Eyeworld

102 | EYEWORLD | APRIL 2023 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 execute numerous small tactics all at once to have the same profit-preserving impact of any one of the last few goliath eyecare business revolutions. Examples of these include: • Unaccustomed levels of frugality in hiring, technology upgrades, and facility development. • Sharing resources with former market com- petitors and collaborating more closely to secure managed care contract access. • Pushing the envelope to optimize surgical volumes and testing utilization. 3. Technology turnover velocity. A bit over a generation ago, how one did cataract sur- gery, with or without phaco, was a prominent technology quandary. Making the go/no-go decision with electronic health records was a headline grabber 15 years ago. An ongo- ing debate is the role of the Light Adjustable Lens (RxSight) and in-office cataract surgery. These decisions are all confusing and all expensive. But the same simple rule of thumb that guided surgeons in the transition from extracapsular surgery to phaco can guide you today: "What's the crowd doing?" The tran- sition to a preponderance of phaco took less than 5 years because it was a very good idea. Many contemporary transitions are taking a lot longer. Decide whether you're the kind of surgeon who will adopt a new technology when the first 15% have made the shift, the last 15%, or somewhere in between. 4. Keeping up with the regulatory and procedur- al churn. If Starbucks had to run their coffee shops like your eye clinic, the customer would sign five forms before they could privately whisper their order to the java technician. Then it would take the barista an extra 15 minutes to get authorization. Forty years ago, a fairly complete patient record (on a 3"x 5" card) said: "Left eye doing better." Twenty years ago, SOAP was sufficient on a full sheet of paper. In the future, the nexus of EHR and progressively narrower payer care pathway algorithms may constrain today's youngest surgeons to an environment where a lot of "I t was better back then" sums up the chief concern we hear from many surgeons today. A realistic assessment of the future of eyecare is more braided and perhaps more hopeful. Here are rejoinders to the all too com- mon—and certainly reasonable—concerns. 1. Bigger is not always better or easier. The general trend today in ambulatory healthcare is consolidation—smaller practices merging into larger ones, larger practices acquiring the stragglers, PE firms building empires, and health systems getting back into practice ac- quisitions at a pace not seen since the 1990s. Even when a practice slowly, organically grows and adds providers, staff, and office locations, operational complexity general- ly increases logarithmically. Though larger practices can sometimes play a tougher game toe to toe with payers, regulators, and local market forces, these gains can be outweighed by complexity. A practice with four times as many doctors needs eight times as much leadership, eight times better management, and eight times more communication to stay organized, harmonious, and productive. If you are in a smaller private practice today, you don't necessarily need to grow to survive and thrive. 2. Lower fees could once be fixed by "one big idea." In the past 40 years, the largest eco- nomic revolutions in ophthalmology have been the development of private ambulato- ry surgery centers, the addition of optical dispensing, the bloom in medical retinal care, premium IOLs, and the employment of larger numbers of non-partner doctors as sources of passive income. This low-hanging fruit has now been plucked by most contem- porary practices and has allowed surgeon owners to preserve and even advance their incomes (both outright, and when expressed as a percent of their personal collections). On the road ahead, it will take a larger number of much smaller tactics to stay ahead of the emerging profit squeeze. Mitigation of the an- ticipated cuts ahead will require a practice to Facing up to eyecare's challenging future

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