June-July 2020


Getting back to good habits

by Corinne Wohl, MHSA, COE, and John Pinto

No matter what practice we work with, large or small, we are on the lookout for a finite number of good habits. When a new client is faltering, it is often because one or more of these good habits are missing. These core habits are the pillars of strength for your practice.
It’s understandable if in the midst of a pandemic some of these good habits have fallen by the wayside in your practice. And if they have, you won’t be too far behind if you get back to them sooner rather than later.
There are hundreds of good business habits, but here are five you always want your practice and management team to stay on top of.

1. Regularly scheduled meetings. Whether face-to-face or on Zoom (our new normal), communication needs to be clear to be effective. When meetings are conducted regularly, communication throughout the practice is enhanced and no one is overlooked. It may feel premature to hold meetings before your staff and doctor schedules are back to normal, but this could leave the practice lagging behind in business growth or staff morale. Whether the office is back to full functioning or not, be sure to re-establish (or begin) the meetings needed for a fully engaged business.
Typical meeting schedules include:
• Board meetings: monthly
• Administrator/managing partner: weekly or biweekly
• Administrator/department managers: weekly or biweekly
• Management team: weekly or biweekly
• Department meetings: monthly
• Provider meetings: monthly or quarterly
• All staff meetings: monthly or quarterly
Note: Large practices might need more meetings than small practices.

2. Financial and volumetric benchmarking data. These have to be timely and well understood by administrators, mid-level managers, and physician owners alike. A monthly review is essential to identify and correct performance gaps quickly and to address adverse trends. In part because of COVID-19, more practices are tuned into their financial reporting and more are closely watching cash flow projections than ever before. If your practice was on top of things, you were able to swiftly and accurately collect and submit the financial data you needed to apply for grants and loans and, as importantly, forecast what your financial support needs were going to be. If your practice struggled, use this experience in the midst of an emergency to re-evaluate the way you collect and present important financial data. Ask your CPA for assistance as needed. Talk to peers in similar-sized practices to find out what they track.
Tracking volumetric data is another important good habit. Instead of simply glancing at your monthly stats, engage deeply with the data. If you are an active user of your data, you’ll know you are building your practice back up with staffing levels, visit volumes, and surgeries all rising in proper ratio to each other.

3. Performance appraisals. Feedback and communication with your staff has never been more important. If, like most practices, you had to make tough staffing decisions in the second quarter of this year, everyone who’s coming back on needs to hear how much you appreciated the sacrifices they made. If some staff are still on the fence about returning to work, hearing your viewpoint about their heroic role will make coming back onto the clinic floor easier.
This is the time to double down on giving your staff performance feedback, especially if staff wages were rolled back or future wage increases are temporarily frozen. Your employees need to hear how they are valued and appreciated in other ways.

4. Revenue cycle management. Hovering closely over your patient accounts is another critical habit that can go soft in the midst of a crisis. Track your A/R aging report closely, looking to keep claims over 90 days to 12% or less of the total. It is not uncommon for us to find overstressed billing departments where staff focus first on getting the claims billed out and receipts posted. When they run out of time, unpaid claims can pile up. If your billing department has been short-staffed during the pandemic, this is an area where good habits may have slipped through sheer overwork and exhaustion.

5. Staffing efficiency. Over the last two generations of abundance, the average practice has kept a moderately close watch on labor productivity. In the best practices, the ratio between patient volumes and staffing levels has been measured by department and fine-tuned along the way. This good habit may now have slipped, as you have had to balance staffing costs with the threat of losing experienced and well-trained employees. If you were in the position of having to return staff to work prior to having the patient volume to support the expenses, be sure to track labor productivity by department more often now to determine, over time, when and if your staffing ratios and expenses are slowly returning to norms. These norms include:
• No more than 32% of every dollar you collect going back out for lay staffing costs
• Technician staffing (techs, scribes, testing) at 0.9 to 1.1 tech hours per patient visit (closer to 1.3 in the typical retina practice)
• Reception staffing (check-in and out, call center, medical records) at 0.5 clerical staffing hours per patient visit
• Billing staffing generally comes in at +/–0.3 biller hours per transaction (including all visits and all surgeries)
• Overall lay staffing levels in a typical general ophthalmology practice is 2.5 staff hours per patient visit (e.g., a practice with 600 visits per month and 50 surgical cases needs about 9.5 full-time equivalents)

Ms. Wohl’s book “Up: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction” is now available. Mr. Pinto’s latest books, “Simple: The Inner Game of Ophthalmic Practice Success” and the Fifth Edition of “John Pinto’s Little Green Book of Ophthalmology,” are now available.

About the authors

Corinne Wohl, MHSA, COE

C. Wohl & Associates
San Diego, California

John Pinto
J. Pinto & Associates
San Diego, California


Wohl: czwohl@gmail.com
Pinto: pintoinc@aol.com

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