January 2018

OPHTHALMOLOGY BUSINESS

To the point: Simple practice tune-ups for complex times
Optimizing optometric relationships


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



“Whether your relationships
involve formal comanagement of
a referred patient’s surgical care or the complete transfer of care from optometrist to ophthalmologist, getting on well with your optometrist colleagues is a critical feature of most thriving practices.”

“Selling is essentially a transfer of feelings … it is something we do for our clients—not to our clients.”
—Zig Ziglar

A side from your relationships with patients, staff, and third-party payers, there is no more practically useful and important party in an ophthalmologist’s practice life than the community’s optometrists.
Whether your relationships involve formal comanagement of a referred patient’s surgical care or the complete transfer of care from optometrist to ophthalmologist, getting on well with your optometrist colleagues is a critical feature of most thriving practices.
Surgeons and their practices tend to fall into four broad camps when it comes to OD relations:
I. Openly adversarial: This is the rare surgeon who thinks (either sincerely or with a prejudice borne of competitive insecurity) that optometrists’ licensed scope of practice exceeds their training and ability and that ODs should either be eliminated or supervised more closely by MDs. (If you think this way, you will not find much to like in this month’s column.)

II. Optometry neutral: These are surgeons and practices that receive a few referrals from ODs, and they do not try to reach out for referral support. They may comanage the occasional case or simply accept referrals but cleave to a policy of not sharing postoperative care.

III. Moderately engaging: In such practices, only light efforts are applied to develop and preserve relationships with the community’s optometric providers. In such practices, typically 10% to 30% of new patients come in from local optometrists.

IV. Avidly comanaging: These are practices that typically source more than 50% of their surgical cases to optometric referral. The practices of avidly comanaging surgeons are among the most profitable in the country, especially when measured in terms of net profit per physician hour. A patient visit to surgical case ratio of five or lower is not unusual (when 25 is the norm in average settings). Such practices tend to be those that (a) are located in the center of rural pockets with high population to provider ratios and little competition for referrals, or (b) are urban and suburban practices putting significant doctor and staff resources into outreach.

No matter your current level, I to IV, if you would like to improve optometric relationships, here are 12 activities that can help.

1. Research to learn where your new patient referrals are coming from now. Unless you have a baseline of average referrals per month per optometrist, you won’t grasp if your deeper outreach efforts are gaining traction. Ideally, you should track new patient sourcing data monthly by provider, which will give you a tool to see if referrals are falling below average baselines and when you should call optometrists who have slipped away from you.

2. Get input from your closest optometric colleagues. Take them to lunch or dinner, and lead off with, “You know we’ve always been grateful for your support of our practice. Through the years we’ve taken care of hundreds of patients together. We wish we were as close to everyone in town as we are to you. With our expanded facilities and new partner on board, we finally have the capacity to accept more patients. We’re making it a core goal this year to reconnect with old friends like you and to make new friends to work with. I’d appreciate your help brainstorming with me on how we can do that.”

3. Inventory the optometrists in your community. Start a database showing name, age, location, contact information, practice type, any subspecialty interests, and their current level of referral support. Write down everything you know—family stats, hobbies, practice aspirations.

4. Develop specific, written goals, which might read, “We currently receive an average of 23 new optometric referrals per month, or 15% of our new patients. We would like this to increase to 45 or more OD referrals per month within 1 year.”

5. Decide who in your practice “owns” outreach and optometric referral development. The logical choices are individual MD owners and associates, an optometrist who helps with peer to peer outreach, beyond their clinical duties, the practice administrator, or a dedicated marketing staffer.

6. Put continuing education at the center of your support for optometrists in your community. This can take many different forms, depending on your goals and your comfort level. The most assertive surgeons host one or more continuing education events each year. These may include hours of accredited didactic lecturing and wet labs, guest speakers, and be supported by vendors. Less ambitious surgeons may find it more comfortable to educate on a smaller scale. This can include small group or one-on-one meals to discuss a recent interesting case, staff “lunch and learns,” or inviting optometrists in to observe clinic or surgery.

7. Augment your in-person education with some form of regular, non-self serving bulletin. This can be sending out a monthly emailed or snail-mailed interesting case, highlighting how you and a local optometrist shared the care of a patient, a blog post on your website, or blast emails abstracting clinical pearls.

8. Outreach to OD offices—like the detailing work performed by drug companies—is a central feature of most serious outreach programs. Though time consuming, there is no better way to jumpstart new optometric relationships or rekindle relations that have gone cold. An increasing number of practices are using professional sales staff. These staff are often highly paid and held to the same level of professionalism and productivity that industry applies. More likely in your own practice, it will be left to each surgeon to pursue his or her own relationships in the community. Formal time each week should be set aside for this, and contact reports should be filed centrally so that every provider and manager in the practice knows what’s up with every optometrist in town. Ideally, in a multi-surgeon practice, the optometric community will be divided up fairly so that every doctor has his or her own OD cohort to orbit.

9. Make sure your outreach is multi-lateral, which is to say that not only do you or your outreach representative call on selected ODs, but your administrator develops a relationship with the office manager of important optometric clinics. Your billing staff is on friendly terms with the billing staff of optometric practices you work closely with, and so on.

10. Be scrupulous in returning patients to their referring optometrist. Have a system in place to flag referred patients prominently, assuring that patients are only provided care they were referred in for, then sent back to their primary eyecare provider. Sometimes patients will refuse to return to their referring optometrist. In such cases, it’s appropriate for the MD or a senior staff member to reach out directly to the referring OD and explain the situation.

11. Make sure that returning patients have a good report on your practice. Upon discharge, make an extra effort to please the patient and plant the seed for a positive report. This can be as simple as the discharging ophthalmologist saying, “I’m so glad we were able to help with your lid surgery. We have the highest respect for your optometrist Dr. Jones, and whenever she sends us patients they’re treated like VIPs in our office. If there is anything else I can do for you today, please let me know. It would mean a lot to me if you would tell Dr. Jones how much we’ve enjoyed sharing you as a patient.”

12. Ongoing optometrist satisfaction monitoring is essential. Don’t assume that an optometrist’s steady referral is a signal that all is well. Conduct regular phone, in-person, or written surveys to learn what you could do more of, less of, or differently. Apply such efforts in a manner proportionate to each OD practice’s level of support to your practice. High-referring ODs should be orbited especially closely. When you discover you’re guilty of a service error or perceived slight, rush to recover and return to the referring practice’s good graces.

About the authors


Mr. Pinto
is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm in San Diego. His latest ASCRS•ASOA book, Simple: The Inner Game of Ophthalmic Practice Success, is now 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 Inc., a practice management consulting firm. She earned her Masters of Health Services Administration degree at George Washington University and has 30 years of hospital and physician practice management expertise. She can be contacted at czwohl@gmail.com or 609-410-2932.

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