Productivity

How to create an ophthalmic Culture of Excellence

Maximizing efficiency gave our practice a boost. Here’s how.

Denise Fridl, COT, COE, OCS, and Robert E. Wiggins, Jr., MD

Robert Wiggins, Jr,. MD, MHA and Denise Fridl, COT, COE, OCS in an exam room.

Medical practices are facing several impending regulatory changes including constraints on reimbursement, new payment models which reward value in addition to volume, and numerous new programs such as PQRS and Meaningful Use Stage Two. Some of these changes will have significant and potentially disruptive impacts on ophthalmology practices. However, what many of the new initiatives have in common is a push to improve the quality and cost-effectiveness of medical care.

Three quality programs

Medical professionals can agree that improving quality and reducing costs are worthy goals, but putting these into practice requires a plan. What can the ophthalmology practice do to make improvements in these areas? At Asheville Eye Associates (AEA), we have used concepts from three different, but related, quality programs to help drive quality while improving efficiency and reducing costs.

1. Continuous quality improvement

“Continuous quality improvement (CQI)” is a program adapted to healthcare from industry, where it was referred to as “total quality management.” W. Edwards Deming, one of the pioneers in the manufacturing field in the last century, said, “when people and organizations focus primarily on quality, quality tends to increase and costs fall over time. When people and organizations focus primarily on costs, costs tend to rise and quality declines over time.” CQI focuses on quality improvement through a number of strategies including:

■ A focus on the patient.

■ Data-driven analysis.

■ Benchmarking.

■ Process improvement.

■ Continuous improvement wherein perfection is the final goal.

■ A Plan-Do-Check-Act method to accomplish continuous improvement.

Kandis Creson, COA, uses a tablet computer with a patient at Asheville Eye Associates in Asheville, North Carolina.PHOTOGRAPHY BY MATT ROSE

Above, Triage Technician Betty Matthews takes a call. At right, Melissa Pressley (standing) and Sandra Presley work the front desk at Asheville Eye Associates.

2. Lean healthcare

The second program AEA utilizes is “lean” healthcare. Lean management also has its roots in industry. It shares many of the concepts of CQI, although its primary focus is the elimination of waste. Eight types of waste have been described. They are:

■ Overproduction.

■ Inventory.

■ Wasted motion.

■ Waiting.

■ Transportation.

■ Overprocessing.

■ Rework.

■ Underutilization.

Being aware of the types of waste can help you identify it. We have taken on a number of projects to eliminate waste we’ve identified in our practice. A few are discussed in this article.

3. State programs

Finally, consider looking into your state or county’s public programs. For instance, we participated in the Baldrige Healthcare Quality Improvement Program at the state level. That’s a collaborative public and private national quality program. It involves businesses in all sectors of the economy and promotes organizational excellence in these six areas:

■ Leadership.

■ Strategic planning.

■ Customers.

■ Measurement.

■ Knowledge management.

■ Workforce and operations.

Changing the culture

To facilitate a change in the culture, we encourage managers and staff to look at their areas of expertise and identify opportunities for improvement in efficiency. Then, we give these suggestions to our chief performance officer and review them with department managers. Often, the AEA board will discuss these suggestions following its annual strategic planning meeting. A process that may result out of benchmark or present a potential increase in revenue or decrease in expenses may become a priority project.

Process changes are all based on data collected from within our practice. In the past, changes may have been made upon assumption. For example, in 2012, after changing practice management systems, the claims denial rate was above national best practice standards (benchmark). At first, we assumed the reason for denials was an inaccurate diagnosis or modifier being utilized by the technicians or doctors. However, after reviewing the data, we found our claims were being denied by payers due to incorrect demographic information being collected. Following staff education and accurate collection of the demographic information, the denials dropped and are currently below benchmark.

EHR efficiencies

Implementation of our EHR system in 2011 created many opportunities for us to evaluate workflow processes throughout our nine locations. The ability to develop a centralized scheduling department due to the accessibility of EHR has enhanced the scheduling process and continuity for our patients. We used to require 15 employees to answer all the phone calls and schedule appointments. They sometimes had no choice but to take calls in front of other patients who were checking in or out. Due to workflow process changes and implementation of EHR, we now have five employees who are trained technicians and can process all the appointments, triage calls, manage the patient portal, referrals, and prescription refills. Monitors are located in the scheduling room to assist the schedulers in visualizing how many patients are on hold, amount of time a patient is on hold, and identifying location. Reporting capabilities from this system identify production per staff member and location to ensure patient calls are being answered in a timely fashion.

Another example of a workflow change after implementation of the EHR involved shifting the staff members responsible for billing and scheduling appointments. Technicians now bill and schedule appointments in the exam room. As a result, we eliminated four positions from check-out and posting. (Those employees have moved to other positions within the practice). This process resulted in increased charge capture due to the reduction in posting errors and improved the filing of claims by 48 hours.

Patient satisfaction has improved since they no longer have to wait in a check-out line, as co-pays and deductibles are now collected upon check-in.

As with any process change, we started on a small scale in one clinic before implementing the process throughout the practice.

Patient feedback

There are many ways we promote patient feedback, including online reviews, “Eye Want to Know” comment cards located throughout the organization and patient satisfaction surveys. Those surveys utilize the Net Promoter Score, a national satisfaction survey utilized in many different industries, in evaluating our patient satisfaction.

Evaluating efficiency

Begin by evaluating the workflow. Involve staff by discussing how the practice can be more efficient, decrease waste and add value for the patients. Find benchmarks and identify areas in which your practice lags. Start small and test ideas on one patient, one clinic, or one day. For example, begin a process like billing and appointments with one doctor before you implement throughout the organization. Once you’ve gained some confidence with these techniques to improve quality, seize on a crisis and begin with a visible project, which will catch everyone’s attention. Demand immediate results and once you’ve proven the value of a culture of excellence and quality improvement, build on the momentum and expand your scope.

Asheville Eye Associate’s marketing director, Katy Farlow joins Robert Wiggins Jr., MD, MHA, and Denise Fridl, COT, COE, OCS.

There are a number of strategies to help you improve operations in your practice that should reap long-term dividends. We can all do better. Start making efforts to improve quality and efficiency in your practice that will pay off for you and your patients. OP