Retina Tool: Strategic plans help retina practice

Editor's Note: Retina practices have experienced a transformation over the past several years, and our group practice was no different. My partners-Bill Tasman, MD, Bill Benson, MD, Gary Brown, MD, Arch McNamara, MD, Jim Vander, MD, Carl Regillo, MD, Mitch Fineman, MD, Rick Kaiser, MD-and I increased our patient volume to accommodate new treatments such as frequent intravitreal injections of ranibizumab and bevacizumab, added new office locations, and also realized that we needed to update many of our practice systems and operations. Our "mom-and-pop" organization had grown to include 60 employees across two states, with seven office locations. We started by calling a practice retreat where we could refine our practice mission and core values. Next we focused on the systems and tools that would allow us to provide the best patient care and provide the best working environment for our staff and physicians. As busy clinicians, we needed experienced consultants who not only would assess our practice and make recommendations but also would take us step by step to implement many of these significant practice changes. From this process, our new organization, Mid Atlantic Retina, was created. While patient care issues were directed by our physicians, Advantage Administration Inc. provided significant guidance in improving our operations.

-Allen C. Ho, MD

Amid adding partners, opening new offices, and managing unprecedented growth, Mid Atlantic Retina turned to a consulting firm (Advantage Administration Inc.) to develop a strategic plan for the ensuing years. An assessment of historic and current operations, as well as an interactive SWOT (strengths, weaknesses, opportunities, threats) analysis, revealed several opportunities to improve Mid Atlantic Retina's performance, both financially and otherwise.

Several of the identified opportunities were implemented: billing office redesign, information technology improvements, and a pay-for-performance program to increase staff productivity.

Problem: Billing

As a result of adding doctors and new locations throughout the preceding years, Mid Atlantic Retina's understaffed billing office was performing below industry benchmarks in the collection of insurance and patient receivables.

The proper steps for billing of services rendered were not being adhered to on a regular and consistent basis, and significant accounts receivables were being written off due to untimely filing deadlines.

Solutions:

Because of space limitations, the consulting firm first made recommendations for space planning changes resulting in the ability to accommodate additional workstations.

Once the business office was staffed properly according to national standards, each employee was trained on newly reassigned job functions and improved the processes and procedures to ensure timely filing and collection of all claims.

Protocols were immediately set in place with a goal of ensuring that all claims were filed daily, that payments were posted within 48 hours, and that all rejected explanations of benefits (EOB) were corrected and resubmitted with 72 hours.

While working on process improvement to ensure timely filing of forthcoming claims, roles and responsibilities of collecting outstanding accounts receivable were reorganized.

Problem: Old Practice Management System

Due to an antiquated practice management system, each additional office location required its own database, meaning that any additional information had to be added to each of the five different databases as opposed to making a single entry.

Additionally, an EOB could not be posted to one database, because payments for multiple locations were on one check, which required the billing staff to locate each patient in one of the five databases to post the payments.

Solutions:

A new practice management system was implemented that was capable of centralizing workflow, thereby improving productivity by allowing multiple staff members to access accounts simultaneously.

Individual tasks were streamlined through the implementation of computerized task lists for each individual while electronically tracking each user’s input, including deletions and changes.

The new practice management system allowed employees to work accounts directly from the user screen rather than wasting time with printing unnecessary paper reports.

From a patient perspective, the new practice management system offered easy-to-understand billing statements and an improved recall/wait list system that resulted in fewer calls to the practice and better patient service.

Problem: Employee Productivity

With so many employees in different locations, it became difficult to measure productivity and to ensure human resource compliance without a formal employee performance appraisal program.

Solutions:

A pay-for-performance program was implemented that was designed by Advantage to motivate employees to view their positions in the practice as careers, not jobs.

A career-ladder system was developed that included specific job descriptions for multiple levels of responsibility, ranging from entry level to level 4.

Each employee’s bonus and merit increase now is calculated based on the employee’s performance within his or her respective career-ladder level, and employees can move to the next levels in their careers-and subsequent pay increases-only once all the clearly defined roles and responsibilities of that level are mastered. As a result, in just 6 months, the average employee performance score increased significantly.