Over the past several decades, optometry has made significant strides in the realm of scope of practice, technological advancements and modality of practice. This is paired with an increasing demand for eye care from the aging population and a growing awareness of the importance of eye health, according to the American Optometric Association. While we are taught the quantitative science of optics and how to identify and manage ocular disease, often, we are not taught about the business of optometry. As a result, many of us make financial decisions without a solid, metric-based approach, as other businesses do when looking to analyze and even expand.

Metrics are important because they instill a quantitative approach that can be used to describe the efficiency of processes. Businesses come in all sizes. Whether you are operating a micro business or large-scale multi-location practice, the goal of efficiency is always a front runner.

In optometry, we can make adjustments to different areas of practices to enhance our metrics. In my opinion, two of the most prominent metrics for enhancement are gross revenue per patient and revenue per working hour. What’s more, changes can often be made to these areas without requiring a large amount of up-front financing. With all this in mind, here, I discuss these metrics and specific enhancements I would suggest concentrating on when starting to build out your practice.

GROSS REVENUE PER PATIENT

In my opinion, gross revenue per patient can be the single most useful measure to track the productivity of your practice. The reason: This measure directly represents your collection efficiency, or the rate at which your practice is bringing in dollars. Revenue per patient can be calculated in several ways, such as by revenue per patient per comprehensive examination: Gross Revenue Per Patient = (Receipts + Billed Amount) / Number of Patients Seen.

Ways to enhance and impact this number include:

• Enhancement No. 1: Practice full-scope optometry. One of the most impactful ways of growing your gross revenue per patient is by practicing full-scope eye care. This requires embracing medical eye care or realizing that behind every visual complaint, underlying issues, such as diabetes, are typically afoot. I have found that many of us are passively cognizant of this, but do not deliberately focus on these areas. With the growing age of the U.S. population and, thus, the increased need for the treatment of presbyopia, AMD and cataracts, to name a few, the need for full-scope eye care becomes more prominent. An example of this enhancement at work is in treating glaucoma, which is a source of recurring revenue for a practice, as patients require monitoring and follow-up.
• Enhancement No. 2: Use of high-performance methods, equipment and materials. Another way to impact gross revenue per patient is by providing the patient with a unique experience. One tactic to accomplish this is utilizing top technology, such as OCT angiography or expanded fundus photography, within your clinical setting, and valued materials, such as high refractive lenses in your sales. Employing these tactics well, along with great customer service, often justifies the professional fees necessary to accomplish these tasks.
• Enhancement No. 3: Understand and form relationships with surgical practices. An incredible amount of ocular surgery options exist, such as those to treat cataract and glaucoma. As the demand for these services grow, so does the pre- and post-op needs of these patients.¹ Co-management fees can bring in substantial revenues.
  Most surgical centers have testing technology that optometrists may not have in their smaller setting. Sending patients to these centers to receive the testing, as we continue their treatment plan and care, is another way of maintaining recurring revenue.² We have the ability to separate the billing of the technical component to the location where the testing service was rendered, and the interpretation component to the location where the doctor utilized the testing to determine a treatment plan for that patient.

REVENUE PER WORKING HOUR

Following this metric associated with dollars per staff hour helps you to evaluate the efficiency of the management of patients, highlighting whether your office is performing at its normal level when it is under- or overstaffed: Revenue Per Working Hour = (Receipts + Billed Amount) / Total Staff Hours. A caveat: There has been a weak correlation with this metric and practice size: Typically, the smaller the practice, the higher this number, as you have a critical mass of staff that must be present to adequately care for your patients.³ Examples of tactics you can use to enhance this metric:

• Enhancement No. 1: Focus staff hours where most pertinent. To help increase the performance of this metric, one step to consider is to customize your staff hours to your patient demands. For example, if your patient flow tends to be heaviest around lunch time and tapers off near the end of the day, fluidly staggering schedules may be a good approach to enhance this metric.
• Enhancement No. 2: Increase the patient base. Specifically, increase inflow to the office to better match support staff. For example, increasing the number of patients who walk in the door, which tends to increase overall revenue, can enhance this number. Other examples could include scheduling patients at a faster rate (i.e., seeing a patient every 15 minutes vs. every 30 minutes.) (See “10 Steps to Grow Your Business,” at bit.ly/3aBqLF7 .)
• Enhancement No. 3: Decreasing patient wait times. Typically, patient efficiency leads to an increased patient experience, and the ability to see more patients. The less a patient tends to wait for you and your staff, the more the patient experience tends to increase. This can also lead to a more open schedule for you and your staff to increase your patient flow. (See “The Benefits of Staff Delegation,” at bit.ly/2DYZSyu .)

GROW AS YOU GO

There is increasingly more opportunity for the future. As the aging population increases, we can help these patients, while also impacting, growing and tracking our own businesses. OM

REFERENCES

1. Gollogly HE, Hodge DO, St Sauver JL, Erie JC. Increasing incidence of cataract surgery: population-based study. J Cataract Refract Surg. 2013;39(9):1383-1389. doi:10.1016/j.jcrs.2013.03.027.
2. Mehta, Nick, Steinman, Dan, Murphy, Lincoln. Customer Success: How innovative companies are reducing churn and growing recurring revenue. 2016. Wiley Publishing.
3. Taylor B. Using Key Performance Indicators to Do More with Less in Your Practice. Semin Hear. 2016;37(4):301-315. doi:10.1055/s-0036-1594000.

DR. VIRANI is Leader of Operations at Kleiman Evangelista Eye Center in Dallas. She is a consultant for Alcon and can be reached at drvirani@keec.com.