December 2018

OPHTHALMOLOGY BUSINESS

To the point: simple practice tune-ups for complex times
Checklist for leadership priorities in successful practices


by Corinne Wohl, MHSA, COE, and John B. Pinto

“Order and simplification are the first steps toward the mastery of a subject.”
—Thomas Mann

“A real decision is measured by the fact that you’ve taken a new action. If there’s no action, you haven’t truly decided.”
—Tony Robbins

Revolutionary discoveries happen in every field, although evolution is more common than revolution. Excellence in ophthalmology over the years has resulted far more from incremental improvement rather than huge leaps.
Sometimes looking for big “gets” is not as effective as simply fine-tuning all areas in your practice. Streamlining processes, goal-setting, and prioritizing communications throughout will help patients, providers, and staff alike.
Here is our top 10 checklist for practice leadership to prioritize and apply.

1. Clinical excellence is the main driver for providers and patients alike. Measure your outcomes, set practice-wide goals for quality improvements. Prioritize provider meetings by scheduling them at least bimonthly for the year in advance. Share case histories, discuss how to improve your clinical services and develop a camaraderie among all providers that ultimately helps to improve patient care. Include your clinical staff in the improvements process, too. Make sure you have an oversight process in place to handle adverse patient outcomes.

2. Customer service expectations have grown in every business setting. Customers have been conditioned to demand far higher standards than they accepted a generation ago. And there are more avenues for patients to express their adverse opinions. Your practice must be very specific about the customer service behaviors you desire from your staff. Each new staffer arrives with their own definition of great service until you set the standards for them to uphold. Each employee’s personal life and previous bosses have shaped their own expectations and experiences, so you must set institutional expectations for consistency.
To help coordinate the effort, provide sample scenarios, preferred wording, role playing to make your points, plus directions for when it’s time to involve a manager to resolve patient satisfaction concerns.
3. Financial vigilance covers numerous areas for incremental steps for business improvement.
• Revenue cycle management: This includes accurate coding and timely billing and follow-up on denials. Often overlooked is cross training and educating the whole practice team in ways that aid the billing department.
• A/R aging reporting: Track benchmarks to determine where delays or improper payments reside. Know how to read this report and where to look for the underlying problems. Your goal for open accounts over 90 days should be 12% or less in most settings.
• Profit margin sufficiency: Performing monthly financial and volumetric data analysis provides the ability to spot adverse trends early, so you can react to challenges quickly. Typical profit margins for general ophthalmology practices are 30–45%. The higher the profit margin, the more resources you will have to seize opportunities and weather unplanned storms such as the unplanned loss of a provider.

4. Written protocols are essential to streamlined processes. Protocols provide clear guidance and hold staff and providers accountable for their actions. Examples include operations manuals by department that help formalize training new staff and advance continuous quality improvement and position descriptions, so every staffer knows their role and can be directed and evaluated by management in ways that can improve performance.

5. Communication is at the heart of business accountability. In even the smallest practices there are hundreds of opportunities a week to clearly or poorly communicate. In our consulting work, we commonly find that communication gaps and misunderstandings are really what has driven poor financial performance, high turnover rates, or clinics running behind.
• Too many practices allot too little time for meetings. Some practices avoid meetings because uncomfortable topics may arise. Managers and doctors in such practices sometimes think in error that meetings are unproductive. Running an effective meeting is one of the most important skills a managing partner or administrator can possess. Running a productive meeting is at the core of how executives add value to their companies. This is a learnable skill.
• Here are meetings typically held in the average practice with a handful of doctors and 20 to 40 lay support staff:
> Monthly with the board
> Weekly with the managing partner and administrator
> Bi-weekly with the Management Committee, including the administrator, mid-level managers, and the managing partner
> Weekly with the administrator and individual department managers
> Monthly department meetings
> All hands staff meetings; frequency varies depending on the size of the practice

6. Professional growth and training helps newer staff learn, and keeps your most talented employees engaged in their jobs, while at the same time reducing the vulnerability in a practice by making sure that as many staff as possible are cross-trained.

7. An administrator/CEO of appropriate expertise, skill and time commitment, whose competencies align with the practice’s scale and current needs. You want an appropriate balance between the hard skills of finance, accounting, and regulatory details, and the softer skills of problem-solving, conflict resolution, HR, communication, etc.

8. A managing partner who is an inspirational group leader, selected based on their desire to lead, current needs of the practice, and their skill. Having a 2-year term for the role is appropriate with no term limits. This provides continuity and growth in the position. A modest honorarium is recommended.

9. The management team provides core strength to your practice. Ongoing efforts should be applied at every career stage to advance each manager’s skills. Every manager—even the best—has a gap in their skills. As the administrator and managing partner, it’s your job to help your people fill in their gaps with a personalized skills development plan. Use a written, annual manager development plan to track progress and focus each team member.
10. Provider performance reviews are often avoided because providing feedback can be uncomfortable for both parties. Share individual performance data at least quarterly. Compare goals and issues. Be sure to treat partner-track employee doctors as much as possible like partners, with at least a voice (if not a vote) in practice operations. Respect and inclusion makes a big difference in performance and longevity—critical at a time when it is getting much harder to recruit new providers.

About the authors


Ms. Wohl
is president of C. Wohl & Associates Inc., a practice management consulting firm. She earned her Masters of Health Services Administration degree at George Washington University and has more than 30 years of hospital and physician practice management experience. She can be contacted at czwohl@gmail.com or 609-410-2932.


Mr. Pinto
is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm in San Diego. His latest ASCRS•ASOA books, Simple: The Inner Game of Ophthalmic Practice Success and the fifth edition of John Pinto’s Little Green Book of Ophthalmology, are available at www.asoa.org. He can be contacted at pintoinc@aol.com or 619-223-2233.

Checklist for leadership priorities in successful practices Checklist for leadership priorities in successful practices
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