

• Create job descriptions. Most practices don’t have provider job descriptions — which doesn’t contribute to the clarity goal. Accurate job descriptions are useful tools for a number of reasons, including: understanding the limits to practice scope for each licensed professional; clarifying responsibilities; and providing characteristics and skill sets to identify individuals who are the right fit for your practice.

• Adopt a meaningful patient-care philosophy. An ophthalmic extender should reflect the goals and values of the ophthalmologist. Writing down your philosophy can help provide clarity for that position. Spend time thinking about practice values and how you educate and treat patients. From there, jot down pertinent interview questions that will reveal if the interviewee shares those values. Ask, for instance, “If you are examining a patient with evidence of cataracts, but the patient has no complaints of visual impairment, what would you say to that patient?”

• Conduct a financial impact analysis. It is vital to map volume and revenue expectations in advance. Perhaps the practice wants to hire a PA who would not generate independent revenue but, rather, would allow the ophthalmologist to increase surgical volume and thus increase the ophthalmologist’s revenue. If everyone understands that from the beginning, no one will be disappointed with the actual numbers. It is essential to have this type of analysis done before recruiting to understand compensation limitations and ranges.

LEARNING DOESN’T END

This is arguably the most neglected step when “extender” professionals are brought into a practice. Don’t assume that because someone has had clinical training, he or she doesn’t need additional instruction. Your practice has its unique operations and you have a style you want the professional to reflect. Here are ideas on how to build a symbiotic relationship with your physician extender.

• Watch your terminology and train staff members on how to credential all providers appropriately. These points are important so that patients ultimately will be willing to see other providers in the practice. As an ophthalmologist, you want to use terms such as my associate, my partner and my colleague. Credentialing the optometrist (or NP/PA) builds patient confidence. You can say, for example, “Dr. Smith has been hand selected for his expertise in postoperative care.”

• Block time for regular clinical meetings. These meetings should be weekly at first, then can gradually be reduced over time. This meeting time is critical for long-term success. Encourage your associate to call attention to any case studies or questions that were encountered during the week. You, too, should bring a patient record or two to discuss (i.e., an unusual diagnosis or something you found interesting).

• Pass on interesting clinical articles. This helps your colleague understand what is top of mind for you and your practice.

• Plan the integration phases. Work with the entire team to define the onboarding and training stages for the new provider. Answer these types of questions: What time frame will be considered training? At what stage will the new provider have his/her own clinic (if ever)? How will patients be directed to the new provider? What type of schedule(s) will the new provider have? What type of support? Every practice will manage the operational changes in different phases and at different speeds, but few people are comfortable with the anxiety caused by the lack of a plan. Map the process out and allow everyone to take ownership.

CLOSE THE GAP

A critical supply-and-demand imbalance is affecting ophthalmologists and all health-care professionals. Physician extenders, including optometrists, will help practices close the gap and better position themselves to meet the needs of a rapidly expanding patient population. OM

REFERENCES

Maureen Waddle is a senior consultant with BSM Consulting, an internationally recognized health care consulting firm headquartered in Incline Village, Nev. and Scottsdale, Ariz. For more information about the author, BSM Consulting, or content/resources discussed in this article, please visit the www.BSMconsulting.com.