Get your post-COVID practice back into balance and ready for the future.

Across the country we are observing varying degrees of post-COVID practice recovery success. Some practices bounced back in only a few months, while some remain, shall we say, “not quite back to normal.” Some vibrant practices have used the peri-COVID era as a prod and are on the other end of the spectrum, having grown exponentially in the last couple of years. Such success can impose its own operational imbalances.

If you are not completely satisfied with the daily operations or strategic trajectory of your practice, it is time to evaluate why and then make changes.

Practice owners and administrators are working in a tighter, more profit-constrained environment today. In addition, COVID has exacerbated a 20-year trend of falling labor participation rates. Your ability to find and hire staff is beginning to get back to normal in the most fortunate markets, but we also see that staffing costs have risen more than 10% in the typical client office. To stay in front of the many challenges that arise from these labor and generalized pricing pressures, practice owners and their management staff need to scan every area in the practice and take intentional steps towards improvement, with accountable progress hallmarks and firm deadlines.

Here are seven practice segments to evaluate, along with notes on potential opportunities for improvement.

1. MANAGEMENT TEAM COMPETENCE

Practices with strong leaders have the ability to respond and recover quickly to unanticipated events and the current profit squeeze. Organized and motivated, leadership like this knows how to approach problems effectively. These leaders prioritize communication throughout the practice with an emphasis on written messaging. Consistently holding scheduled meetings is a priority that pays dividends.

Staff education and training are critical as well. Great leaders assure that their teams are always learning and improving.

If the above does not describe your practice culture or response to issues, evaluate the following:

• How do your managers define and prioritize good communication?
• Are meetings held regularly and not postponed or canceled because, “No one has time?” Typical recommended meeting frequencies are:
  • Management team meetings — bi-weekly;
  • Managing partner and administrator — weekly;
  • All-staff meetings at least — quarterly;
  • Department meetings — monthly;
  • All-provider meetings — monthly.
• Is staff training and education supported by written operations manuals? Do the administrator and department managers assure this documentation is created, stays relevant and is updated annually?

2. RECRUITMENT AND A COMPETITIVE SALARY AND BENEFITS PLAN

Becoming and staying competitive in the marketplace keeps you ahead of the still-rolling staffing shortage crises. Stay proactive in this area to not only attract new candidates but to retain the experienced employees you have already invested in.

Having a formalized salary and benefits plan can relieve uncertainty and anxiety of the unknown for your staff. This can be accomplished by developing a formal salary range distribution by position. To stay competitive, perform a local market study of salary and benefits annually. There are several considerations as you dynamically tune up your salary and benefits plan in this fluid era, including:

• Salaries rose sharply and in some markets continue to rise to compete for experienced employees. You may need to adjust wages at a faster pace than in the past.
• Smart practices make the choice to implement robust internal training programs in order to become less dependent on hiring staff with experience.
• Retention is the key to labor productivity. Long-term staff are more efficient, resulting in fewer staff being needed; experienced staff cost more individually, but can help keep overall labor costs in line.
• Performance appraisals are key today, not only to help staff make improvements in their work but to assure they are getting adequate, formal praise, thus aiding retention. Remember that appraisals and compensation reviews need not coincide. Many practices find that a salary review (and adjustment where indicated) is best applied 3-6 months after the performance appraisal.

3. WORKPLACE ENJOYMENT

In addition to the necessary formalities of salary and benefits administration, creating a culture that includes workplace enjoyment — along with the hard work — is crucial on many levels, especially for patient satisfaction and customer service excellence. Happy employees consciously and unconsciously share their feelings about the practice with patients. You will find thousands of suggestions on Google for how to do this, but here are a few ideas to get you started:

• Provide lunch for employees when you (and they) anticipate an abnormally busy day with less-than-optimal staffing.
• Hold contests to celebrate holidays (pumpkin decorating) and sports events (season finales) or just for the fun of it.
• Keep a stack of gift cards at the ready and distribute as you catch someone doing “the right thing” with a patient or for a coworker.

4. STAFFING RATIOS BY DEPARTMENT

Compare your results to these basic benchmarks for a general practice:

• Overall lay labor costs as a percent of total collections: 28-34%
• Total annual lay staff payroll hours divided by total patient visits inclusive of post-ops: 2.4-2.8
• Tech/scribe/testing staff payroll hours divided by patient visits: 1.0-1.2
• Reception/phone staff payroll hours divided by patient visits: +/-0.5
• Turnover rate (the percent of total lay staff leaving each year): 15-30%

If your results are out of range, take a deeper dive into the efficiencies or lack thereof within each department to see where improvements can be made. Don’t be surprised if your staffing has become unbalanced. Immediately post-COVID, many practices struggled to hire enough staff, and the right distribution of staff and staffing ratios were lower than historical norms. As provider schedules came back up to max capacity, the staff felt overwhelmed, in many cases leading to over-staffing. This area can easily fall out of balance and needs continual monitoring as volumes change.

5. KEY PERFORMANCE INDICATOR BENCHMARKS

Excellent practice leaders don’t make fewer errors. In fact, they may make more errors because they are confident managers who are willing to be vulnerable, take risks and try new things. But what makes them excellent is their ability to identify errors faster and apply mid-course corrections.

The ability to know when things are going awry depends on knowing your baselines (like the internist who evaluates patient laboratory data before diagnosing and treating). There are more than 50 such medical business benchmarks, which are widely published, including the classic reference text, “John Pinto’s Little Green Book of Ophthalmology,” available on Amazon and now in its 6th edition.

6. STRATEGIC AND TACTICAL PLANNING

It is easy to become unbalanced as an organization if you don’t have a map to follow, and without written tactics that support that plan. A strategic plan can be a concise five to 10 page document that highlights the practices strengths, weaknesses and opportunities ... and what your plan of action will be. Action driven by opportunity rather than by plan often leads to disappointing results.

7. CUSTOMER SERVICE AND PATIENT SATISFACTION

As important as the objective medical and surgical quality of the services you provide are, customer service can slip when the spotlight shines primarily on employee and provider convenience, rather than delighting each patient. This can unintentionally happen when short-staffing is an ongoing concern and the practice feels desperate to retain even so-so staff. It’s time to assess if priorities have slipped ... waiting times are creeping up ... next appointment slots are excessively far out in the calendar ... recall is slipping, etc. OM

Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. Corinne earned her Masters of Health Services Administration degree at The George Washington University and has over 30 years of hospital, physician practice management and management consulting experience. Her latest book, co-authored with John B. Pinto, is “UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction.” For information on how to purchase this book or other inquiries, she can be reached at czwohl@gmail.com or 609-410-2932.

John B. Pinto is the founder of J. Pinto & Associates, Inc., an ophthalmic practice consulting firm established in 1979. He is the most published author in the world on the subject of ophthalmic management and economics. The firm serves organizations worldwide, ranging from solo practices to high-volume market leaders, teaching centers and medical product companies, providing strategic planning, financial benchmarking and analysis, operations enhancement and marketing counsel. He can be contacted at pintoinc@aol.com or 619-223-2233.