There is little question the United States is navigating unsettled economic seas. While not yet officially classified as a recession, we saw in 2022 two consecutive quarters of negative GDP, which is the classic definition long relied upon by many economists of a recession. Interest rates and inflation also remain high (as of this writing), and most industries, including health care, are feeling financially pinched these days.

That said, there is little point in wringing our hands over conditions beyond our control. Instead, there is much to gain by recognizing the challenges we face and taking reasonable steps to protect our practices — and our patients — until the uncertainty passes.

ECONOMIC IMPACTS ON OPHTHALMOLOGY

According to a recent report, “Special Topix: Impact of Inflation and COVID 19 on Specialty Practices” (https://tinyurl.com/yv95b35a ), ophthalmology is clearly feeling the impact of current economic conditions, although perhaps not as severely as might be expected. Published by Spherix Global Insights US, Inc., the report is based on the responses of more than 300 physicians across six specialties, including 54 ophthalmologists, to a survey conducted Aug. 17-29, 2022.

Among the survey’s many findings (see “The state of ophthalmology by the numbers,”), 65% of ophthalmologists noted a “slightly negative impact” on their practice from current economic conditions, while 20% reported “no impact at all,” and 7% reported a “very negative impact” on their practice.

Among the hardest hit aspects of practice, 77% of ophthalmologists reported higher costs of labor and medical/office supplies; more than half reported higher rates of patient cancellations, no shows and failure to return for follow-up visits; and just more than 40% reported higher costs of office-administered medication. More than one-third reported failure of patients to pay their bills, 26% reported higher rents and 18% reported declines in new patient visits.

In addition, ophthalmologists reported challenges hiring and retaining staff. Nearly 25% reported difficulty retaining physicians and physician extenders, 63% noted trouble holding on to nurses and medical assistants and 74% say they faced challenges in hiring general office staff.

MANAGE YOUR PRACTICE LIKE A MUTUAL FUND

Fortunately, ophthalmologists are among those specialists who are able to offer elective and non-elective procedures and products. As a result, practices that offer both are in an ideal position to weather economic slowdowns. Based on our experience and that of other practices from around the country, we know that many people, particularly those of Generation X and younger, are choosing to delay or forgo elective procedures such as LASIK surgery. And while consumers are still purchasing eyeglasses, some are opting for $100 frames instead of $200 frames.

On the other hand, the desire to prevent blindness is a strong motivator to keep up with eye care, and reductions such as those aren’t as apparent with respect to cataract, glaucoma and other non-elective treatments. This helps to compensate for revenue blows to the elective side of the practice. At our practice, for example, retina, glaucoma, cataract, dry eye and other co-morbidity treatments have remained constant. It’s much like operating a mutual fund: Funds that hold a diverse portfolio of stocks and bonds are less likely to crash in a down market. In the same way, eye-care practices that offer a “portfolio” of elective and nonelective procedures, products and supplies are less likely to falter in a weak economy.

ADJUST YOUR APPROACH TO BUSINESS

That is not to say some adjustments will not be necessary, even for the most comprehensive of practices. It may be necessary, for instance, to put off hiring that additional staff member or two until next quarter or consider implementing temporary executive team salary reductions or cutting vacations from six weeks to five this year.

In our view, it’s the responsibility of practice leaders — not the staff — to take less time and money for the well-being of the practice. Realizing that conditions were changing toward the end of 2021, our executive team and physician owners took less time off in 2022 than we did the year before. We’re also planning to take less vacation time in 2023 than we did in 2022. Never have we asked staff to take lower wages, nor will we ever.

DON’T DOWNSIZE STAFF: UPSIZE PATIENT VOLUME

Still, it’s important to carefully consider your options before taking action. It may sound counterintuitive, but we’re not fans of reducing medical or administrative staff to help navigate an economic downturn. Cutting medical staff, in particular, limits your ability to maintain patient volume. It also risks burning out the remaining staff.

Instead, we are focusing on increasing our marketing efforts to grow patient volumes. We believe word-of-mouth advertising beats Facebook and any other avenue every time. Take every opportunity to give your business card to satisfied patients and ask for referrals, as well as to speak at meetings of local social, business and fraternal organizations.

Finding room in the schedule to add two or three patients a day can potentially boost revenues enough to cover the costs of retaining, and potentially even adding to, current staffing levels. We have a staff member dedicated solely to scheduling, as well as other staff responsible for calling patients and for finding gaps and filling those immediately.

Often a patient will cancel a week out from their appointment; our staff will make sure to fill that vacancy. We recommend making sure doctors are not doing anything but seeing patients (rather than, for example, doing workups) so that they can maximize their abilities to produce for the company.

LOOK OUT FOR YOUR PATIENTS

Another strategy we recommend — during both good times and bad — is to look out for your patients’ financial well-being, not just their visual health.

According to the Spherix report, 44% of ophthalmologists say patients today “very frequently” stretch their prescriptions to minimize expenses, while 37% said they do it “occasionally.” Other patient issues reported by respondents include forgoing office visits to avoid copays and relying more heavily on pharma and other programs to help defray prescription costs.

That last issue doesn’t come as a surprise, considering that some drugs for AMD or diabetic retinopathy, for example, cost tens of thousands of dollars a year (some cost even $4,000 to $5,000 per month), posing a significant obstacle for un- or underinsured patients. Even some less expensive prescription treatments, such as those for dry eye disease, can be cost-prohibitive for some patients.

To be sure, it isn’t fair to charge Mr. Jones full price for his glaucoma medication but charge Mrs. Smith a fraction of the price for the same drug because she happens to be in weaker financial condition. We have a responsibility to treat all patients equitably while recognizing the economic realities that face us as health-care providers.

That said, nothing hurts a practice more than adopting a mindset of, “Your bill is overdue so we’re turning you over to collections.” Our philosophy is that we’re not going to lose a patient over a $500 balance; it’s better to take the time to understand what challenges your patients are facing and help them find solutions. This is reflected in the Spherix report: almost half of the survey respondents indicated they have cut back on prescribing branded drugs in favor of generics to help their patients save money.

We have no guidelines set in stone; we address each patient on a case-by-case basis. Our billing staff are tasked with staying on top of payment issues; they aren’t hesitant about asking patients directly if they are having financial issues. Then, our leadership determines how to proceed based on our best judgment. For example, we assist our patients in getting connected to government and nonprofit agencies, such as the ASCRS’ Operation Sight program.

HARD TIMES DON’T LAST FOREVER

This is our third trip through what we believe will be a recession similar in severity to those that occurred after September 11 and during 2008-2009. Those were rough times, but we rebounded from those downturns and will rebound from this one. It may not come for a year; it may not come for two years. Either way, it won’t last forever.

From our perspective, the best strategy for navigating today’s choppy economic waters is to keep your head down, work harder and treat your staff and patients like the essential resources they are for the health and well-being of your practice. OM

Michael Patterson, DO, is a board-certified ophthalmologist specializing in cataract surgery, laser vision correction, surgical and medical treatment of glaucoma, ocular surface disease and cosmetic and functional procedures of the eyelids. In addition to his role as managing partner at Eye Centers of Tennessee, Crossville, Dr. Patterson serves as a consulting physician at Cumberland Medical Center and Cookeville Regional Medical Center. He is a captain in the United States Army Reserves.

Ray Mays is the chief executive officer of Eye Centers of Tennessee, Crossville, and a former United States Marine Corps Officer.