Practice Management

7 Things to Do to See More Patients Per Day

By Casey Packer, OD

Nov. 1, 2017

As doctors, we strive to provide superior patient care, but we also want to be as efficient as possible, so we can build our profitability. Over the last seven years I have been in practice, I have made improvements to see more patients, and it’s paid off. I’m more available as a doctor, and I have greater revenues coming into the practice.

Over this ramp-up period, a number of critical decisions and practice improvements have driven up the number of patients exams conducted each day. Many of these steps, which are listed below, increased efficiencies to ensure that not only do we see more patients and increase gross revenues, we increase our net revenues, as well.

In my solo practice, I started out seeing one patient every 30 minutes, like most optometrists start. Our patient flow initially was so slow that it didn’t make sense to schedule people every 15 minutes. Once our patient base increased to the point where my daily schedule was completely booked I started to evaluate each step in the exam process to see where we could increase efficiency to see patients every 15 minutes.

I do a comprehensive exam every 30 minutes, and then any other visit filling in the time gaps between those. So, we only schedule appointments on the hour, or half-hour, spots. The reason we do it this way is because we only have two exam lanes. If all the comprehensive exam spots are full for the day, then we will still schedule more exams on 15-after-the-hour, or 45-after-the-hour, spots for the day, but we fill the appropriately spaced out spots first.

I plan to move my office to a space with greater square footage in the next couple of years, and when that happens, I will expand my exam lanes, and will be able to see any kind of patient every 15 minutes.

Along with a desire to better accommodate and serve patients, seeing more patients per day pays off financially. The year that we went from seeing patients every 30 minutes to every 15 minutes we increased our overall annual revenue by 2.4 times.

I am careful to preserve the quality of the exam as I make improvements to efficiency. I know of doctors who see patients every 10 minutes, or even every five minutes. I personally prefer not to practice that way. I find our profession more satisfying when I can develop a relationship with people and truly understand their ocular needs.

Our practice management software, Crystal PM, allows us to track the time someone signs in/out. From that information I can track how long it takes a patient to be ready for the doctor. I track this, and provide real-time feedback to staff when patients take longer than 20 minutes for check-in and pre-testing. I’ll then ask the technician why it might have taken longer, and then talk about strategies to more efficiently perform testing. This is phrased in a constructive, rather than demeaning, way, and that’s important to working together to become more efficient.

Streamline Check-In
We streamlined the check-in process first. Most of the time our patients don’t get a chance to even sit down in our waiting room because our goal is to get them started with pre-testing before that happens. We utilize an iPad for check-in that captures name, reason for visit and the signature for our HIPAA agreement. By cutting out paperwork you can get patients started faster.

Use Scribes to Take Patient History
Like doctors using dictation services to speed up their charting, we utilize our technicians as scribes to take down patient history. In the exam room they verbally go through the medical history, review of symptoms, and then explain the exam process to the patient, and take down notes as I conduct the exam.

Rearrange Exam Order as Needed
Proper scheduling to eliminate bottlenecks in your office is key. We will switch around the order of the exam process to better suit the scenario. If we have two full exams arrive at the same time, we’ll start one in the pre-testing area, and the other will be taken into another room for history, chief complaint and any other testing we can do. Then, after the pre-testing area opens, we’ll hopefully be done with all the exam room testing, and we can transition the patient back to that area to finish up the pre-testing workup.

Delegate
My support staff performs all the normal pre-testing (topography, AR, retinal imaging, special testing if necessary), they set the phoropter to the parameters, they pull up all imaging on the computer, so that when I get in the room everything is ready to go, and there is no lag for loading images. In addition, I will often hand off the parts of the contact lens portion of the exam. All my staff are trained to support my contact lens fittings, even hybrid fittings.

Manage Late Patients
We have a 15-minute policy where if a patient is over 15 minutes late then we reschedule them. We call them at the 15-minute mark to reschedule them, and prevent them from making the trip to our office only to be told they’re too late. If our schedule allows, then we will fit them in that day, but they will be put behind every other patient scheduled.

Make Every Computer a Check-Out “Desk”
Some practices still have just one credit card processing machine, which blows my mind. We have USB magnetic strip scanners on every computer, so that our cloud-based credit card processing system makes every computer a check-out location.

Keep in Mind Further Improvements
No matter how efficient you are, you usually can do even better. Getting a third exam lane in our new office is the goal. With that we might be considering a second pre-testing lane. If you pay attention to your practice, it’s easy to see where the bottlenecks are, and how you can work to make each patient visit a speedier, more pleasant experience.

 

Casey Packer, OD, is a certified optometric glaucoma specialist and therapeutic optometrist, and owner of Lone Star Eye, in Austin, Texas. To contact him: docpacker@gmail.com

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