Eyeworld

106 | EYEWORLD | MARCH 2021 P RACTICE MANAGEMENT by John Pinto and Corinne Wohl, MHSA, COE About the authors John Pinto President J. Pinto & Associates San Diego, California Corinne Wohl, MHSA, COE President C. Wohl & Associates San Diego California A s this article goes to press, national pandemic response planners are struggling to hold two conflicting data sets in their minds. The good news: Vaccination rates are slowly accelerating, new case rates are finally on a modest decline in many parts of the country, and treatment protocols continue to soften mortality rates. The not so good news: In a significant part of the country, ICUs have run out of surge ca- pacity, a low percentage of the country has been immunized, and COVID-19 strains from the U.K., Brazil, and South Africa appear to be more transmissible, potentially more fatal, and with unknowns about efficacy of current vaccines. Taken altogether, 2021 may not be the year that COVID-19 "goes away," but rather the year that we all use what's been learned to dig in for the next phase of a longer fight than was ever expected in March 2020. But even in this still hunkering-down year, practices have to continue to pursue their devel- opment plans. These include growth dimensions like: How large is our natural service area today and should it expand or shrink? What new services should we offer, and what old services should we wind down? What mix of providers makes the most sense? How fast might we grow in the future, and how can we have more control over that? What are our real facility needs, especially if some of our pandemic habits hold over, like having patients wait in their vehicles rather than in a reception area? Lately, we've had more client requests for input in this last area regarding office space. Their issues include: "Our senior doctor is taking an early 'COVID retirement,' so our space needs may shrink; should I give up part of our space?" "Can we negotiate better rental rates and terms now that the commercial property sector is softening?" "Despite the pandemic, our practice is grow- ing rapidly; how large should our next office be?" "Would it be better to expand our current space, perhaps moving into an adjacent suite, or better to open a satellite office?" This is an especially vexing business devel- opment problem in the current environment. Even before the pandemic, deeper health re- form and fee cuts loomed, and labor costs were poised to rise. To help sort it all out, here is a starter list of a few basic points to ensure that your facility thinking is in line with your wider development goals. 1. Know your facility utilization numbers. Let's assume you have a general practice. The best coarse gauge of whether you need more space or not is to count up the number of active, fully equipped exam rooms, multiply by 173 (the nominal number of hours your clinic is open each month), and divide the resulting figure into the number of patients seen in the average month. The resulting figure should be about 1.0, with units of "patient visits per exam room per hour." Here's an example: Your practice has five exam rooms. You have 5 x 173 = 865 room hours per month. You serve 800 visits per month. Divide 800 visits by 865 room hours to get 0.9 patient visits per exam room hour. If your practice had these statistics, your facility would be running at only about 90% of potential capacity, at least on paper, and you don't need added space. This is obviously a gross, first-pass calculation. Depending on your subspecialty, the intensity of optical dispens- ing or special testing space, pace of growth or general layout flaws, you may still need more space. 2. Explore a "temporal" expansion before adding more square feet; that's to say, think about expanding office hours rather than add- ing facility space and cost. If you are trying to make just four exam rooms stretch to serve two doctors who both want to work Monday–Thurs- day, 9 a.m.–4 p.m., shift clinic hours around so that the providers are a little less bunched up. For example, one doctor works on Friday in alternate weeks, and run from 8 a.m.–5 p.m. Facility development in the peri-COVID era

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