How to improve clinical efficiency

Create opportunities to cover reimbursement cuts by assessing the practice and identifying pain points.


As practices look for ways to increase or maintain their incomes in the face of declining Medicare reimbursements, they must figure out how to do more with less. Now, more than ever, ophthalmology practices have the opportunity and obligation to leverage their resources and strengthen their lines of business to grow their bottom lines.

Strategic planning

Before practices can focus on enhancing clinical efficiency to improve their revenues, they must engage in a strategic planning process. This helps practices become grounded in their purpose and committed to disciplined business planning. As a result, they are better poised to successfully weather difficult storms. For instance, physicians may ask if their practices should open an optical shop or focus more on dry eye treatments to counter declining revenues.

Practices usually discover these answers in a broader discussion that addresses the direction of the group. For example, adding an optical shop or building a dry eye service line could be an opportunity for the practice, but these services can also become a distraction, absorbing time and resources the practice may not possess.

Practices should make such decisions in line with who they want to be, which then dictates what services they should offer and how they want to position themselves in their markets. Only then can they effectively and confidently move forward.

Benchmark productivity

When calculating how much declining reimbursements will impact the practice, administrators can analyze how many patients their doctors see each year. Then, determine how many more patients or surgeries the practice will need to perform to offset the revenue difference. (BSM has created a free tool just for this purpose, the Medicare Reimbursement Impact Calculator, available at .)

Typically, a full-time ophthalmologist will have 4,000 to 7,000 patient visits per year, while an optometrist may see 2,000 to 4,000 patients per year, according to BSM benchmarks. These figures include Current Procedural Terminology (CPT) codes for eye exams, evaluation and management, and no-charge visits, such as postops. Determine if the practice is above or below these ranges, and seek to understand why so as to properly adjust patient volume, possibly by improving efficiency in the clinic.

Clinical areas to examine

Looking to improve clinic efficiency can help mitigate some of the industry’s recent reimbursement cuts. Below are areas we recommend focusing on when examining opportunities to operate more efficiently.

Patient flow. Conduct time studies to understand where possible breakdowns occur in the practice. To complete a time study, practices should monitor patient times, tracking how long the patient spends in each area of the clinic. Is there a bottleneck at check-in? How long does it take the call center to schedule a new patient? On average, how long does it take an ophthalmic technician to work up a new and established patient? How long does the doctor spend with each patient? Does the doctor leave the clinic area to address administrative duties, or does the doctor arrive late to the clinic? Time studies can help reveal these answers and guide improvements.

Clinic processes and protocols. In reviewing clinical efficiency, practice administrators may discover that one (or more) of the clinic processes has broken down. Perhaps the process became outdated when the practice switched to electronic health records (EHR), or maybe the process does not make sense to the team members performing the tasks. When outdated or broken-down methods have been identified, take the time to build them back up.

Team members likely know how to fix some of the issues in the clinic — so ask them! Gather staff members to discuss challenges and solutions. The meeting may include techs, scribes, counselors, front desk, call center, and compliance officer. Clearly define the meeting rules: “This session is not to assign blame or gripe. Colleague to colleague, let’s brainstorm the issues that negatively impact patient care.” On a whiteboard, write down all ideas that might fix clinic flow problems. Decide which plans to focus on first, break them down into mini-goals, and start working on recommendations for each department. Have a team approach — acknowledge the issues as a group, and make a commitment to resolve the problems together. This approach also reduces the risk of designing a process that is not compliant for the sake of efficiency.

Internal patient referrals. Practices may want to review how they refer patients internally between doctors and departments. One common problem is a busy surgeon’s schedule is filled with routine eye exams, causing a backlog for surgery patients needing an appointment. If the practice can develop a system to refer these routine patients internally to another doctor (MD or OD) whose schedule has open capacity, the practice can increase its reimbursement by filling the busy surgeon’s schedule with what he or she does best: surgery. There may also be an opportunity to improve efficiency between departments, such as the patient handoff between the doctor and optical, or develop a system to flag patients interested in refractive surgery. These seemingly small internal adjustments can prove valuable.

Four actions to address fee cuts

Monitor productivity. Data can help each practice to determine how many more patients they must see to make up for falling reimbursements. Acquire baseline information, then take actions to improve.

Identify problem areas. Find those processes that have broken down for one reason or another by performing a time analysis, observing the patient experience, or by asking the staff. Then, brainstorm ways to fix them with the staff.

Maximize surgeon schedule. Ensure that the surgeon’s time is spent doing what he or she is passionate about and does best. This can be achieved by using physician extenders or by being strategic in the services that the surgeon is scheduled to perform.

Perform a chart audit. Take a look at randomly selected charts to ensure that all proper codes and documentations are being made to ensure full reimbursements are acquired.

Physician extenders. Another issue affecting clinic efficiency can be the misuse or lack of physician extenders. For example, technicians, scribes, surgical and/or premium option counselors, and optometrists can provide tremendous support to MDs. However, practices must structure that support in such a way that the MDs can be more productive. According to BSM’s industry benchmarks, the average MD spends 5 to 7 minutes with each patient, with the extenders helping the physicians throughout the patient experience. If practice providers run behind schedule, review how physician extenders support the doctors and decide if staffing adjustments need to be made.

Self-pay services. Practices may look for ways to improve clinic efficiency without adding more patients to the schedules. One way to do this is to focus on enhancing clinic efficiency for self-pay services. For example, the practice may have a refractive cataract surgeon who offers self-pay specialty IOLs or astigmatic correction at the time of surgery. So, the practice may decide to enhance education about surgery options for patients who qualify as candidates for these procedures. Practices may also concentrate on streamlining the surgery counseling process, consolidating or simplifying their pricing structure, and reviewing or updating their surgery paperwork. By making surgery options easier for patients to understand, the practice can improve clinic flow while simultaneously increasing revenue.

Billing and coding. When reviewing clinic efficiency, consider how the practice completes billing and coding functions. While practices want to ensure they have sufficient documentation in the patient chart to support the CPT codes submitted for payment, they certainly do not want to leave money on the table by failing to add proper codes or complete the necessary documentation. The billing department may wish to complete a coding and compliance audit or a revenue cycle management (RCM) assessment. An example of an RCM assessment may include tracking reimbursements from the date of service to the claim’s resolution for a sample number of patient exams. These exercises may help to identify where lost or delayed revenue can be found.


In today’s reimbursement environment, ophthalmology practices must continue to evolve to be successful.

As an ophthalmic professional, regardless of position, you can help influence the success of the businesses. Start looking for ways to participate in strategic planning and improve clinic efficiency to make a lasting difference! OP