Focus, dedication and creativity

Using these three can help you solve practice issues.

The issues you deal with right now as a physician-leader or administrator in a cataract/refractive practice probably claim hours of sleep. And you’re in good company — ask your peers what keeps them up at night, and you may get two earfuls. But, these challenges don’t need to send you over a cliff — or even a speed bump. If approached properly, they can actually become opportunities for greater success.

In my attempt to identify and address common practice management challenges, I solicited input from physicians and administrators of several cataract/refractive practices and received a variety of responses. What follows are the concerns I saw as most relevant, how to approach them and examples from our practice where applicable.


One person can’t do everything exceptionally well, clinically or administratively. Physicians generally focus on one subspecialty, possibly two, while practice administrators usually excel in certain areas (i.e., marketing, finance). Similarly, your practice can’t be all things to all patients, so carefully consider your range of services.

A key concept in this regard is ensuring that your mission, vision and values reflect your highest priorities for the organization. What service or product is your practice’s reason for existence? You might start with something broad and then narrow your focus through vision and values statements.

In our practice, we have a “defining statement” rather than a mission: “We provide patient-centered care.” Although somewhat vanilla, we see beauty in simplicity. From there, we adopted “guiding principles,” one of which is the notion of “core competencies.” For us, they are cataracts, refractive, medical retina and dry eye. These choices were somewhat natural for us, as each of our four surgeons has an interest in one of these four areas, for which they also function as our clinical “champion”. Our physicians provide some care outside these four areas, but our overall goal is to be really good at just a few things rather than being somewhat good at a larger number.

Whether broad or narrow, be deliberate about your focus, and beware of inadvertent mission creep.


As our industry moves toward value-based reimbursement, regulatory burdens have climbed significantly. EMR, a shift principally driven by the federal government and hailed as a game-changer for practice efficiency, has largely not produced the anticipated advantages.1 Declining reimbursement rates for cataract surgery are another source of downward pressure on revenue.

The best guidance for this complex issue might be to get creative. Consider some of these ideas:

  • Join an accountable care organization.
  • Eliminate payers that are difficult to work with or reimburse at low rates.
  • Increase premium services to improve profitability (more on this later).

Some of these concepts might seem counterintuitive, but traditional approaches no longer work; current reimbursement and regulatory requirements are not subject to traditional forces.


The U.S. Bureau of Labor reports that the health-care industry added almost 375,000 jobs over the last 12 months.2-4 In a strong job market such as this, attracting quality candidates to your practice can be tough. Even when you successfully hire staff members who have the right attitude, work ethic and experience, retaining them can be difficult. Another practice is always willing to pay a little more than yours and offer a few more perks.

So, what’s the secret to hiring and retaining that amazing lead technician or coordinator who is the linchpin for your refractive program? While competitive pay and benefits are a starting point, organizational culture can be the competitive advantage that allows you to retain the best employees. Our practice has focused on its culture in recent years, emphasizing employee-centered leadership as an internal corollary to our greater mission of providing patient-centered care.

We instituted a popular, perfect attendance program to encourage better attendance, including quarterly bonuses of $50 and an annual drawing for a trip to Hawaii to those with two or more consecutive quarters of perfect attendance. A process improvement incentive in which employees can share in any savings they help generate has also been very successful; one employee recently received a bonus of more than $3,000 for an idea that will save the company more than $60,000 over the next five years. We regularly have all-staff lunches and set up Skype links between the clinics and administration building, allowing employees and practice leadership to interact. These and other programs have greatly enhanced our company culture and created value for employees and the organization.


When the first baby boomers became eligible for Medicare in 2011, they comprised the first wave of many such entitled patients to come. According to a 2005 census report, the number of Medicare-age patients is expected to more than double by 2030: from 2000, at about 35 million to more than 72 million.3-5 Meanwhile, the number of ophthalmologists is projected to slightly decline between now and 2020.4-6 This disparity presents a possible dilemma, but the potential for growth is substantial for practices willing to adapt.

That adaptation calls for cataract/refractive practices to accept new ways of providing care; namely, by incorporating physician extenders. Optometrists are a natural fit because of their specific ocular training. In fact, in recent years, ASCRS created a task force to advance an eye-care delivery model for cataract patients based on a collaboration between ophthalmologists and optometrists in spite of historical conflict between the two specialties.5

Other alternatives exist. Many practices now employ physician assistants in various capacities, both in clinic and surgery.6 Adding a nurse practitioner is another option, but this is a less common choice for practices in my experience. Both options carry advantages and drawbacks, most notably a lack of specialized training programs that necessitates extensive in-house training.


As previously discussed, the recent focus on value-based care is leading to reductions in reimbursement and an increase in regulations. One way that some practice leaders are confronting this issue is a renewed focus on cash-pay services, which now include refractive surgery, premium IOLs, femtosecond laser-assisted cataract surgery and dry-eye treatments. With the economy improving, a growing portion of the population has disposable income and may be interested in premium or elective services.

To take advantage of this opportunity, practices must market their cash-pay services. For example, conduct a “grass roots” campaign, emphasizing word-of-mouth recommendations from current happy patients. Also, use social media to market premium services to Internet-savvy patients. If you believe your practice offers superior services, don’t be afraid to engage in a bit of shameless self-promotion — in a tasteful way, of course. You can “humble brag” on social media about innovative things your practice is doing, or trademark a phrase — “Soft touch cataract surgery,” for example.


Surmounting these challenges — and the myriad others that cataract/refractive practices will encounter in coming years — requires focus, dedication and creativity. Take an incremental approach, and prioritize your efforts.

Also, smart management teams rely on a constant exchange of information and experiences with peers who share this growth mentality.

So as formidable as these issues may seem, using these concepts will help adept practice leaders to succeed where others may falter. OM


  1. Health Care Current: September 16 2014. Deloitte US. . Accessed March 1, 2017.
  2. The Employment Situation - January 2017. U.S. Bureau of Labor Statistics. . Accessed March 1, 2017.
  3. He W, Sengupta M, Velkoff VA, DeBarros KA. 65+ in the United States: 2005. United States Census Bureau. . Accessed March 1, 2017.
  4. Physician Supply and Demand: Projections to 2020. Bureau of Health Workforce. . Accessed March 1, 2017.
  5. Reese S. Can ophthalmologists and optometrists work together? Medscape. Oct. 1, 2013.
  6. Larson PM. The roles of nonphysician practitioners in retina. Retinal Physician. 2016;13:40-44.

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