In difficult times, productivity and efficiency vital to practice success

Even if you are weathering the financial storm, take inventory of your resources and needs.

Issue: February 10, 2009

ByJohn B. Pinto

In a recent study, spiders in an experimental environment newly abundant in crickets (a large, difficult prey) somehow knew it was time to bulk up their webs from the gossamer ones they had been spinning for light, easy prey.

John B. Pinto

Now, I doubt that many spiders go to business or medical school. But it turns out that the common house spider is a pretty efficient operator, metering its hunting resources to its practical, professional needs.

Are you as efficient as a spider?

Take this simple five-point test reviewing the five most important practice resources you use every day to take care of patients: doctors, exam rooms, technicians, patient accounts staff and receptionists.

Doctors: Count up the number of patient visits (including postoperative visits) your entire practice sees in a typical month. Then divide this patient count by the number of doctor equivalents, or DEs. A DE is one physician working full time or two optometrists working full time.

Example:

Two surgeons and one optometrist, all working full time, are 2.5 DEs.

These doctors see 1,350 patients per month.

The 1,350 visits divided by 2.5 DEs equals 540 visits per doctor-equivalent per month.

Exam rooms: Count the number of fully equipped and active exam rooms in your practice. Multiply this number by 173 (the number of hours of operation in the typical practice). Divide the resulting figure into the number of total patients (including postops) seen in a month.

Example:

The above 1,350 patient per month practice has eight active exam rooms.

The 1,350 visits divided by 1,384 room-hours (eight rooms 3 173 hours) equals 1.0 patient visit per room-hour.

Technicians: Count up the number of technician full-time equivalents (FTEs) in your practice. (An FTE is one staffer working 40 hours per week. Someone working 20 hours per week would be 0.5 FTE.) Count as “techs” anyone who is rooming and working up patients, assisting chairside or performing special testing. Multiply the resulting FTE count by 173 (the number of paid payroll hours in the typical month) and divide the resulting number by the number of patient visits per month.

Example:

The above 1,350 patient per month practice has 6.5 tech FTEs.

The 1,125 tech-hours (6.5 FTEs 3 173 hours) divided by 1,350 visits equals 0.8 tech payroll hour per patient visit.

Patient accounts staff: Count up the number of billing staff FTEs in your practice. Count as “billing” anyone who is securing authorization, posting charges, submitting claims, posting payments, chasing denials, submitting secondary claims, handling collections and all of the other myriad details that go with this tangled labyrinth in your practice. Multiply the resulting FTE count by 173 and divide the resulting figure by the number of total monthly transactions (for ease, typically the patient visits plus the surgical cases).

Example:

The 433 billing staff hours (2.5 FTEs 3 173 hours) divided by 1,420 transactions (1,350 visits plus 70 surgeries) equals 0.3 billing staff payroll hour per transaction.

The above 1,350 visit (and let’s say 70 cataract) practice has 2.5 billing staff FTEs.

Reception/clerical staff: Count up the number of clerical staff FTEs in your practice. Include anyone who is checking patients in or out, handling the phone lines or keeping the medical records tidy. Exclude personal secretaries and transcriptionists. Multiply the resulting FTE count by 173 and divide the resulting number by the number of total monthly patient visits.

Example:

The 1,350 visit practice above has 3.0 reception staff FTEs.

The 519 billing reception hours (3.0 FTEs 3 173 hours) divided by 1,350 visits equals 0.4 reception/clerical staff payroll hour per transaction.

Results

Your results as an efficient, productive general ophthalmologist should be roughly in line with the above sample practice, with:

Five hundred or more patient visits per doctor equivalent per month;

Between 0.7 and 1.1 patient visits per exam room per hour;

Between 0.6 and 1.0 tech payroll hours per patient visit;

Plus-or-minus 0.3 billing staff payroll hours per transaction; and

Between 0.3 and 0.5 receptionist payroll hours per patient visit.

Managing challenges

As New York Times columnist Paul Krugman wrote in his book, The Age of Diminished Expectations, “Productivity isn’t everything, but in the long-run, it is almost everything.” If yours is the kind of practice lulled by decades of easy times into high resource utilization, low intensity and low output, realize that you have now entered an entirely new watershed era that demands a change in efficiency and a significant boost in production with any given set of resources.

Even if the “Great Recession” has not yet reduced your patient volumes and average revenue yield per encounter, do not let down your guard. The productivity challenges now waiting in line at your office door are getting longer by the quarter: slated 2010 Medicare allowable fee reductions; President Barack Obama’s promised systemic health care reform; and just when the recession reverses, a likely rise in inflation and staff wage expectations.

In military circles, generals speak colorfully of the “tooth-to-tail” ratio. In other words, how much “tail” (support clerks, equipment, supply lines, fuel, etc.) does it take to support the “tooth” (the front-line soldiers)? As a surgeon, you are the front line of your practice army. In today’s more constrained financial environment, winning the daily office battle obliges hard work and a right-sized tail.

John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees, The Women of Ophthalmology and the new book, Legal Issues in Ophthalmology: A Review for Surgeons and Administrators. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; Web site: www.pintoinc.com.