Training your staff to use high-tech equipment is a key to practice survival

Issue: September 1996

CHICAGO—The growth of fixed-fee vision programs coupled with the predicted increase in the number of presbyopes in the United States creates a dilemma for the optometrist: the opportunity to have more patients, but at reduced fees. The solution? Delegate tasks to your staff through instrumentation.

"There's no way optometrists can continue to spend 30 minutes per patient and continue to make the net profit they're currently making," said Richard S. Kattouf, OD. "The math just doesn't work out." Kattouf and Burt W. Dubow, OD, addressed this topic here at the EyeQuest meeting.

Kattouf, who heads a consulting business, said in the United States there are 70 million presbyopes and more people over 40 than ever before. He also said 9 out of 10 people older than 40 seek vision care, compared with only 5 out of 10 younger than 40. In 1990, one-third of the population participated in a vision care plan. By the year 2000, he anticipates that two-thirds will participate. The vast majority of the vision plans are and will be fixed fee.

In addition to being a skilled clinician, Kattouf said, today's optometrist must also be a businessperson and a sales person.

More patients, less profit?

mughshot --- Richard S. Kattouf, OD

"In most areas of the country we are seeing more patients," Kattouf said, "but every time we sign up for a fixed-fee program it carves out a lot of people, and we get more bodies in our offices, yet at a lesser profit. The technology aspect be comes important."

Delegating the tasks that come with this technology is the key to success in the managed care environment, he said. "We must go toward higher levels of delegation. Wherever you are, you need to go to another step," Kattouf said.

Instrumentation is only as good as the staff using it, Dubow added, "and it is important to find staff who fit into the philosophy of your practice," he said.

Dubow, who is in group practice in Minneapolis, recommended making staff teams and enabling them to make decisions, so you create an environment where the employees are competent and confident. You want your patients to leave feeling they have dealt with a competent technician. Staff members should complete an ophthalmologic technician or optometric assistant program, he recommended.

Having a properly trained staff "takes a lot of work," Dubow said. "It's not something you just put in place, and it works."

Delegate refraction

mugshot --- Burt W. Dubow, OD

One area of delegation is refraction, Kattouf said. "By having the technician refract with highly technical equipment such as the Marco Total Refractive System (TRS), it saves me at least 8 minutes a patient," Kattouf said. And he pointed out that the patient may spend less time with the doctor, but still spends the same amount of time in the clinic. Delegation need not curtail the doctor's personality.

The Marco TRS is designed for a technician, he said. The readings can be loaded into the refractor, and Marco offers a textbook and a 2-day training seminar. This programmable instrument makes the examination much quicker because the patient has fewer choices, Dubow said, adding that patients and observers are impressed.

"I feel like I'm giving the same care," Dubow said. Despite managed care, his revenues are up 20%.

Another area of delegation is contact lens checks, Kattouf said. In his practice, technicians do the checks, although they do not change lenses or check toric, bifocal or monovision contact lens patients. Checking lenses does not produce income, he said, "and ODs are getting eaten alive because there's no profit margin here."

Kattouf said he has seen ODs who spend 10-20 minutes on contact lens checks. "Get the highly skilled lens technician to do the acuity and the symptomatology, review the hygiene and the wearing time, do the biomicroscopy for movement and centration, and record it all. And then you be the diagnostician."

With contact lens software programs in the EyeSys corneal topographer, Kattouf said technicians can do everything, then come to the doctor with a lens recommendation.

"It takes a tremendous amount of design time away from us and gives it to the technician, but we still have the final word," Kattouf said. "Plus, it's very impressive to the patients."

More efficient equipment

Kattouf listed other equipment that can help ODs improve office efficiency.

Stereo Optical infant vision analyzer: This can measure the acuity of young patients as part of a pediatric evaluation.
Nikon hand-held autorefractor: "I was amazed at how accurate it is. It's very useful for children," he said.
Patternless edgers.
Videotaping: You can videotape patients in your optical department, another example of how to "upgrade things in fixed-fee programs," Kattouf said.
X-ray light boxes: These enable you to display color photos to demonstrate neovascularization, toxoplasmosis and central retinal vein occlusions.
Binocular indirect ophthalmoscopy with video support: "That's a lot of sizzle to the steak," Kattouf said. "It enables you to show pathologies and contact lens problems."
Optek's surfacing equipment.

In Kattouf's practice, he has turned his assistants into income producers through instrumentation. For example, he has a full-time developmental vision therapist who uses a computer orthoptics program and developmental software. Her department grosses $720 a day. He designs the program, but the therapist has her own schedule and does the one-on-one therapy.

Technicians must help educate patients, who are a "captive audience" in the office, Kattouf said. "Patients will see technicians using very complex, sophisticated equipment, but often technicians don't educate and motivate patients," he said. "You can spend hundreds of thousands of dollars, but if you don't have internal education, then it's just another piece of machinery to the consumer."

In exams, he said, you should always answer three questions: What you are doing? Why are you doing it? Why must this procedure be performed each year?

"A lot of decisions are market driven," Kattouf said. "You can increase your radius of draw by becoming more high tech and specialized."

For information about paraoptometric programs, call the American Optometric Association at 314-991-4100 and ask for the Paraoptometric Section.