Practice Management

Leadership Challenges I Met to Boost Annual Gross Revenue 20%

Dr. Marshall (center, front) with her staff. She says that staff training that keeps employees engaged in the performance of the practice offers a huge boost to employee engagement, better service for patients and greater practice profitability.

By Jessica Marshall, OD

April 13, 2022

The leadership challenges you face can spur your practice to greatness–if you take the right approach to meeting those challenges. Here are a few challenges I showed leadership to successfully meet, and how the improvements we enacted enhanced patient care and profitability.

Motivating Staff to Be More Involved in Increasing the Practice’s Profitability
In my initial years in practice I was afraid to be open with staff about finances. I thought my employees would quit if they thought the practice wasn’t financially strong. To prevent this, I always acted as if all was OK with cash flow and other financial metrics. The end result was a disconnect between myself and my staff. I was always pressing for more patients, larger sales, more testing and other markers of growth. And while my staff were great about this, they started to feel like I was overworking them just to make more money for myself. In actuality, I was often just trying to ensure that we had enough cash to cover all the practice’s bills that month.

I found that involving my staff more with financials, business decisions, equipment purchases and other financial realities created a team spirit. This team spirit can be felt by patients. They can tell my guys are fully invested in their experience in our office.

Having a staff that is involved in profitability has improved nearly all of my practice’s metrics. For example, our Optos capture rate has increased, as has our eyewear capture rate.

To increase employee engagement in the business, I sought out help from Profit First, an optometry-specific program, and the Great Game of Business. These programs get employees involved by having each track a specific metric and present progress of that metric to the rest of the practice. I started having weekly meetings just to discuss what works and what doesn’t, and I added a profit-based bonus structure.

My staff members are now happy to take the time to make sure we have medical and vision insurance on file for all patients, so I can bill ancillary testing appropriately. Prior to our regular staff meetings, many patients would only have vision benefits pulled before the exam because it was easier for staff. In addition, my technicians are no longer forgetting to ask about Optos, which used to be an issue for us. We also decided as a team to streamline our contact lens pricing and use price sheets that easily display why annual supplies make more sense financially for patients.

After initiating the weekly meetings, bonus structure and better communication, our gross revenue increased by just under 20 percent from the previous year with no additional staffing cost.

Don’t be afraid to be vulnerable with your staff and discuss with them where you are feeling stress in the practice. They often have more insights into patient flow, and other aspects of the patient experience, than you do.

Developing Consistent Patient Care Processes & Procedures
Prior to being in private practice I had a sublease for 11 years that was open seven days per week. I would have different associates and fill-ins working throughout the week. As we all know, every OD brings their own set of experiences into the exam room with them that dictates how they provide care. The challenge this created in my office was that patients would receive different levels of care depending on which doctor was working. We ended up with gaps in care between different providers.

I invested heavily in advanced equipment to provide the highest level of care to patients. Having doctors unsure of how to use equipment, or having doctors using it without billing for it, was always a struggle for us. Some patients would wonder why their spouse got a test, but they didn’t. Or they would wonder why they have to pay for a test this time, but last time they didn’t. This inconsistency creates a lower-quality patient experience and hurts the practice financially, as under-billing or under-utilization of technology leads to lower reimbursements.

What I learned from years of running into this problem was that my current practice needed to have its own guidelines and training programs for doctors and staff to work together. I now train associates for 2-3 days before letting them work alone with patients. I also have written guidelines for staff, and e-mail them training materials on equipment. I review how to use and bill for equipment. I pay them for this training at the normal hourly rate. I also involve all associate ODs in our regular office meetings.

In addition to paying for new staff members’ training time, it cut into my time off. To make the training on instrumentation and billing more efficient, I am considering creating training videos.

It’s important to understand how each of your practice partners and associates approaches patient care. Are they timid, do they over-test, under-test? Track their equipment utilization and the number of diagnoses each makes. You may find that Doctor A loves glaucoma, Doctor B loves dry eye and Doctor C is an AMD person. Creating an atmosphere where internal referrals can be made is a great revenue booster and ensures consistency of care.

My associate doctor refers any patient who fails dark adaption testing to me because she knows that one of my passions is treating AMD. She sees about 30-35 patients per week. On average, I get 4-5 referrals per week from her. That’s an exam, dark adaptation, photos or OCT depending on the patient’s needs. That adds up to over 200 AMD patients per year requiring additional testing, totaling around $40,000 more per year.

Hiring the Right Person for the Job
Over the years I had employees who were hired as one thing, often for the front desk, and then ended up better suited for something else. I struggled to figure out what to do. At one point I had five great techs and only one front-desk employee.

Patient experience and care falls apart if one link in the chain is broken. Having a bad front-desk employee can cause patients to get annoyed because the employee doesn’t understand the insurance. Having a poorly trained technician can cause patients to mistrust the test. Some people are just better suited for certain jobs than others. I’ve had difficulty identifying where each applicant would best serve our practice after nothing more than a job interview.

To meet this challenge, I devised a list of required skills for each position in our office. I then have potential new hires shadow the staff person in the position that they are applying for. The applicants are paid to do this over three days. I tell them upfront it’s part of the interview and not a guarantee of being hired. I found that when they see the job done for a few days they are better able to understand what the job requires. I’m also able to watch them to see if I think they will be a good fit.

This new hiring system is working well for us. I have a great team at the moment! Patients always comment on how well-trained and efficient we are.

We saw about 600 new patients last year, the majority ( about 68 percent) of those patients report that they found us either on Google, based on our strong reviews, or via a patient referral.

Train your people well— put them in positions where they can excel. Your employees have a huge impact on the business. I’ve had many of my team for over 10 years.

Jessica Marshall, OD, is the owner of Marshall EyeCare in Aberdeen, N.J. To contact her: jessmarshall12@gmail.com 

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