This modest project can help you make the most of 2021.

Each year on Jan. 1, perhaps due to my hangover and the surprising clarity it provides, or because of the opportunity to begin anew, I launch some serious mental housecleaning. I create a household budget, schedule all holidays, medical meetings and vacations in my calendar, and purge all of my files. It’s a macro look at the upcoming year. This year, I added a set of goals for my practice.

Of course, we do this throughout the year in the form of monthly manager meetings and partner/consultant meetings; add to this periodic internal and external audits (highly recommended). But my New Year’s Day project is different — a mini “personal retreat” of sorts. A rare chance to sit quietly, undisturbed, and simply think. My intention is that this yearly bucket list may provide a checklist you can use to improve your own practice, as well as request that you share your business goals with the rest of us, as part of one community of colleagues facing similar challenges.

So, here I sit, Bloody Mary in hand …

DO A DEEP DIVE INTO ACCOUNTS RECEIVABLE

We should all know our current AR off the top of our head, specifically looking at days 0-90, 120-180 and older than 180, and we should follow, quarter by quarter, how our percentages of collections compares to our colleagues. This information is readily available through your state medical society. We must have a clear understanding of how our billing staff attacks the different AR scenarios: 120 days and younger, 180 days and older, denied claims and processes for claim scrubbing and resubmitting and those that are often, but not always, unpaid due to “lack of timely filing”.

Sometimes, with an explanation, even these older claims can be (re)submitted and collected upon rather than writing them off. In our offices, we have two teams of billers: those who work hard on 0-120, and those who work aggressively on 180 and older, because the mechanism (scrubbing and re-submitting a kicked-back claim) takes more time than a straightforward, clean claim requiring processing.

Review the success of your outsourced bad debt/patients sent to collections company and compare it to national standards. Many reputable companies provide this service. You should be seeing payments with a fair processing fee (25%), usually a reasonable percentage of what is collected. Require a monthly report from the collections company to document and follow its work product.

BECOME MORE PATIENT-CENTRIC (AGAIN)

Running a practice and perhaps other entities (ie, ASC, optical, clinical research) while seeing more patients to compensate for reduced reimbursement can easily lead to a more sterile patient encounter. We may fall into the habit of performing a thorough exam, educating the patient about their condition(s) and then leaving the “cleanup” for the scribe to answer other questions and provide further education. Our face time is already of a much shorter duration than patients are accustomed to with their primary care doctor. Patients who come in for a complete eye exam are often in our offices for 1.5 to 2 hours and get less than 5 minutes with the physician — which is what they will take home from the encounter.

I make it a point for the patient to hear about their condition three times during the course of most encounters: When I dictate to the scribe, when I explain my findings to the patient and then when I dictate to their referring doctor in front of the patient. This allows me to enjoy more face time with the patient and family and reassures them that I have communicated to their doctors. It makes patients feel good to hear about themselves while I am dictating.

I try to be more deliberate about eye-to-eye contact and conversation (especially in the “masked” era), though it is important to maintain control of the encounter so that the conversation does not “run away” from us listening to stories about other family members or unrelated issues.

RECONSIDER SERVICE CONTRACTS

Review and renegotiate every service contract to determine if there is a better package or pricing structure available. This includes business office services: fax/copy machines; stamp machines; contracts with FedEx, DHL and UPS; IT service agreements; land-line and cellular phones (frequently you can improve individual pricing by bundling or changing vendors).

Don’t forget technical contracts for diagnostic equipment, such as: visual field analyzers; OCT; fundus cameras; A/B scanners; topographic and other anterior/posterior segment analyzers; companies that service broken equipment such as slit lamps and exam chairs; and lastly, reception room equipment, such as television, with contracts for patient education video.

RENTAL AGREEMENTS

Review and potentially renew rental agreements, including the space occupied by your practice. It is not uncommon for a landlord to lower rates to be more competitive if you are willing to extend your contract before it becomes due. Physicians are coveted anchor tenants as we are stable, reliable with payment, long-term renters and attract other businesses to the building.

Consolidate or eliminate off-site storage units. Shredding old patient charts and downloading current records into an EMR has allowed us to pull out of a storage facility, saving thousands of dollars.

MORE POTENTIAL MONEY SAVERS

Review and update marketing initiatives for the new year. We have pulled out of printed Yellow Pages (but are still in the online Yellow Pages), again saving thousands of dollars. Renegotiate your website optimization contract, and consider new bids to keep ideas for your practice fresh.

Consolidate multiple fixed loans on equipment you have purchased at different times to create a single loan with potentially a lower overall rate of interest.

Lastly, build into your schedule new vacation time, and request that your staff take at least one of their weeks of vacation when you are out of the office.

I wish each of you a most peaceful, happy, healthy and prosperous new year! 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 e-mail is ssilverstein@silversteineyecenters.com.