EyeNet Magazine

Practice Perfect: Coding & Reimbursement
Boosting Practice Efficiency, Part Two—When to Hire a Tech
By Chris McDonagh, Senior Editor

I often hear doctors say, ‘I don’t want to hire an extra tech because I don’t want to increase my payroll expenses,’” said Derek Preece, a senior consultant with BSM Consulting Group, a nationwide practice management company. “But adding an extra tech could mean that the doctor can see five more patients per day, and that extra revenue would result in a lower payroll ratio.” If, however, a practice hires too hastily, it may subsequently have to lay off somebody who is depending on that job for his or her livelihood, said Mr. Preece, who is based in Orem, Utah. So how do you determine whether adding another tech is the right move for your practice?


5 Red Flags That Might Mean You’re Understaffed

Mr. Preece urges you to watch out for signs that a bottleneck—possibly caused by understaffing—could be limiting your practice’s productivity.

The appointment lead time is getting longer. If the time until the next available appointment starts lengthening, it may mean your practice needs more clinical help and that the doctor may need to delegate more to his clinical people.

Techs are complaining. Are employees with good work ethics starting to complain that they don’t have enough time to get everything done? If you don’t heed those complaints, you run the risk of losing good staff members due to burnout.

Patient flow is disrupted. How often is the patient flow disrupted because techs have to stop working up patients in order to do special tests, such as visual fields or OCT? If this is starting to happen more frequently, then you may be shorthanded.

Patients are spending more time waiting around. If wait-times are getting longer, “that may indicate the doctor needs more assistance so he or she can stay on time better,” said Mr. Preece.

Physicians are seeing relatively few patients. If a physician is seeing, say, 30 patients per day, while other physicians in comparable practices are seeing 45 patients per day, will adding an extra tech reduce that disparity?


Is the Solution a New Tech or New Work Patterns?

Before you decide to hire an additional employee, you should evaluate whether there are ways for the current staff to get the work done more quickly without burning them out. “Start by getting your staff members together and discussing each step of what they’re doing,” said Richard H. Lee, MD, who is in private practice in Oakland, Calif. Do the current processes involve unnecessary work or delay? Is there a way to streamline the work flow? Staff may be wary about changes to work processes, so it is important that a leading member of the practice champions this review.

Mr. Preece also urges you to watch how work is distributed. “A constant vigilance has to be maintained to make sure workload is spread evenly.”


How Will an Extra Tech Impact Costs and Revenues?

If you do add a tech, will that have a positive or a negative impact on your bottom line? Traditionally, few practices have done a financial analysis before hiring a tech, but said Mr. Preece, “I do think it is incumbent on them to gather the appropriate information and make a careful analysis before making the hire.” If a tech is added, how will the revenues change, and how will the costs change? “Tracking the difference between those two values—change in revenue minus change in costs—gives you an idea of whether it makes economic sense to add that tech,” said Mr. Preece.

For example, suppose a practice is generating $150 in revenue for each patient seen in the office. If the practice hires an additional tech, its expenditure on wages and benefits would increase by, say, $200 per day, but the doctor would be able to see four additional patients. Would the $600 boost in revenue justify the extra $200 in expenditure? Dr. Lee suggests a rule of thumb used in many high-skilled service industries, such as architecture and law, where an extra employee will only be hired if the increase in revenue is at least three times the increase in costs.


What If the Dollars Don’t Add Up?

“Some judgment has to be used,” said Mr. Preece, because it may make sense to add the tech even when your analysis of costs and revenue fails to make a case for doing so.

Suppose, for instance, you’re losing techs because they are burned out. “Even when adding an extra tech doesn’t allow you to see more patients, it may be worth making the hire if it means you’re not losing staff,” said Mr. Preece. “There is a definite cost of turnover, and if hiring one more tech reduces turnover then it could reduce your overall costs in the long run.

“And some doctors will add an employee not because it makes them more money but because it makes their life better. If they have an extra person to do some of the things that they have been doing, it means they’re not so frantic and exhausted when they leave the office each day,” said Mr. Preece.


Do You Have Enough Space?

“Suppose your practice currently has one ophthalmologist who is supported by three techs, and they have four rooms to work up and examine patients,” said Mr. Preece. “A fourth tech won’t be a huge boost for your productivity because, at any one time, there’ll be one tech who will have no place to work.”

How many work spaces do you need for an efficient work flow? Mr. Preece’s rule of thumb is that you need one room for the doctor, one for each of the work-up techs who are supporting that doctor plus one additional room. “If you have two techs and one doctor but only three work spaces, then for much of the time you’ll have one of those techs standing around waiting for the doctor to finish with a patient so they can start working up a new patient.”

How can you cram more work into the same space? Suppose you are keen to see more patients, but you are not able to expand the size of your office at your current location. If you’re worried about moving to a new building—perhaps the nearest suitable office space is several miles away—what options do you have? “Opening on Saturdays is one obvious solution, and I know one practice that is open seven days a week,” said Mr. Preece. “Other practices work in staggered shifts, with patients scheduled so the doctors don’t overlap as much. In other words, you’ll have one doctor who works from 7 a.m. until noon and then does surgery in the afternoon, and a second doctor comes in from noon onward.”


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