A new-venture integration plan

Quash hasty impulses; launching any product, service or surgery requires a complete, detailed blueprint to succeed.

By Robert Calandra, contributing editor

Keeping an ophthalmology practice vibrant and growing means staying abreast of the latest developments in services, technologies and procedures.

Relatively speaking, that’s the easy part.

Integrating a new technology into a practice can get dicey. For those practices that just can’t wait to start using that new piece of equipment or trying out a new therapy, foregoing a careful step-by-step assimilation process will likely impede success and probably disrupt practice flow. So, whether it’s an EMR system, a new therapy, diagnostic technology or innovative surgical procedure, a well-thought-out, gradual integration plan is necessary.

“You need to come up with a written plan, bulleted, with timelines and the [names of those] responsible to complete each of those bulleted points,” says Cynthia Matossian, MD, founder of Matossian Eye Associates. “Without that kind of blueprint, a practice seeing patients day in and day out will not be able to successfully integrate a new product or service.”

Procedure manual

How to go about blending a new service or device into a practice depends on what it is and the practice’s structure. You could assimilate different elements simultaneously depending on which departments are involved. For instance, it’s possible to introduce a new front desk service and a clinical procedure.

“In most businesses and practices there are many concurrent things that are being implemented,” Dr. Matossian says. “But you have to have the manpower to be able to devote adequate time to the project.”

Coalescing something new into a practice requires staff-wide education and training. But that’s not all; you also have to update pricing, billing procedures, insurance coding and marketing. You also might need to set rooms aside and rejigger patient flow. For proper implementation, “the process for just a simple diagnostic technology usually takes three to four months,” says Daniel Durrie, MD, owner of Durrie Vision in Overland Park, Kansas.

That’s why it’s important to appoint someone to keep track of the integration process by creating a timeline, starting with staff education. The timeline should include informing marketing about the new service and when it will be available so it can be mentioned in a newsletter or patient e-mail block. The timeline should also cover contacting the practice’s network of referring physicians to inform them about the new service.

“All this takes time, and somebody has to lead the integration to make sure that they are following a timeline in order to stay on track,” Dr. Matossian says.

Starting the process

Agreeing to try something new usually falls under the domain of the physicians. At Durrie Vision, the optometrists and surgeons meet to discuss whether the potential advantages of adding an item makes sense to the practice from a bottom-line vantage point and for the practice overall. “It needs to not only financially have a good return on investment, but really work for the flow, for patients and for the staff,” Dr. Durrie says.

If the decision is yes, Durrie Vision purchases, leases or contracts the product or device after making a plan, which besides the launch date delineates mileposts for when each aspect of the integration must be accomplished.

“There are some people I know who are making the leap and going out on their own,” Dr. Durrie says. “They need to ask questions of their mentors about how to do this.”

And those questions, says Dr. Durrie, should be directed at practices that opened three to five years ago.

“Find out what problems they’ve had, not the successes but what were the problems,” Dr. Durrie counsels. “What would they do differently if they were able to do it again.”

Education and training

Education and training are important ingredients to a successful integration recipe. That requires carving out time for doctors, technicians and staff to learn how to use the product, service or device.

“You have to educate staff because if staff members don’t know about the product or service, they can’t play an integral role in disseminating the information to the patient,” Dr. Matossian says.

Depending on the technology, company representatives may have to teach staff members about the product. Also, doctors and technicians need hands-on sessions with equipment to learn the fundamentals, like how to position a device or at what point in a patient visit it should be used. The fact is, physicians don’t always know how to position a piece of equipment or at what point in a patient visit it should be used. If staff members try to learn how equipment works on the fly that often leads to failure because the device may not work as expected.

“The product or service can be falsely blamed, ‘oh it doesn’t work, or we didn’t find it useful,’” says Dr. Matossian. “That’s because the appropriate steps for the successful integration were not followed.”

When a new device comes into his practice, Dr. Durrie asks one doctor to take the lead and work out the details before green-lighting it for practice-wide use. Once the surgeons are comfortable, the practice begins introducing it to the senior technicians who can comfortably handle change.

“And then we work through some of our other technicians who are uncomfortable with change to make sure that they are on board,” he says.

Marketing

Whenever something new is integrated, patients need to know about it. That involves educating the marketing staff, or whoever manages the practice’s website, so the information can be shared correctly with patients through the practice’s newsletter, website or group e-mail. But marketing can also happen between staff member and patient. Staff members can play a key role in informing patients who might benefit from it, such as a product for dry eye. Having technicians, with whom patients spend more time than physicians, know about products and services makes good business sense, Dr. Matossian and Dr. Durrie say.

Marketers can also tout the practice’s new service, device, or surgery to area optometrists and other referring physicians, and to subspecialists like dermatologists and endocrinologists.

Billing

Another consideration is what to charge. It isn’t simply a matter of slapping on a new dollar figure. The practice has to create a model for the new integration that includes how it will affect things like patient flow and the surgical schedule. It can take six weeks to four months to get a new product up and running. So the business office has to start charging the new price long before the first procedure is scheduled. And that has a ripple effect.

“How does that affect the counselors?” Dr. Durrie says. “How does it affect the people on the phone? How does it affect the overall process? And what about the patients that you saw last year and you quoted them one price and now you have another price when they show up? Are you going to honor those prices? You have to have a rational way to explain it to patients.”

Also, the practice needs to create internal codes to track the service within the billing department. This also allows the practice to report the usage rate of the product or service so the physician owner or manager will know the return on the practice’s investment.

“The billing department needs to be educated to understand whether the new service or product is billable to insurance or whether it will be an out-of-pocket charge and if there are specific pre-certifications that may or may not be required,” says Dr. Matossian.

Patient flow

Introducing a new patient therapy or surgery almost certainly adds time to patient visits and slows patient flow. In addition, certain in-office procedures require a dedicated room or space, such as LipiFlow’s prerequisite for a reclining chair.

“Consequently, you have to have all the appropriate ancillary aspects completely thought through before launching it,” Dr. Matossian says.

Another example is the ORA system (Alcon). Not only did the practice have to add more time per patient in the operating room, but it also changed its entire ordering process because ORA requires 10 to 12 lenses per patient.

“To arrive at a reasonable price for this new service, we had to come up with models,” says Dr. Matossian. “We had to figure out how to alter the surgery schedule initially to allow more time per case for ORA patients. “So our entire ordering process had to be completely redesigned for ORA patients.”

Conclusion

Even with the most detailed integration plan, a practice should still expect a few wrinkles to contend with. But ironing out a few wrinkles is a whole lot better than not having an iron with only a balled-up linen shirt to wear.

For example, Dr. Matossian says her practice needed four months of planning before they were ready to integrate LipiFlow and LipiView (TearScience). And she readily admits that they still faced some small hurdles along the road.

“But they were tiny little bumps,” she says. “We corrected them in maybe one or two sessions because the foundation was solid and strong.” OM