Measuring, interpreting and improving your practice’s surgical density
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“Formal education will make you a living; self-education will make you a fortune.”
– Jim Rohn
“I’ve failed over and over and over again in my life. And that is why I succeed.”
– Michael Jordan
A calorie-rich diet will put on pounds. A surgically rich practice will do the same for your bank account. Consider two practices:
Practice A serves 1,000 patient visits a month and transits the quite average 40 cataract surgeries. In this practice, there are the typical 25 visits per surgery, and the net revenue collected per visit comes to an also quite average $200.
Practice B serves the same number of visits but is twice as surgically dense, with 80 cataract surgeries per month. (There can be several reasons for this practice’s improved surgical density: a more assertive surgeon, an older patient base, a lack of competition or a bias toward optometric referrals.) Because there is more surgery, the net revenue per visit is going to be higher — around $250 would be expected.
But in both anterior segment practices, the cost to serve one patient visit is about the same. In the U.S. today, that’s around $150.
So, Practice A’s net profit in a month is ($200 – $150) × 1,000 patients = $50,000.
And Practice B’s net profit is ($250 – $150) × 1,000 patients = $100,000.
It is for this reason, and a lot of other professional satisfaction factors, of course, that many surgeons want to do more surgery and spend less time in the clinic. There are a number of things you can do to increase your surgical yield, but none is more important than starting to simply measure the baseline historic surgical density of your practice.
The math in this month’s column is easy. With it, you can assess your own individual surgical density or assess the surgical yield in your overall practice if you work in a group setting. Pick a reasonable time frame of at least a full calendar quarter, which will yield a more meaningful average.
You only need two figures, each for the same time frame:
- The total number of patient encounters (all paying new and established patient exams, as well as unpaid postoperative visits, surgical consultations and minor procedure visits).
- The total number of major surgical cases in your practice. Note that what you include in “major” is up to you. In a general setting, this is usually just cataract surgery, but it can also include LASIK surgery, plastics or other procedures provided in your setting. The key is to be internally consistent with what you include as you measure this benchmark over time.
Let’s look at an example using these two numbers. Imagine a solo practice with an average of 500 patient visits per month and 25 major surgical cases. The surgical yield would be 500/25 = 20 patient visits per case — a pretty favorable number. Said another way, this doctor generates a major surgical case for every 20 patient visits.
The upper and lower normal limits for a general ophthalmology practice can be rather wide, from around 10 to 50 patient visits per surgical case. In the typical cataract practice we consult with, the range can skew a bit lower, as few as four or five patient visits per case. In extremely young and old practices and in clinically conservative or managerially neglectful settings, the ratio is closer to 50 or even more patient visits for every major surgical case.
The same ratio can be used by subspecialists. Retina surgeons will typically see 40+ visits per surgical case. In plastics, the number is closer to five or fewer.
Obviously, the more comprehensive a provider you are, and the greater the diversity of surgical procedures you offer in your practice, the higher your surgical density is likely to be. Surgical density can be higher or lower for a number of other reasons:
- In an older, more established practice, the average age of patients is higher, and the cataract yield is thus elevated.
- Practices that actively market nearly always have an improved surgical density.
- Surgeons who actively comanage patient care with referring optometrists generally have the highest surgical yield.
- A highly experienced surgeon with a low complication rate will often perform surgery on borderline patients — patients a less experienced surgeon might pass up, refer or delay.
- Some surgeons, for absolutely appropriate philosophical reasons, will only provide surgical care when a patient’s case is well advanced or other options have been exhausted.
- Other surgeons lose cases because their rapport or communication skills with patients is poor, or their office is poorly organized. In any competitive environment, where your patients are being actively sought out by other colleagues in the community, you must have systems in place to transition good-but-hesitant clinical candidates into surgical patients. These deficits can usually be improved with a little outside coaching or by simply visiting higher-volume practices in noncompeting markets.
For a revealing look at the trends in your individual or group practice, graph the surgical density month by month over the past 12 or more months. Here is an example from one client setting (chart).
Notice in this example how the trend is toward a more favorable surgical yield over time. This resulted from three simple activities:
- A long-term recommitment to optometric outreach.
- A tightening of the practice’s recall policies so that surgical candidates were less likely to be lost to follow-up (which also improved YAG capsulotomy rates).
- Supplemental training for the practice’s surgical counselors (which also elevated the premium IOL rates in the practice).
Monitoring the surgical density of your unique setting and circumstances, whether you compare yourself to external benchmarks or your own internal standards, can be one of the most interesting and useful gauges to put on the “dashboard” of your practice.
Surgical density tracking is a tool you can use to measure the progress of young physicians. It can help you communicate with your marketing staff about their contributions to the organization. And, most critically, this metric can be an early warning that your practice is heading for trouble.
- For more information:
- John B. Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the country’s most published author on ophthalmology management topics, including John Pinto’s Little Green Book of Ophthalmology: Strategies, Tips, and Pearls to Help You Grow and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance, and Career Satisfaction (with Corinne Wohl), Simple: The Inner Game of Ophthalmic Practice Success, and Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams. Available now for purchase at slackbooks.com. Receive 20% off with promo code PINTO20. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.
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