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What Burning Man taught me about ophthalmic practice management
Focusing on 'matter out of place' can help clean up all aspects of your practice.
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“[Burning Man] is like a cross between Vatican ceremony, Cirque du Soleil and a necro-erotic cannibal mantis mating ritual.” Bruce Sterling
“Human beings are flawed and complicated and messy.” Brit Marling
“I like messy. What fun is tidy?” Dasha Zhukova
Burning Man, an annual, temporary flash city of 70,000 splendidly artistic, variously intoxicated, citizens is coming to a fiery climax on a dry lakebed east of Reno, Nevada, as this column goes to press.
Burning Man has grown up. There were only 25,000 of us 14 years ago, the first and only time I attended with a couple of ophthalmologist pals, John Corboy and David Schneider, now both happily retired. It was a fun field trip to explore alternate realities, with just enough practice business discussion on the side to make our tax advisers happy. We were the three squarest attendees, except maybe Corboy, who was never quite able to find his pants.
After 3 days of desert camping, somehow managing my contact-lens-over-RK-incision hygiene with talcum-fine sand swirling, they lit off an articulating 80-foot wooden man standing atop a pyramid filled with 1,000 gallons of propane and $150,000 of fireworks. And then we all went home.
The most important concept I learned at this (ahem) CE meeting was “MOOP,” short for “matter out of place.”
Because of restrictions put on this annual bacchanalia by the Bureau of Land Management, the organizers of Burning Man are obliged after the festival to remove every trace of MOOP. So for weeks, staff and volunteers stick around to pick up cinders and gum wrappers and abandoned bicycles and haul it all away.
While physics has a more elegant name for it — “entropy” — MOOP lends a more evocative, yeasty grip on the concept of practice messiness. MOOP is also a lot more fun to say out loud during your next staff meeting.
MOOP is not just a messy hallway or cigarette butts in the parking lot. MOOP takes many forms:
- Misplaced staff. This can be excess staff or departments that are not equally balanced with enough labor to handle patient loads, or staff whose core skills are not aligned with their job duties (eg, a gruff but excellent biller who has been assigned to fill in at the front desk).
- Unproductive satellite offices, which can rob profits. A practice with two offices is four times as complex as one with a single location. By measuring the net profit per doctor-hour in each of your locations, you will quickly identify any targets for closure.
- Tests and procedures that are no longer effective or profitable. Every surgeon loses time and money over the course of a long career learning unfruitful techniques and buying equipment you will never use; some of this is inevitable, especially in the early years of your career, but use your experience to be more critical in the future.
- Money that is located in the bank accounts of patients, the federal government or insurance companies, instead of your practice’s account, because staff are behind in billing.
- Misplaced thrift, which can rebound into costly practice failure when marketing is cut back, continuing education meetings are skipped or staff training is neglected.
MOOP test
Here is a 10-point MOOP test to score your practice. Apply the following points for each item:
2 points: “This describes our practice.”
1 point: “We try but fall short on this.”
0 points: “This really does not describe us.”
1. _ Our board, lead doctor and administrator are aligned on our standards of appearance and operations; most of these standards are in writing.
2. _ Our facilities look a little fresher and better kept each year; we stay ahead of routine maintenance, make repairs as soon as possible and make frequent upgrades.
3. _ We use benchmarks to make sure we employ the right number of support staff (eg, in general ophthalmology, we generally employ 2.5 staff hours per patient visit).
4. _ Staff do not freelance how they do their job; they follow written protocols, which, in turn, are reviewed and updated frequently to improve efficiency.
5. _ We collect, on time, from patients and payers all of the money that is reasonably owned to us; we do not tolerate excessive open accounts.
6. _ We only buy medical equipment when it is needed to keep up with community standards, enhance patient care or improve financial performance; we do not make purchases on a whim.
7. _ When a patient lodges a reasonable complaint, it is not ignored; it is used to improve the level of service for all of our patients.
8. _ Our providers are kept appropriately busy; we do not waste their time with empty appointment slots, nor do we overwhelm them with excess patients.
9. _ We formally review all external vendors at least annually; we praise great ones, encourage good ones to improve and replace weak ones.
10. _ We continuously review our “internal vendors” — our support staff — and replace weak links without hesitation.
How did you score? Very few practices will get a perfect score. Our average client who is trying hard to improve comes in at around 14 points. Gather the leaders of your practice, take this quick test, discover your consensus score and agree as a group on where you would like the score to be in 3 months.
Closing with the four rules of MOOP
1. Practice growth (and especially anything above an 8% per year growth in patient visits, about twice the national average) leads to extra MOOP. You have to apply greater anti-MOOP vigilance if your practice is thriving than if it is just growing slowly.
2. MOOP thrives on the tolerance and leniency of doctors and staff who overlook things out of place. Use the concepts in this month’s column to immunize yourself against MOOP passivity. Make it a game to find one thing out of place in your practice every day, and then fix that thing.
3. Your administrator and mid-level managers are your practice’s anti-MOOP squad. Make sure they are just as sensitized to MOOP as the practice owners.
4. MOOP is not just harmless office clutter. It is anything that is out of place that harms efficiency, profitability and customer service.
- For more information:
- John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. John 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, The Women of Ophthalmology, Legal Issues in Ophthalmology, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams and a new book, Simple: The Inner Game of Ophthalmic Practice Success. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.