Article

Improving access for cataract patients

By creating efficiencies within its existing environment, Mississippi Vision Correction Center can welcome additional cataract patients.

When her granddaughter was in the neonatal intensive care unit, Michelle Jackson, an ophthalmic technician with Mississippi Vision Correction Center, received a phone call each day. The calls came from ophthalmologist L. Brannon Aden, also of the Flowood, MS, practice, who called to check on the newborn.

“The doctors are just wonderful people,” says Ms. Jackson. “They are so giving and so caring, and they treat us like family.”

Mississippi Vision was founded 44 years ago by Dr. Brannon Aden’s father, Dr. William Aden, who still practices part-time as a medical ophthalmologist. The senior Dr. Aden has long-cultivated a family-like culture in the practice, in which all employees are valued members of a cohesive team that strives to provide the best in eye care in a warm and friendly environment.

Kim Cox, surgical technologist, (right), assists L. Brannon Aden, MD.

This culture drove the practice to respond to an increase in the demand for cataract surgery, a result of the aging population, an increase in referrals from optometrists and a decline in the number of area ophthalmologists. Rather than saying, “we are no longer accepting new patients,” Mississippi Vision created efficient processes to care for these patients — and all without the need for additional personnel, space, or infrastructure, Dr. Brannon Aden says.

“We simply made the best use of our existing space, equipment, and personnel, who are comprised of six ophthalmic technicians, two scribes, and two surgical coordinators,” says Dr. Brannon Aden. In fact, the practice’s two surgeons performed approximately 3,200 cataract cases in 2018, up from 2,500 cases in 2015, according to practice administrator Gretchen W. Kimble, JD, COE.

This article describes how Mississippi Vision implemented several significant practice efficiencies.

Reconfigured exam rooms

Previously, Mississippi Vision had 11 exam rooms where the technicians would work up the patients. Whitney Junkin, COA, ophthalmic technician and scribe, explains that once the technician finished the work up, the patient would wait in the exam room for the surgeon. The technicians then had to wait for the surgeons to clear rooms before another round of patients could be brought in. This process caused a “boom or bust” workflow bottleneck.

Now, each surgeon uses two adjacent exam lanes; all other lanes are used to work up patients. “It used to take us [the surgeons] roughly 30 seconds to travel among all 11 exam rooms,” Dr. Brannon Aden explains. “Now, it takes me three seconds to go from one designated room to the other. That’s a huge time savings!”

Shaleria Terrell, ophthalmic technician, performs testing with a Marco Nidek autorefractor.

Mary Hilton, COA, ophthalmic technician, operates the Lenstar LS 900 optical biometer.

Once the patients have been seen by the technicians, they move to a secondary reception, or dilating area, just outside the surgeon’s two exam lanes, thereby freeing up the work-up lanes for the next round of patients. If the provider runs behind, the technician can still cycle through patients, Ms. Junkin explains.

As an added bonus, in this open reception area patients can see that the provider is working diligently to throughput patients. And in cases when the number of patients waiting increases, the providers have a visual cue reminding them to maintain an efficient workflow, Ms. Junkin says.

She adds that the change in workflow has greatly decreased the number of steps each technician and provider take across the exam lane each session, thereby saving time that can be used to see more patients. Patients also prefer the new protocol, as they feel like “something is happening” instead of just sitting in a dark room with the door closed.

Efficient equipment use

Ms. Junkin says that the clinic used to have an autorefractor located on one side of the clinic and one on the other side, “requiring staff travel time.” Now, the practice’s autorefractors, IOL measurement calculators and lensometers are all centrally located in an open area on the floor near the exam lanes. Staff and patients save steps as they “no longer have to go to another area of the practice,” says Ms. Junkin. (See the “Overview” sidebar on page 12 for more equipment information.)

The practice has also invested in equipment to assist in increasing efficiencies, doubling the number of pen tonometers used in the clinic and upgrading digital acuity systems. A dedicated triage technician was also implemented, whose duties include triaging all incoming patient calls, making referral appointments, and performing testing ordered by the doctor at a current visit, freeing the other technicians to focus solely on working patients up and performing previously ordered testing.

From Left to right: Marc A. Richardson, MD; L. Brannon Aden, MD; William M. Aden, MD; Christopher C. Evans, OD.

MISSISSIPPI VISION CORRECTION CENTER OVERVIEW

Founded: 1974

Practice specialties: cataract and refractive surgery, comprehensive ophthalmology

Doctors: Two surgeons, one part-time medical ophthalmologist, one optometrist

Allied health staff:

Two front desk staff (one check in/one check out)

One phone receptionist (with backup from other office staff)

1.5 billing staff (office manager spends about half her time on billing)

6 technicians

2 scribes

1 practice administrator

1 office manager

2 surgical schedulers

Cataract surgery-related equipment used:

  • Lenstar (Haag-Streit)
  • Marco Nidek autorefractor
  • Oculus Pentacam HR
  • Zeiss OPMI Visu microscope
  • LenSx, ORA, and Centurion are used during surgery for advanced technology cases

Training and scheduling improvements

Mississippi Vision staff implemented two efficient processes to accommodate additional cataract patients:

1. Cross training. “When we’re falling behind, which is a rarity nowadays but can still happen, an allied staff member immediately notifies our practice administrator, who lends a hand, be it herself, or by moving a staff member into another spot to provide support,” explains Marc A. Richardson, MD. “And staying on top of this also helps our cataract patients have a better experience because they know we’re doing everything we can to accommodate them.”

Communication among the staff plays a big part in the success of the cross training efforts. For example, while the scribes work with specific doctors, they communicate their respective doctors’ preferences to one another. This allows them to scribe effectively when working with any of the doctors, Ms. Junkin says. In addition, scribing provides a bonus beyond efficiency: “The doctors don’t have to turn their backs to their patients to explain how they want us to chart, so the patient doesn’t feel forgotten,” she says.

The practice also leveraged the power of its EMR system to create efficiencies, utilizing features, such as order sets and encounter favorites, to reduce the need for typing out frequently-used notes, diagnoses and treatment protocols. The EMR system also enhances patient education, allowing the staff to provide weblinks or printed information, which is identified by pre-loaded preferences specific to the patient’s diagnosis.

2. Block scheduling. On certain days, afternoon appointments belong to patients requiring cataract evaluations, says Ashley Irwin, COA, one of Mississippi Vision’s two surgical coordinators.

“Seeing our cataract patients in a block helps me and my fellow coordinator keep straight how much surgery can be done based on how many evaluations we’re about to see,” she explains. Because the coordinators know that cataract patients will be coming through the clinic during specified times, the schedulers are able to focus their attention on scheduling surgery during these times. They reserve the non-block scheduled time to accomplish other tasks, such as ensuring appropriate measurements have been completed on all surgery cases, coordinating post-operative care with co-managing partners, and making pre-op calls to patients prior to surgery.

Larry D. Stephens, CRNA (right), assists L. Brannon Aden, MD.

Amanda Rovano, surgical coordinator, adds that scheduling one-day post-op cataract patients in a block creates practice efficiency. “The techs, for example, are consistently performing the same tests, and the providers are performing the same post-op evaluations back-to-back, so there’s no stopping to move to another device,” Ms. Rovano explains.

Dr. Brannon Aden noted several other improvements: (1) the staff’s focus, including her own, is on one type of patient, so the mindset doesn’t have to switch, which takes time; (2) on non-block schedule days, she doesn’t have to worry about a cataract patient “derailing” the rest of the schedule; and (3) by virtue of block scheduling, there’s statistically enough variation in the mix of cataract patients, that regardless of the time each patient takes — more or less — patient flow is not interrupted.

These increased efficiencies have allowed the practice’s providers to increase the number of cataract evaluations performed without significantly increasing the amount of time required in the clinic. Dr. Brannon Aden says she has dramatically increased her surgical volume over the last several years without overly impacting her quality of life.

Expanding care in 2019

As of Jan. 1, Mississippi Vision will increase its cataract surgery days from three to four. Because of the increased surgical time, the practice will have the capacity to perform 3,800 surgery cases in 2019, an increase of 600 patients over last year, says Ms. Kimble.

“When our efficiency is improved, we have more time to spend with our cataract patients educating them, and we have the ability to add cataract visits into the schedule,” Dr. Brannon Aden adds. OP