Eyeworld

26 Ophthalmology Business • July 2018 One day I wake up and say, 'What's going on here?' Now I have to fix it and I am way behind. I'm trying to work out of the same space and see 50 patients as I did when I was seeing 20 patients." Most affected Efficiency problems generally are linked to the type of ophthalmology practice, rather than the size of the practice, Mr. Rabourn said. "If you are a practice that sees a lot of elderly patients with a lot of very sick eyes, people with diabet- ic issues, glaucoma issues, macular issues, those have a tendency to get clogged up because they come in, get tested, it's inconclusive, and the doc- tor issues more testing," Mr. Rabourn said. He has found efficiency is a solv- able problem. "Most practices have to go through a real thought process of how to be efficient because that allows them to see more patients, which allows them to do more sur- geries and generate more income for their practices to expand and afford new technology," Mr. Rabourn said. Inefficiencies affect many more practices than people assume. "Everyone is trying to look for efficiencies, and they are trying to look for a number of reasons," Mr. Rabourn said. One reason practices regularly confront inefficiencies is because physicians want their patients to be well taken care of and happy. "If they are taken care of and happy they are going to be healthy and they are going to share that in- formation with their friends and fam- ily, which is the best advertising you can have," Mr. Rabourn said. OB Contact information Rabourn: brabourn@medcgroup.com Shuman: jshuman@eyetechs.com mark for a comprehensive patient history is about 3.5 minutes for an established patient. "The major problem I see is that technicians may not ask appropriate questions based on the chief com- plaint, therefore the history as it reads may not pertain to why they are there," Ms. Shuman said. Additional training can improve technicians' inefficiencies, but it may not completely solve it because of other factors, she said. More factors Other issues that may affect efficien- cy include a physician's rate of seeing patients. "If he is efficient, by the time he finishes seeing a patient, another one is waiting," Mr. Rabourn said. "The doctor should flow from one patient to the next and the next." Ms. Shuman agreed that the amount of time the physician spends with the patient is a big factor in overall efficiency. "If you have an average 10-min- ute time of each patient with the doctor and you book eight patients an hour, you're going to run behind by the end of the first hour," Ms. Shuman said. Efficiency problems are general- ly interwoven, with technician and physician efficiency driven by and affecting utilization of the practice space. That could mean insufficient rooms for the size of the practice. Facility and staff efficiency challenges are frequently driven by growth in a practice, Mr. Rabourn said. For instance, an ophthalmol- ogist may have only needed one technician and two rooms when he launched the practice and lose track of the infrastructure needs as the practice grows. "It happens gradually over a period of time," Mr. Rabourn said. "I develop bad habits, my techs devel- op bad habits, and I'm out of space. Practices trying to improve their efficiency, Mr. Rabourn said, need to examine three areas: • Understanding how physician time is spent • Understanding how technician time is spent • Understanding their facility needs "Everything starts from there," Mr. Rabourn said. "What you are trying to manage are those three pieces of information. When I look at efficiencies in flow those are the first three things I ask about." Technician challenge One challenge to technician efficien- cy is a lack of training. Jane Shuman, president of Eye- techs, Ashland, Massachusetts, said a lack of efficiency is a common issue in practices she has examined. "Part of it is rather than be- ing certain as to what each patient requires based on their reason for the visit, technicians want to give the doctor more information rather than less information," Ms. Shuman said. "That is because very often they are not sure what is appropriate, and they don't want to be called out for doing too little or missing some- thing." One area where efficiency is commonly lacking is in the compre- hensive exam, which includes refrac- tometry, for which the benchmark time is 5 minutes. "Without knowing the endpoint of every stage along the way, techs will keep giving patients the sub- jective, 'What if I changed this, do you like it a little bit better?'" Ms. Shuman said. "That ends up not only taking more time but can result in an overcorrection for the patient." This also results in a remake of the patient's glasses, the cost of which is absorbed by the practice. The second area where techni- cians struggle is in the time used to take patient histories. The bench- continued from page 25

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