Finances

Streamline the Exam Process: Reduce Extraneous Testing to Save Time and Increase Appointments

By Scott Jens, OD

Eliminating tests that patients do not need can save time, allow you to schedule more exams, and increase revenues.

Optometry is rich in tradition and that includes very formatted examination sequences. The unfortunate outcome of following those protocols is that patient care is not focused on the individualized needs of the patient, and following routines of delivering tests dictated by an historical pattern puts the patient through unnecessarily long examinations.

By customizing care to the needs of each patient, my practice has improved the patient experience, as well as boosted revenues. Top-line revenues grew by over 10 percent at a time when we budgeted nearly half of that for the year.

Thinking about which testing can be reduced from standard annual examinations can enable you to see more patients per day, and more importantly, keep your patients happier and more comfortable. Rather than keeping patients waiting for testing they do not need, streamlining the testing process will allow you to improve the flow of office visits and get patients out of your office–and on with their lives–much faster.

To get started in the streamlining process, I participated in the ODLean program sponsored by Vistakon’s Vision Care Institute in Jacksonville, Fla. It applies the principles of Six Sigma and Lean Management to optometric practice operations.

Implement More Customized Care

The largest change we made was to commit to delivering care that is very specific to the patient’s presenting “reason for visit.” We used the advice of specialized consultants from ODLean to eliminate testing that was in our exam flow if it met the criteria of “just because that is how we always do it.” The resulting change in the patient experience significantly reduced waiting time and improved door-to-door process time which was noticeable to our patients upon post-implementation surveying.

Waiting room at Isthmus Eye Care
….and in the exam room

We focused care on the needs of the patient, which resulted in more staggered timing of tests rather than elimination of tests altogether. For example, keratometry is a test that is very valuable when considering the cornea’s curvature for fitting of contact lenses and for analysis of the cornea’s optics, as unhealthy corneas can contribute to poor vision. For those reasons, this test is delivered to every new patient as well as periodically for contact lens wearers and cases of changing vision. But it is no longer performed at every annual or bi-annual exam, since the collection of this data in many cases is just repeating the collection of static information.

Another example is color vision testing. There are patients whose baseline color vision testing should be tested regularly such as those experiencing visual changes or medical conditions that could affect color vision capabilities. But there are many other patients who have had a baseline color vision test already and have no need for it to be tested again unless a new condition arises. By modifying our delivery of these two tests to an as-needed basis, we can calculate 90 seconds of reduced process time which for 30 patients a day is a lot of time. And there are many other examples of tests that can be delivered on an as-needed basis relative to the patient’s risks, conditions and concerns.

Economics of Streamlining Office Visits

To examine which testing was unnecessary and how to implement a new regimen for patient visits, we invested about $7,500 in ODLean consulting fees and expenses, and we spent about two days of staff preparation and training in order to get the metrics from a practice analysis that was used to develop the plan for implementing new processes.

Elimination of Testing = Happier Patients

Our most important finding has come from patient responses to our post-examination surveys that are e-mailed after an office visit. We are routinely getting feedback from patients that they can tell that our processes have been refined and that the flow of their examination was enhanced with minimal wait time. Some patients have even stated that they can tell that we are more attentive to their needs and that we are delivering a more personal level of care, even though we prided ourselves on personalized care in the past.

Providing targeted care to patients that delivers only those tests that will benefit each patient will speed up the flow of patients through your office and will improve the patient experience. You will be able to provide each patient only with those tests that best suit their needs.

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Scott Jens, OD, is the owner of Isthmus Eye Care, with offices in Middleton and Madison, Wis. In addition, Dr. Jens is the CEO of RevolutionEHR, a provider of online-based electronic health records. He can be reached at: sjens@revolutionehr.com.

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