Ancillary Services

With ancillary services, practices treat Beyond the eyes

How The Eye Associates added hearing and dermatological treatments.

Lindsey Getz, Philadelphia, Pa.

As a means of growing and expanding business, some ophthalmology practices have begun offering ancillary services. Along with driving additional revenue, adding new health services also means meeting more patient needs by offering them a “one-stop-shop” solution. If done right, the ability for patients to get more out of their visit can help improve customer service and build patient loyalty. However, if not done with tact, adding services can bring negative consequences. In the Bradenton/Sarasota area of Florida, The Eye Associates has judiciously extended its offerings with both dermatology and hearing services, which have proven to be a good fit for the practice.

Some services are a more appropriate match for ophthalmology than others. The Eye Associates Chief Executive Officer John Swencki says potential new services are evaluated from multiple perspectives. For entirely new services, such as the practice’s hearing division, market demand, competition, potential financial investment, and anticipated return are all key factors. If the service is more of a technological advancement to existing ophthalmic services, such as the practice’s addition of the femtosecond laser for cataract surgery (see “Training with the femtosecond laser” below), potential improvement to patient or visual outcomes is also analyzed.

Train the trainers

Staffing is obviously a critical issue when it comes to adding any new service. Mr. Swencki says existing staff is cross-trained, whenever its possible, to limit the increased cost of adding new staff. In addition to being financially beneficial, cross training also helps when it comes to coverage issues due to employees taking vacation or sick leave. For brand new equipment or services that require technical skill, the vendor typically provides training, Mr. Swencki says. “We usually utilize a ‘train the trainer’ approach in which the vendor trains our clinical staff leadership, who, in turn, become the trainers for our organization,” he adds. “We also have physicians train staff whenever appropriate.”

Matching services to staff

When cross-training staff to perform in new roles, it’s important to recognize if the new function is a good fit. Sometimes it’s not, says Harris Silverman, MD, FACS, founder of The Eye Associates. When the practice added dermatology, some technicians filling in on the dermatology side simply didn’t like it and weren’t a good match. Others appreciated the variety and eased right in. Things will operate more smoothly if staff is well-matched and comfortable with their post.

John Swencki, CEO, left, and Harris Silverman, MD, founder of The Eye Associates at the Bradenton, Fla. office.PHOTOGRAPHY BY BERNARD PHOTOGRAPHY

John Limbrunner, board certified heading instrument specialist, tests a patient’s hearing at The Eye Associates in Bradenton, Fla.

“We left that to the staff to decide,” Dr. Silverman says. “It’s important that they feel comfortable admitting if it’s not working for them as that can affect work flow for everyone.”

Bringing staff on board

Jill Grawe, patient care director, adds that it’s also important to educate staff on why a new service was added. Staff buy-in is critical to a new service’s success. Grawe says that once The Eye Associates’ staff understood that adding dermatology and hearing services could offer sincere benefits for the patient, they were on board.

“We’re not strongly sales-oriented, but hearing services are often associated with a hard push for selling hearing aids,” Ms. Grawe says. “In our region a lot of the big chains go for that hard sell. But that’s not what we’re all about.”

The right match

Still, that reputation attached a stigma to the service that the practice’s management found it necessary to overcome for both staff and patients. In fact, Dr. Silverman says his team learned the hard way that maintaining the premium level of service the practice has come to be known for meant finding someone who shared a “patient first” philosophy.

“Our first hearing specialist had a high rate-of-return,” Dr. Silverman says. “He came from the chain stores where it’s all about ‘sell, sell, sell.’ The emphasis just wasn’t on the patient. We knew that could put our core philosophy in jeopardy in other areas of the practice. Any time you’re looking at expanding your business with a new service, risk is involved. If you’ve had a long-term relationship with the patient and you’ve built their trust and then you refer them to the service and the provider does not do a really good job, you lose some of that good will, which is a costly price to pay.”

Dr. Silverman says that’s why they went through several hearing specialists before finding a good match in John Limbrunner, board certified hearing instrument specialist. “Our return rate has dropped to almost zero,” Dr. Silverman says. “That’s largely because John is not giving out appliances to people who don’t really need them. He puts the emphasis on the patient rather than sales and that builds good will rather than steals it.”

Rebecca Stidham, certified dermatology technician, performs Blu-U Light therapy on a patient at The Eye Associates in Bradenton, Fla.

Marketing to your region

Similarly, with dermatology, The Eye Associates set out from the very start to do something a little different. In the Florida region where skin cancer rates are high and dermatologist offices are pretty busy, it can be difficult for patients to see an actual MD. They almost always see a PA. But Dr. Silverman says the practice teamed up with a physician who valued one-on-one time with patients. Giving patients direct access to an MD has been a nice value-add for The Eye Associates. They found the perfect marriage with a dermatologist who enjoyed the idea of being in a private practice setting, but didn’t want the headache of managing the business himself.

“The Eye Associates has a truly excellent group of people who deal with all the business aspects of medicine, which allows me to almost exclusively concentrate on providing the best dermatologic care that I can,” says Gary B. Rosen, MD, board certified dermatologist.

A seamless blend

No matter what the service, a key challenge to overcome is ensuring that these new services don’t distract from the original reason why the patient came in—which is eye care, says Mr. Swencki. “Don’t forget their eye complaint while you’re trying to upsell services,” he says. “Ophthalmology is already very complicated these days. Often, you’re already throwing a lot of information at the patient that they don’t have a good understanding of. It’s important not to overwhelm the situation even more by upselling additional services.”

Allowing for skilled technicians to “work patients up in the front” and then see the doctor at the end is a methodology that has worked well for ophthalmology, and is working well with the hearing clinic too, according to Dr. Silverman. Patients may receive a quick hearing screening by a technician and, if indicated, are then referred to the hearing specialist. Using skilled technicians for initial testing boosts overall efficiency and practice flow, allowing the doctor or specialist to have time to see each patient.

Don’t sacrifice trust

While hearing and dermatology are proving to be strong complements to the overall practice, Mr. Swencki says that other services have been tested and turned out not to be a fit. “We thought allergy testing might be a good fit for the practice, but we experimented with it and found out it was not,” Swencki says. “You have to be able to recognize when something isn’t working.”

Dr. Silverman agrees. “The ophthalmologist-to-patient relationship is something we have taken a long time to build and we are going to guard that carefully. If a service or a provider of a service isn’t working out, it’s important to move on before it can do any damage.” OP