Retina Foundation Oration
(All Gujarat Ophthalmology Conference 25 SEP. 2011, Hall A, 11:30am to 12:00pm)
How to Increase your Revenue through Ophthalmology Practice
Prof. Dr. S. Natarajan
Chairman & Managing Director
Aditya Jyot Eye Hospital
First of all I want to convey my sincere gratitude to Dr P. N. Nagpal for giving me this honor.
Retina foundation award was started in 1982 and was given to Dr S R K Malik.
Definition of success is different for different people. For Sincere Student to get good marks in exam is success while for an average student the goal is to pass. Same way for a doctor to treat patient is always the ultimate goal but along with that to increase profit is always a subject of concern for private practitioner.
To achieve success one needs to have a vision for that. Visualisation of the dream and benefits is a first step to success. A guiding vision, a great dream, and a sense of focus gives one a goal and direction. To achieve the visualized goal one need to have a “Passion” and “Courage”. Passion for the thing gives us energy and reason to weather the storms. Courage does not always roar, sometimes courage is the quite voice at the end of the day saying “I will try again tomorrow”. Life expands, or contracts, in proportion to ones courage, willingness to take risks, and acceptance of new challenges. Ultimately it is the courage that counts, not success or failure. During the journey to success keep your character protected and your belief in yourself intact. Character is what endures you through your journey till you reach your destination. Good is not enough; strive to be the best in your chosen field. Competence is the difference between mediocrity and excellence. And finally discipline in your work will take you a long way. Discipline means persistence and perseverance – the ability to continue through bad times, obstacles and problems.
To increase profit from your practice start examining patient as a whole. Don’t give refraction only, start dilating the patients. Certain retinal disorders can be managed by general ophthalmologists in their initial phases. WHO and International Diabetes Federation (IDF) have predicted that the number of cases of adult-onset diabetes would more than double by 2030 from the present level of 171 million to 366 million-an increase of 214%. In developed countries, this increase in diabetic population would be around 42% and in developing countries, particularly in India, it is even higher; i.e. 150%. In India, the prevalence of diabetes mellitus in the urban population is around 12.1%, as reported by the national urban diabetes study2 conducted in six major cities. To handle this burden there are only approximately 500-600 retina specialists. Your involvement will help reduce our burden and will also increase your profit.
Diabetic retinopathy in its initial stages can be managed by strict control of systemic status and regular monitoring for early detection of progression. Refer patients showing signs of progression to retina specialist or you can advised required investigations like OCT and FFA to know the status of disease and further management. Retina person can further manage advanced cases with laser, Anti-VEGF injections or pars plana vitrectomy. Age Related Macular Degeneration (ARMD) in its dry form can be managed simple by anti-oxidant tablets. Each patient with dry AMD should be given Amsler’s chart at home for monitoring. We have seen in our hospital that patients showing progression from dry to wet form are caught by newer machines like Preferential Hyperacuity Perimeter (PHP) in a very early state. Therefore we can intervene at early state to prevent further progression. Majority of hypertensive retinopathy patients are managed by simple control of hypertension.
For refractive surgeon, each and every high myopic patient coming for refractive surgery need not to be referred to retina specialist if they do fundus examination. You can easily go ahead with surgery in a patient having no treatable lesions in periphery. Refer only when required.
For that every emerging ophthalmologist need to strengthen their basic examination technique. They need to know binocular indirect ophthalmoscopy and Slit lamp biomicroscopy with 90D.
Regarding technical aspects of increasing your profit, you need to find ways to increase your efficiency along with reducing your expenses. According to one article in ophthalmology management, there are main 4 ways of increasing efficiency.
1) Hire and office writer
• Save data writing time
• Can field your phone calls
• Can perform routine callbacks to patients and pharmacies.
I personally prefer two writers and at least two dedicated retina rooms. While one writer stays with me in 1 room for assisting and scribing, the other moves the patient to the second room or laser suite and carries over chart information needed for documentation. When I'm finished, the writer reviews any instructions and counsels the patient. If the patient requires surgery, surgical counselors take over and make the appropriate arrangements.
2) Develop quick response report forms
Implement the use of fluorescein angiogram and OCT report forms using a "circle the appropriate response" or "fill in the blank" format. This type of form saves both time and dictation costs. Other testing can be reported in the same way.
“A circle-response/fill-in-the-blank form” that could be filled out immediately after a patient's examination and faxed/mailed to the referring physician. They get what they want the same day, patients are happy with the efficient communication, and we save time and dictation costs -- a win-win situation.
3) Have a well trained technical staff
A well-trained staff of technicians is essential. Certified technicians can take the patient history; check vision, pupils motility, confrontation visual fields, and tensions; refract; and perform most of the external and anterior segment examinations.
A well trained optometrist is must for good and proper post-operative correction after a good surgery
4) Have a surgicenter setting
Surgical facility adjacent to your clinic is the ideal set-up. It increases efficient use of time, so one can see OPD patients till time of surgery. A professional, trained team in OT is crucial. With the advent of 25-gauge-transconjuctival vitrectomy, retina cases can be handled even more efficiently in this type of environment.
To keep your expenses low, look for ways to cut costs.Monitor supply usage and make certain it matches your patient needs. Consider reducing your printing and office supply requirements with streamlined documents and offer electronic documents whenever possible. Incremental reductions in expenses will increase your profit significantly on long run.
Increasing sales of different products will increase your profit on each patient. Consider having Optometry outlet, Medical store, Low visual aids outlet etc. Look for services and items that are a good fit for the type of medical practice you run. The goal is to provide products and services that you can endorse and provide to your patents.
Focus on maximizing your insurance payments. However, price control is increasing and recovery of the claim form the insurance company often takes long. You need dedicated staff to follow insurance claims. Working with insurance companies can be a time-sensitive process that requires attention to details and adequate tracking. Reduce the amount of money you lose because of incorrect billing or inadequate follow up and your profits will increase.
Providing appropriate cost-effective care with compassion and competence is the right path to restore the lost prestige of this profession. Thus, the four "Cs" of a good doctor must always be kept in mind: Competence, Cost effectiveness, Convenience and Caring.
A referral base a must for a VR Practice. Go out and meet the Practicing Anterior Segment Surgeons and Physicians. Make it a point to write back to the referring doctors regarding the patient. There is enough work for everybody around. NEVER EVER try to grab a patient. Referred patients should ALWAYS be sent back to the referring consultant.
ROLE OF ACADEMICS & RESEARCH IN A VR PRACTICE
Try and be part of Clinical Trials carried out by large Pharma Majors. It would be financially as well as academically rewarding. Publications will help lend credibility and recognition amongst peers and patients and will also help in increasing Referral Base.
ALWAYS STAY UPDATED
Attend National & International Conferences, present papers and be the 1st to Adopt Newer Technologies.
AND FINALLY… BE REALISTIC
Nature of Retinal disease is such that many times even after perfect surgery one may or may not achieve Anatomical Success. Anatomical Success never ensures Visual Improvement. Patient Counselling IS A MUST. Promise Less, Deliver More. A patient with lower expectations will be a more satisfied patient.
Key points to increase your practice
• Dedicated time to patients – Good counselling
• Thorough in your subject
• Satisfied and well managed patients will multiply
Partnership deal requires planning. Becoming a partner usually implies two things to an ophthalmologist: more money and more security. New partners may be surprised to find their income dropping instead of rising if the deal is not structured optimally. Group practice has been adapted successfully in the West and in several places in our country. Colossal investments are required to put up vitreoretina service. Choose your partners wisely and set high standards for their selection Or else it’s a One Way Ticket for you..!! Select the right number of doctors for your Group practice. Never overload your practice as security rests in small groups only.
Remember….. A successful Posterior Segment practice stems from diligence, humility and steadfastness. One must remember to cater to all the socio economic strata of the society.Towards this, one must incorporate a service oriented approach by establishing a Charity based practice.
Few Pearls For Young Ophthalmologists
Building a practice is not an overnight project. It takes at least FIVE years to establish your practice. Patience is not the ability to wait but the ability to keep attitude while waiting. According to Yoinfo online newsletter 4 “As” for young ophthalmologist.
1) Affability : Ease talking to patients, Good terms with staff members and Make a good team
2) Accessibility : Easy access to referral sources, Willingness to take a phone call at any time and Provide urgent care to patient
3) Ability : Your knowledge and ability is important but won’t help without above two in a private practice
4) Advertising : Do Not Market anything like Soap, market scientifically. Join local/regional societies, take lectures regarding any newer technology/method you are following and do publications
Lew Mc Bee – Administrator, Silverstein Eye Centers, Kansas, USA has said "Turn the medical practice into a Five-Star service organization. We want to build patients for life, we want these repeat patients, and we want these patients to tell their sons, daughters, mothers, fathers, grandmothers, and grandfathers to come see us because it's that important !"
Finally, I quote Swami Vivekananda… “Arise..! Awake..! Stop not until you achieve your goal”. To extend this to the Bhagvad Gita, Swami Chinmayananda says, “Have your goal sky high and do karma always with outstretched hands… You will rise to greater heights….!Nothing great will ever be achieved without great men, and men are great only if they are determined to be so.
In race of life don’t forget to take a break and Laugh. Keep enjoying life.