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Analyzing the ophthalmic practice goes beyond objective measures
Subjective analytics, turned into objective ones, can be useful when evaluating the business aspects of your practice.
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“With me, everything turns into mathematics.”
– Rene Descartes
In 1900, Lord William Thomson Kelvin, the great Scottish mathematician and physicist, addressed the British Association for the Advancement of Science and stated, “There is nothing new to be discovered in physics. All that remains is more and more precise measurement.”
Lord Kelvin also said, “When you can measure what you are talking about and express it in numbers, you know something about it.”
He was as spectacularly wrong on the first count as he was spot-on in his observation that measurement begets understanding.
This applies as much in high-level physics today as it does in your progressively more difficult labors to run an efficient, effective ophthalmic practice-business.
Analyzing your practice
Much in the business of medicine is perfectly calculable.
With your core practice management system — no matter how cludgy — you can track service counts, patient visits, collections, no-shows, denial rates and scores of derivative benchmarks, such as the average collections yielded by a single visit, your practice’s comparative surgical density and your surgeon’s assertiveness in special testing.
If you are one of the growing numbers of practices with more advanced systems augmented with electronic medical records, you can perform regression analysis on the impact of various treatments and surgical approaches in your hands.
Meanwhile, your bookkeeper and accountant should be able to generate and interpret all of the key performance ratios signaling your practice’s business health: profit margins, various cost ratios, capital reserves and the like.
But there is another class of analytics available, something you are very familiar with as a physician but are probably not using as a business owner.
There is not a lot of pain treatment associated with ophthalmology, but from your training days you will recall how internists and nurses commonly ask their patients, “On a one to 10 scale, where one is low and 10 is high, what is your current level of pain?”
This is a brilliant question that helps to get around the fact that a “pain meter” does not yet exist. So, physicians and nurses have to resort to asking their patients how they feel. But rather than asking a question that will yield a mushy answer like, “It hurts a lot,” doctors ask in a way that gives a progressive score. One patient’s nine may be another’s six, but asking for a number, especially over time, communicates relative progress, expectations and accountability.
Let us apply this familiar and useful verbal medical contrivance to the business side of your practice in three different dimensions.
Staff performance
More than 3 decades ago when I started in this business, I would ask a doctor client, “What’s your impression of your staff?” That simple question would often lead to hours of narrative, peppered with words like “dreadful,” “spectacular” or “overworked.” Later, I learned a simple expedient to help doctors get to the point faster and more clearly. I would simply ask three focused questions about each staff member:
- What is Dave’s current global performance score on a one to 10 scale? (Like a patient’s pain score, right?) This would include everything from timeliness and co-worker relations to job knowledge, customer service and the like.
- What is his potential score?
- What must be done to help this person reach his potential score?
The result in your setting may look something like the example in Table 1.
Vendor performance
The same one to 10 scale can be used to perform an annual evaluation for the key vendors serving your practice. Make up a grid like the one in Table 2, and enter your principle outside vendors in the first column. In the second column, write down their global score. Is pricing fair? Is the service timely? Do they follow through on their promises? In the last column, write down the next action you are going to take.
Just as vision comes in plus, minus and plano, your vendors probably fall into similar categories: vendors you want to hold onto forever, vendors who need to improve soon or be terminated, and vendors between these two extremes.
When you make up a grid like this, it may look something like the example in Table 2.
Rating your current computer system
When I ask front-line ophthalmic workers what they think of their current practice management or electronic health records system, they can respond in a number of ways. Some respond non-verbally with a sour face or a wide smile and a thumbs-up. Others, especially those who are detail-oriented, will go on for several minutes outlining selected strong and weak points, but no overall rating.
As a consultant, neither of these responses is terribly useful. So, a long time ago, I started asking in a different way:
- If your computer system was a student, and you were the teacher, what letter grade (eg, A-minus, B-plus, etc) would you give out?
- What would your current system (or its vendor) need to do differently to deserve a higher grade?
- What is the minimum acceptable grade an IT system must earn in this practice to remain and not be replaced by something better?
Questions like this, which make the responder nominate and commit to a specific, narrow score, are part of the inner game of ophthalmology. Whether you pose these objective questions one-on-one or use them to stimulate a group discussion, communication will improve, staff reports will be more precise and your people will be more accountable for agreed-upon outcomes.