Article

Enhancing Practice Performance

Checklists help “pilot” your practice

This simple tool to increase productivity and efficiency checks all the boxes.

For newcomers to the ophthalmic space, the complexity of running a practice is underappreciated. We received a phone call from the administrator of a $10-million Midwest practice. She had enthusiastically accepted her position six months earlier, thinking it was an easy personal succession plan after stepping down as the CEO of a 350-bed hospital. She wanted the last few years of her career to be new and interesting, but also less demanding than running a hospital.

Unfortunately, she found this wasn’t the case. She misjudged the talent and knowledge needed to run her ophthalmic practice, a “surprisingly” complex organization, and decided to resign after six months on the job.

Many dimensions of the organization frustrated and stumped her. In addition to its complexity, ophthalmology (and those attracted to it as providers) inherently demands exactitude. It’s a tough, tough world in eye care if you are not a well-prepared, detail-oriented administrator.

In the face of operational complexity, administrators need obsessive discipline. At least one remedy to minimize complexity is a simple tool used by pilots, ship captains and nuclear energy engineers: a checklist.

A PRACTICAL TO-DO LIST

A checklist is an accountability document that creates a deliberate process. Quite simply, checklists assure that all work is done in a manner you choose.

If you notice that projects get dropped and protocols are unintentionally changed, you may find that simple checklists are all you needed to get back on track. Using departmental-level checklists can help you to hardwire your expectations, streamline processes to make them more efficient and catch balls that would otherwise be dropped. They also remove ambiguity, reduce staff “freelancing,” provide structure and direction for tasks and unclutter communication. In a manager’s always-shuffling world, with distractions interrupting routine tasks, it is easier to cleave to priorities using a checklist as a reference.

Newer managers often need guidance, mentoring and oversight to learn that when they delegate work to staff, they are still responsible for assuring the staff complete it successfully and on time.

Checklists are useful tools to enhance and maintain operational integrity, especially when used consistently. (Even the most experienced pilots do not stop using checklists every time they take off, and neither should the “pilots” of your practice.)

DEPARTMENTAL CHECKLISTS

The following are four abbreviated departmental checklists that you can expand and implement in your practice. Revise them to fit the needs of each department, focusing on your current trouble spots. Also, include middle managers when developing each checklist, as they are likely the ones to whom you or your administrator will delegate these responsibilities. You could even hand them these samples and ask them to bring expanded versions back for your review.

Weekly reception & phone department checklist:

❑ Backed up the computer system daily and stored tapes off-site or in the cloud

❑ Covered the phones sufficiently

❑ Emergency patients worked into the schedule and seen cheerfully

❑ No more than a five-day delay to the next urgent appointment slot

❑ No more than a 15-day delay to the next routine appointment slot

❑ No-show rate at or under 5%

❑ Called all no-show patients within an hour

❑ Did not exceed 20-minute primary waiting time for any doctor

❑ Fairly distributed new patients among the doctors

❑ Notified patients 24 to 48 hours in advance to remind them of their appointment

Weekly patient accounts department checklist:

❑ Verified third-party eligibility before each exam or surgical case

❑ Front desk staff entered demographic data accurately and completely

❑ Collected all possible patient-responsible amounts at the time of service

❑ Posted charges within 24 hours of the services being provided

❑ Submitted claims within 24 hours of posting the charges

❑ Posted payments and made deposits within 24 hours

❑ Collections work proceeded satisfactorily

❑ Turned over delinquent patients to a collection agency

❑ Day-end closings were timely, and all drawers were balanced

❑ Spot-checked laser and special testing equipment logs against charges submitted

❑ Third-party payments were timely, and payments match the fee schedule

❑ Appealed payment denials when unreasonable

Weekly clinical services department checklist:

❑ Doctors arrived in the clinic at least 10 minutes before their first patient was ready to be seen

❑ Techs, scribes and doctors entered accurate and complete chart and superbill data

❑ Checked charts randomly for missing information, missed charges, lack of continuity of care and missed opportunities to provide needed services

❑ Followed up with special testing ordered

❑ Completed dictation within 24 hours and sent consult letters within a week or sooner

❑ No patient charts missing (if you still use physical charts)

❑ Surgeon or a staff member placed evening calls to all surgical patients

Weekly marketing & outreach department checklist:

❑ Asked all departing patients to refer to the practice

❑ Re-appointed all (appropriate) departing patients or put them in the recall system

❑ Sent thank-you notes or calls to patients who referred

❑ Entered referral sources in the computer

❑ New providers who are still building a practice followed through on their outreach and referral development work

❑ Social media and e-marketing completed follow-up work

❑ Total marketing outlays fit with new patient growth goals, neither over- or under-shooting requirements

CONCLUSION

Every department beyond these four examples can develop its own checklists: optical, HR, facilities, regulatory compliance and even the managing partner.

You may receive pushback from managers who don’t want to be held accountable or those who are fearful of staff resistance. Attend a department meeting, and make it a working session to review serial drafts of the checklist while it is still in development.

If you prioritize the use of checklists, the managers will, too. OM