March 2019

OPHTHALMOLOGY BUSINESS

To the point: simple practice tune-ups for complex times
Launching a personalized management checklist


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

“Whether you drive a boat or a plane or a practice, it helps to have a generalized checklist to run through from time to time to make sure you’re not forgetting anything.”

“I’m the type to over-analyze everything. If I was to rob a house, I’d have a checklist to make sure nothing goes wrong.”
—Israel Broussard

“The art of simplicity is a puzzle of complexity.”
—Douglas Horton

When we’re not at our day job as advisors to practices, doctors, and administrators, we live on and operate a 40,000-pound trawler based in San Diego. Her name is Castella, and she’s a beast, with 950 gallons of diesel fuel, three finicky engines, miles of wiring and hydraulic lines. There are almost as many federal, state, and local rules governing how she has to be operated as are present in an ophthalmology practice. Push the wrong buttons and you could be faced with a half million dollar fine. Make a sloppy turn and your insurance will be canceled. Sound familiar?
That brings us to the point of this month’s column.
Your practice can’t be skippered from place to place, and you probably don’t buy much diesel fuel, but your clinic has systems and standards aplenty. It’s a stationary battleship. Like Castella’s owners, you have to stay on top of the details, and poke around often to make sure everything is shipshape.
Whether you drive a boat or a plane or a practice, it helps to have a generalized checklist to run through from time to time to make sure you’re not forgetting anything. The frequency with which you use this list depends on the complexity and fitness of your practice, your role, and how particular you are about the details.
The managing partner of the practice is going to be interested in high-level, long cycle issues. “Are we on track with succession planning?” “Are we adopting and staying current with clinical and surgical technology?” The administrator necessarily gets more granular. “Is our new doctor credentialed with Medicare yet?” “Did our roofer fix the leak?” A department head has to largely keep his/her head down in the weeds with the fussy details. “Have we printed off enough intake forms for this week?” “Did the slit lamps get covered last night?”
The sample, generic list that follows is not meant to be a finished form for you to directly adopt, but a general template to get you started in developing—then evolving—your own checklist or lists.
Depending on your role, you may have one master list that you go through each month, like the bookkeeper who has to generate a standing suite of reports. Or you may find that you need daily, weekly, monthly, and even quarterly or annual checklists.

Sample items to help you build checklists
• The managing partner has participated actively this month with the management team.
• All appropriate meetings have been held.
• Any protocol or policy changes have been put in writing and distributed.
• Personnel records have been updated as necessary.
• New staff are mentored by an assigned “peer buddy” in addition to their direct supervisor.
• All staff have worn their uniforms and name tags.
• A formal cross-training makes sure all critical positions are covered by two or more people.
• An administrator walk-through has been conducted daily and any problem areas addressed.
• A staffer patrols the office three times a day to straighten up.
• OSHA and general safety requirements have been met this week.
• All payable invoices have been signed off by the relevant agent in the practice and paid.
• Staffing schedules have been matched to patient volume in all areas (or side work assigned).
• The phones have been covered satisfactorily this week.
• All insurance policies (health, life, disability, facility, key-man, staff bonding, vehicle, general liability, directors, etc.) are adequate, up to date and paid.
• Emergency procedures (for fire, patient slip-and-fall, patient code, earthquake, robbery, etc.) are written and drilled at intervals appropriate to the risks.
• Safety gaps are closed: non-slip surfaces, sidewalk shoveling/salting, loose carpet, handrails, lighting, evening staff and patient escorts for the parking area.
• Exam rooms are tidied up throughout the day by technical staff.
• There is a rational and fair distribution of new patients among the doctors.
• Emergency patients have been worked into the schedule and seen cheerfully.
• There is no more than a 5-day delay to the next surgical consult or urgent appointment.
• There is no more than a 15-day delay to the next routine appointment.
• Patients have been called 24 to 48 hours in advance to remind them of their appointment.
• The no-show rate this week has been at or less than 5%.
• All no-show patients have been called within an hour.
• Primary waiting time has not exceeded 20 minutes for any doctor.
• New patients have been fairly distributed among the doctors this week.
• Payment type and eligibility has been checked before each exam and surgical case.
• Patient information is updated accurately at check in or earlier via phone registration.
• All possible patient-responsible amounts have been collected at the time of service.
• Charges have been posted on the same day services were provided.
• Claims have been submitted within 24 hours.
• Payments have been posted and deposits made within 24 hours.
• Collections work has proceeded satisfactorily this week.
• Open accounts more than 90 days stand at 12% or less.
• Delinquent patients have been turned over to a collection agency.
• Lasers and special testing equipment logs have been spot-checked against charges submitted.
• Payment denials have been appealed when unreasonable.
• Doctors have arrived in the clinic at least 10 minutes before their first patient is worked up.
• All providers gather monthly to review charts, socialize, and increase team cohesion.
• New doctors are mentored by an assigned senior member of the clinical staff.
• Techs, scribes, doctors have entered accurate and complete chart/EHR data.
• Charts have been checked randomly for missing information, missed charges, lack of continuity of care, and missed opportunities to provide needed services.
• Special testing ordered has been followed up.
• All surgical patients received an evening call from their surgeon or a staff member.
• Optical and contact lens orders have been filled on time.
• Patients have paid 50% upon ordering and the balance on delivery for contacts, glasses.
• All departing patients have been asked to refer to the practice.
• All (appropriate) departing patients have been either reappointed or put in the recall system.
• Patients who have referred received thank you notes, calls, or small gifts.
• Referral sources have been entered in the computer.

Is it time to develop or improve your custom checklist? It would be easy to set this column aside and “get to it later.” Try to avoid that. In the spirit of this column, do it now. Circle the items above that apply to your part of the practice and transfer these to an e-file.
Spend a few minutes each day editing and adding to the list. Break out any categories that make sense. Keep it simple, especially to start off. Your list can always expand.
Show your emerging checklist to coworkers for input (and to encourage them to develop their own list).
Finally, post a hard copy of your list where you’ll see it often. Develop the habit of checking off items at sensible intervals (again, this might be daily, weekly, or monthly, depending on your role).
Airplane pilots and boat captains wouldn’t dream of launching without going through their highly specialized checklists. Neither should you, no matter which part of the practice you steer.

Editors’ note: This article is excerpted in part from Ms. Wohl’s and Mr. Pinto’s upcoming book, Up: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction. Published by the American Society of Ophthalmic Administrators (ASOA), Up will soon be available for purchase through the ASOA bookstore at asoa.org.

About the authors


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


Ms. Wohl is president of C. Wohl & Associates, a practice management consulting firm. She earned her Masters of Health Services Administration degree at The 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.

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