By Eric Hammond, OD
May 1, 2019
When our practice moved into a larger office space two years ago, we knew we would need to rethink patient flow.
We had the capacity to see more patients, but we wanted the patient experience to remain high quality. We wanted to be efficient, but not rushed. Here’s how we did it.
Why Patient Flow Is Worth Your Attention
Improved patient flow doesn’t only aid the patient experience; it boosts profitability.
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With improved flow in a 2-3 doctor practice, conservatively, the practice would be able to see three more patients a day. Let’s use a conservative number of 240 work days. At an average $350/patient x 3 patients, that would $1,050 dollars per day for a yearly total of $252,000.
Studies show that getting a patient through the exam process quickly increases optical sales. It also gives the staff and doctors more time to discuss auxiliary procedures such as meibomian gland expression, supplements, multiple pairs and other products and services. And it also impresses the patient: “Wow, this place sure knows what they are doing!” “That was a fun experience!” Which then leads the patient to trusting their doctor’s recommendations, and having more time to shop in the optical, resulting in an increase in items purchased.
Greater Patient Capacity Comes with Challenges
One of our challenges in a bigger office is the increase in the number of appointments. We have up to five doctors working at the same time. That is five patients coming in at the same time for their appointment. This can create a backlog at the front desk when patients first arrive.
As technology advances, we have more to add to our preliminary diagnostic testing process (Optomap, OCT, Autorefractor, topography, HVF screening, just to name a few). This has increased preliminary diagnostic testing times from 10-15 minutes 10 years ago, to about 15-20 minutes for a full eye exam work up. If you are running multiple doctors, there are times that there is a bottleneck in the process with certain pieces of equipment if you only have one of each.
Having access to an exam room can be the most frustrating. There could be a tech or doctor finishing up with a patient, or a technician using an exam room for checking contact lenses. Your exam room is the most profitable room in the whole office (excluding optical). So, not having the ability to get patients in and out of there can be frustrating!
Add Technology to Reduce Waiting
For the check-in process, we try to keep it paperless for the patient as much as possible. Patients do not have five pages of history, medications, health problems and other details to fill out. The technician takes all their medical information in the history rooms. We also use the CQueue system for check-ins, which only takes a moment, and then the patient is free to relax or browse the optical as they wait for their appointment to begin. (Our average wait time before starting an exam is less than five minutes, our check-in process averages two minutes).
We also have shortened wait time in the pre-testing process. We duplicated a few of our testing instruments that were causing the most bottlenecks in our preliminary process. We have two Optomaps and two autorefractors, we also have two autolensometers and five iCare tonometers.
In addition, we have designated “history” rooms, where our techs can take history, check pressures, stereo and perform other tasks. It also helped that we taught the techs exactly what is necessary for a full eye exam in our state, Texas.
In Texas, we only need to get an objective Rx measurement (retinoscopy, AR, etc) on new patients. So, if all the autorefractors are taken, and the patient has had no complaints, vision is good, and they are an established patient, we have told techs they can skip additional measurements and just input the old prescription into the phoropter.
Do As Much As Possible Outside of Exam Rooms
We try to do everything we can outside of the exam rooms. Review of contact lenses, fees and insurance coverage is done in our large, open contact-lens area. We want to reduce the amount of time techs use our exam rooms. Like I said earlier, it is one of the best rooms to make money in. That room should be for doctor time as much as possible, and not tech time.
Refraction, Optos/dilation, review testing, slit lamp examination are done in the exam room, then get the patient the heck out of the exam room! There are only three ways to increase net income – increase the number of patients seen, increase dollars per patient, decrease expenses. Getting exam rooms open faster helps with the first one of the three ways to increase net income.
Cost of Making Patient Flow Improvements
The Cqueue system is approximately $400 for a year. Optomaps range between $65,000-$100,000 depending on the model. AutoRefractors range between $7,000-$40,000 depending on the bells and whistles.
Almost no training is required on the Cqueue system. There was some training and education for the techs on what is required for new comprehensive eye exams vs. established. There was some training and reinforcement needed to create habits on where to do contact lens review of care, explaining fees and insurance coverages, along with training on Optomaps and autofractors.
Innovate New Solutions
We have a drive-thru to facilitate patients picking up eyewear and contact lenses, and for quick services like eyewear adjustments. There is a sliding door for opticians to walk to the patient’s car to adjust glasses or to hand-deliver their contact lenses, and still have time to pet the family dog, or wave to the kid in the back seat.
There is a rubber strip in our parking lot that rings a bell inside our office when a car drives over it. We usually already have an employee near the drive-thru door, so like the rest of our patient experience, there is little waiting time.
Eric Hammond, OD, is an associate at Lakeline Vision Source in Cedar Park, Texas. To contact him: DrEric@lakelinevision.com