Ophthalmology Business

APR 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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as much fun or as secure as the first two-thirds." The short answer to this surgeon's dilemma is, "Don't count on as much fun or security." The long answer is more braided and perhaps more hopeful. Here is a seven-point rejoinder to this surgeon's all-too-common concerns. 1. Bigger is not always better or easier. The general trend today in ambulatory healthcare is consolidation—smaller practices merging into larger ones, larger practices acquiring the stragglers, and institutions get- ting back into practice acquisitions at a pace not seen since the 1990s. Even when a practice slowly, organically grows and adds providers, staff, and office locations, operational complexity generally increases at the size of the practice squared. Even though larger practices can play strength-to-strength to payers, regulators, and local market forces, this surgeon-writer's frustrations are very common. A practice with four times as many doctors probably needs eight times as much leadership, eight times better management, and eight times as much communication to stay organized, harmonious, and productive. 2. Lower fees could once be fixed by "one big idea." In the past 30 years, the three largest business revolutions in ophthalmology have been the development of private ambulatory surgery centers, the addition of optical dispensing, and the employment of larger numbers of non-partner optometrists as sources of passive income. This low-hanging fruit has now been plucked by most contemporary practices and has allowed surgeon owners to preserve and even advance their incomes. On the road ahead, it will take an ensemble of much smaller tactics. Mitigation of the anticipated, much larger cuts ahead will require a practice to execute numerous small tactics all at once to have the same profit-preserving impact of any one of the last three business revolutions. Examples of these include: • Unaccustomed levels of frugality in hiring, technology upgrades, and facility development; • Sharing resources with former market competitors and collaborating more closely to secure managed care contract access; • Pushing the envelope to optimize surgical volumes and testing utilization; and • Personal sacrifice to see more patients per hour or work more hours per week. 3. Technology turnover velocity. A generation ago, how one did cataract surgery, with or without phaco, was the prominent technology quandary. Making the go/no-go decision with electronic health records has been the headline grabber for nearly the last decade. All things femto is the technology debate du jour. It's all confusing and it's all increasingly expensive, right? But the same simple rule of thumb that guided surgeons in the transition from extracapsular surgery to phaco can guide you today: "What's the crowd doing?" The transition to a preponderance of phaco took less than five years because it was a very good idea. Many contemporary transitions are taking a lot longer. Simply decide whether you're the kind of surgeon who will adopt a new technology when the first 15% have made the shift, the last 15%, or somewhere in between. 4. Keeping up with the regulatory and procedural churn. If Starbucks had to run their coffee shops like your eye clinic, the customer would sign five forms before they could privately whisper to their java-technician, "I'd like a venti, sugar-free, non-fat, vanilla-soy, double-shot, decaf, white chocolate peppermint mocha, please." And then it would take the barista an extra 15 minutes to get authorization. Forty years ago, a fairly complete patient continued on page 18 April 2013 • Ophthalmology Business 17

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