As an independent eye care practice, it’s easy to feel a bit left behind in today’s rapidly changing healthcare market—to feel like the government, consolidating health systems, and payers are conspiring against you. It’s also all too easy to get complacent and stuck in your ways, relying on old beliefs that just may not be true. After all, as a physician, you’re used to being, well…right. Right?
But it’s a mistake to feel like you’re at the mercy of your environment. The beginning of a new year is a great time to examine your closely held assumptions and look at things from a new perspective—one that opens new avenues to profitability that you didn’t know you had. First, let’s get the tough stuff out of the way and talk about MIPS. Is your practice ready? (Hint: look at MIPS as an opportunity, not a burden)
Myth #1: You can ignore MIPS again this year.
Reality Check: In 2017, you could “pick your own pace” for participating in MACRA’s MIPS reporting program, but that’s changed. 2018 was still technically a transition year, but in 2019, “it’s going to be tougher,” says Mike Schmidt, director of client certification and success at Eye Care Leaders. How to succeed in MIPS is beyond the scope of this article, but here’s a quick rundown of a few updates:
- The minimum performance threshold will increase from the current 15 points to 30 points. If your MIPS final score falls below 30 points, you will see the maximum negative payment adjustment on your claims in 2021.
- Doing really, really well in MIPS will also get more difficult in 2019. The exceptional performance threshold will increase from 70 to 75 points. The maximum bonus incentive for those high performers is also increasing.
- While you still must report the same number of practice improvement, there will be more to choose from in 2019. CMS added several new improvement activities, including “IA_AHE_7 Comprehensive Eye Exams.”
Myth #2: You can depend on your registry to succeed with MIPS.
Reality Check: Qualified Clinical Data Registries (QCDRs) like IRIS® and AOA MORE make quality reporting easier, especially if they play nice with your EHR. But if you think you can rely on them to reap the maximum MIPS bonuses and avoid penalties, you’re wrong. “We encourage you to use a registry that is electronically integrated with your EHR to earn the bonus points for electronic reporting,” recommends Schmidt, but “they really can’t be counted on to own your practice’s overall MIPS success,” he warns.
Registries assist you with MIPS so they can capture and aggregate your raw quality data, Schmidt explains. They are functioning with this goal in mind, so while they do ease your reporting burden, don’t look to them for every answer. “There are individuals [with the registries] that are really fantastic that work with practices, but really their mission for their company is not to ensure your practices success. It’s to run their registry,” asserts Schmidt.
And in today’s scary cybersecurity climate, you should plan for the worst, according to Kevin Corcoran, a presenter at 2017’s AAO conference. “If the IRIS® registry goes down, where does that leave you?” he posits. Most practices don’t have “plan B,” he notes.
Now that we have MIPS covered, are you ready for some lighter fare? We’ve got that too, so keep reading…
Myth #3: The busier, the better.
Reality Check: Many doctors judge their success by how full their schedule is—or isn’t. “One of the biggest distress calls that we get as consultants is ‘my schedule is so empty!’ They [doctors] are pretty sure the world is ending,” say Gary Gerber, OD, and Bethany Fishbein, OD, who spoke to optometrists about business assumptions at 2017’s Vision Expo West. Sure, you might be rushing around like a madman (or woman), but if those patients aren’t spending any money, what’s the point? Gerber and Fishbein ask.
Plus, if your practice is booked out for weeks and weeks, you could actually be losing patients who go elsewhere for quicker service. Start by calculating your fill rate: the number of exams you do divided by the number of appointments available. The ideal fill rate is 90 percent.
And if you think you just need to work more hours to get more patients, that’s not necessarily true, either. Gerber and Fishbein routinely hear independent physician-owners say things like “We had a really terrible September so I’m going to open more hours next month.” This is usually mistake, they say. There are practices where this works—those driven by walk-in traffic. But for the rest, there are only so many patients who are going to call, and being open more hours is not going to change that. Instead, think about whether you could decrease your hours, see the same number of patients, and do something else with the rest of the hours. Gerber and Fishbein suggest using them as focused management time.
Myth #4: Potential patients visit your website to find out about your practice.
Reality Check: Potential patients are looking for information, just not information about you—yet, according to Jim Flynn, a certified Brand Strategist who spoke about online marketing at AAO2017. Early in the decision process, when a patient is thinking about whether they should get contact lenses, LASIK, or some other product or service, they are simply searching for answers to their problems. For your website to be truly effective, you want to be the one that provides those answers, Flynn says.
A truly effective website—one that coverts potential patients to paying ones—provides content on your site that addresses patients’ common questions and concerns. “A lot of sites tend to talk about themselves too much,” Flynn notes. “The stuff about you is a little bit further down the line when they are starting to make decision between two or three providers.”
Wondering what information to feature? Flynn suggests starting simple. “People don’t know the distinction between the ophthalmologist and the OD,” he says. Explain it, then “take that way downstream and teach about specialties and subspecialties.” He also suggests thinking about general content categories that you can easily adapt to many different topics:
- Explanations of cost or price (you don’t need to be specific but you can give ranges)
- Problems and pitfalls
- Comparing and contrasting procedures (LASIK vs. PRK or belpharoplasty vs. a blow lift, for example)
- Ultimate guides (“I Have AMD…now what?” Or “Your Ultimate Guide to Contact Lenses)
Myth #5: When a patient is happy, it means they don’t want to change.
Reality Check: Don’t give patients the same thing over and over when there is something better available. Whether it’s dry eye medication or new contact lens technology, “if there is something better out there, you owe it to your patients to tell them,” Fishbein says.
To get her point across, Fishbein conjures images of the latest iPhone release: All those people lining up the night before, they all already have iPhones. They’re happy with their iPhones. But they still want to buy the newest, best one. How much money would Apple lose if they stopped creating new iPhones because everyone is fine with what they already have?
Tip: Even if your patient is happy, dig deeper. Fishbein recommends asking probing questions like “What could make your contacts better? Not having to clean them? Not having to take them out?”
As the physician, you need to make sure you’re on board with change, too. “It’s amazing to me the number of eye doctors, ophthalmologists more often, who say ‘there’s not much change from last year so don’t worry about changing prescriptions,’” says Kevin Harrison, an optician who spoke at Vision Expo West. “They don’t remember that they said that the time before, and the time before, and now [the patient] want[s] new frames and it’s a diopter of change.” It would have been easier for the patient to adapt visually, not to mention more profitable for the practice, if those small changes were made over the years.
Myth #6: Online eyewear sales will eventually ruin your business.
Reality Check: “Today’s challenges are not unique,” says Barry Santini, ABOM, who spoke at Vision Expo West about confronting the threat of online eyewear sales. “Is there really a difference between local competition and online [competition]?” he asks. “People will always need glasses, but they might not need them from you.”
In order to build your practice in the face of fast, cheap online purveyors, traditional eye care providers need to let go of a few assumptions, according to Santini. Among the worst offenders:
- “Online stores are stealing our patients!” “When [patients] buy elsewhere, are they really lost?” he posits. “They can return to be your best customers.” If they choose online eyewear wisely, they might only need a small adjustment and they’ll save money, Santini explains. If they choose poorly, it might end up costing them more. Either way, make it a point to let the patient know that you are there for them.
- “We have to convince our patients not to go online.” Think of it in a way where you’re not trying to control the patient anymore, recommends Santini. “We like to control. You think Essilor and Luxxotica like to control, but your mom and pop optical likes to control too.” If a patient brings up buying online, don’t try to deter them. “I don’t get emotional and neither should you,” he says. He likes to tell those patients something like “we’ll be here for you when you’re ready.”
- “We could never compete on price.” Ok, so this one is partially true. But that’s because online retailers are giving patients only a fraction of the service they’d receive at your practice. Tell patients “Of course online has to be less expensive,” Santini advises. “Then tell them all the things they [online retailers] aren’t doing.”
Myth #7: Your front office and back office will never get along.
Reality Check: Sam from the front desk forgets to double check a patient’s demographics, so the claim gets denied and Sally in billing has to deal with it. Your tech Jane escorts a just-seen patient to the front desk and says “Mrs. Jones is ready to schedule her follow-up.” But when your scheduler opens Mrs. Jones’ file, there’s no treatment plan there and no indication of what that next appointment should be. Sound familiar?
Front office/back office tension is common in many eye care practices, but that doesn’t mean you must accept the drama. These issues can stem from personality differences, but more frequently it has to do with how staff from one area in your office perceives how staff in another area are performing on the job. One remedy that will help both your employees and your practice? Cross training.
“Cross training in a small practice [is] important because if someone calls off, there aren’t a lot of other options for covering that position and maintaining productivity throughout the day,” says Natalie Loyacano, COMT, ROUB, OCS, who spoke to practice administrators at AAO2017. But a lesser-known benefit is that it can help create bonds—or at least an understanding—among staff members. When cross-training staff on tasks normally performed by a different position, be sure to explain why those tasks are important, Loyacano says. That helps give staff a new (and sincere) appreciation for the job duties they may have previously discounted as “easy” or “unimportant.”