December 2017


Preparing for changes in ophthalmology
Pearls for managing a practice

by Ellen Stodola EyeWorld Senior Staff Writer

Bruce Maller, president and CEO of BSM Consulting, talks about the company’s services

Experts discuss factors like hiring staff, new areas of focus, and new technology

In the constantly changing ophthalmic sphere, practices have to deal with a variety of issues on a day-to-day basis to make sure the practice is running in the best way for physicians, staff, and patients. Laurie Brown, MBA, senior consultant, BSM Consulting, Tucson, Arizona; C. Jolynn Cook, RN, senior consultant, BSM Consulting, Worthville, Pennsylvania; Robert Weinstock, MD, Eye Institute of West Florida, Largo, Florida; and Candy Simerson, FASOA, iCandy Consulting, Marana, Arizona, discussed hiring staff and doctors in a practice, goals and new areas of focus, and incorporating new technologies into a practice.

Key hiring factors and who makes decisions

When hiring new staff, one of the main things Ms. Simerson looks for is that the person seems to have adaptability and flexibility. “The ability to adapt to change is key,” she said, adding that a positive personality and a positive outlook on the future are also important. The person has to be willing to continue to invest time in professional development and not be afraid to go beyond what he or she knows.
Ms. Simerson said it would depend on the practice as to who makes the hiring decisions. In a large practice, the human resources director and a manager for the particular team hiring the employee may make the decision. In a smaller practice, the physician owner may be involved. Additionally, it could depend on the position, Ms. Simerson said. If it’s someone who works closely with doctors, they might want to be involved.
One of the most important things to look for is excellent clinical skills, Ms. Brown said. This includes both surgical skills and patient care skills. It also has to be a good cultural fit. Additionally, she said that practices are looking for physicians who are continuous learners and process improvers.
Ms. Cook agreed that it has to be a good cultural fit for both the physician and the practice, and she said it’s sometimes hard to tell at the interview how the person will fit into the practice. The physician has to be adaptable because the practice is constantly evolving and changing with new technology, regulations, and more.
Employees have to demonstrate a background of commitment to the delivery of quality patient care, Ms. Cook said, adding that she thinks it is important for the physician to have a good sense of humor.
When it comes to the decision of who to hire in a practice, Ms. Brown thinks it is best for a concentrated team to lead the process and make a final decision. Candidates should have time with existing staff, and they should have time for in-practice observation.
Ms. Cook said that in her experience, it’s typically the board of shareholders making the final decision with input from senior leadership on who to hire. In a larger practice, human resources may be involved, as well as a CEO or COO.
Dr. Weinstock said that there has been a big push toward not just great outcomes and great medical care but also patient satisfaction and the patient experience. “When hiring staff, we’re trying to make good decisions on the front end,” he said. The better decision we can make up front, the better investment it will be down the road, he added. “We want to pick someone who is going to have a value add in terms of personality, customer experience, and customer service attributes.”
Dr. Weinstock said his practice relies on a management team when making hiring decisions, but the philosophy comes from above on hiring people who are outgoing, with a great personality, and who are natural caregivers.
He added that his practice is growing and currently has around 20 eyecare providers and a supporting staff of about 250 people.
When it comes to hiring new doctors, Dr. Weinstock said they are not only looking for someone who is well trained but also someone with a good personality. “When we hire a new doctor, we spend quite a bit of time getting to know that doctor,” he said. “We understand that in today’s busy world, sometimes the doctor only has a few minutes with the patient, and those few minutes have to be very powerful and impactful for the patient.”
In a short amount of time, patients have to feel confident in the doctor, they need to develop a trusting relationship with the doctor, and they need eye contact, Dr. Weinstock said, and that is a lot to ask for in a short amount of time.

New areas and goals

Both Ms. Brown and Ms. Cook said that a key area of focus in the practice is on the patient experience and quality of care in order to meet all the new compliance requirements of the Merit-based Incentive Payment System (MIPS) and reimbursement.
Employee training was another area that Ms. Cook identified, as well as recruiting physicians and building relationships with optometrists and other physicians in the community.
In the past, it was more about technical skills, Ms. Simerson said, but now there is a focus on intrapersonal skills. It’s important to focus on the patient experience and making sure staff is engaged, she said.
Dr. Weinstock said that his practice currently places an emphasis on physician extenders and collaborative care. For example, they are focusing on the concept of optometrists in the practice who subspecialize in certain areas of ophthalmology. That way, the optometrist can help with patients on the preoperative and postoperative side and notify the ophthalmologists if more treatment is needed.
There’s a lot of collaborative care going on in our practice, he said, and as things get busier and there are more people in the “eyecare age group,” this will set the stage to help the practice handle the volume of patients without losing the personal touch, he said.
Ms. Cook finds a lot of practices are trying to handle the changes that the Medicare Access and CHIP Reauthorization Act (MACRA) brings and how they’ll make that work in the day-to-day operations of the practice. She said another main goal is to be sure that the practice doesn’t lose sight of what they do well by getting distracted with trends or technologies.
Ms. Brown added that strategic planning is imperative so that the practice can set strategic and tactical goals to accomplish the overall mission.

Purchasing new technologies

When it comes to purchasing new technologies and incorporating them into a practice, Dr. Weinstock said it’s handled on a case-by-case basis. You have to look at the technology and ask, “Do I need this?” or “Do I want this?” If you need something, that’s an easy decision, he said, because you have to spend the money no matter if you get the return on investment or not. When it’s a technology you want to have, you have to consider the investment and reimbursement options. In his practice, any technology that is $50,000 or more is brought to the board meeting, and the surgeon who wants that technology has to make a presentation as to why it’s necessary, what the reimbursement looks like, etc. Deciding to purchase it would require a vote.
When it comes to purchasing new technologies, Ms. Brown said that best practices include researching needs and the desires of the physicians and staff regarding clinical and administrative equipment and software.
Ms. Cook added that decisions may be made based on the budget of the practice, the cost of the equipment, and reimbursement factors. Sometimes it depends on the need and utilization. For example, if it’s something that’s going to only be utilized a few times a year, it probably wouldn’t be considered. She added patient outcomes come first when considering new technologies.
Ms. Simerson said it often depends on the practice size when deciding what new technologies are needed in the practice. In her experience working with a large practice, she found that many of the doctors were involved with new technologies and would suggest ones to consider. She added that it’s important to negotiate a trial for the technology and to do a cost/benefit analysis to figure out what the return would be and how it would fit with current equipment in the practice. In a smaller practice, it might be something that a consultant or an administrator would identify and suggest for a gap.

Editors’ note: The sources have no financial interests related to their comments.

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