It’s a fine thing to be keeping some metrics in the practice. We’ve been doing that together these past few months. It’s an even finer thing to be keeping those metrics relative to clearly established objectives for each of them (which I HOPE you’re now doing). And it’s a finer thing yet to be having team members report outcomes relative to those objectives in what I call the Weekly Vital Signs Review. These things and more have been the fodder of our last couple blog conversations, and that’s all great. But I think you’ll agree at some point, the idea is to actually IMPACT those outcomes!
So, let’s have that discussion, Colleagues. And let’s do so in a context that’s very familiar to us all – the context of history, diagnosis and treatment. Keeping a designated vital sign (metric) in the practice and plotting this month’s outcome as a point on the graph completes our history, if you will. Connecting the dots and seeing how a vital sign is trending any given month or year relative to established objectives gives us our diagnosis. And most importantly, team discussions on how to IMPACT that trend (continue a favorable trend or change an unfavorable one) is our treatment plan. So, we see yet again just how much the practice is like the patient, and managing the metrics is basically the practice version of patient care. I like to call that practice care, as I think that term is more revealing and more exciting than management.
Receipts First
Let’s start with every practice’s “buck-stops-here” vital sign. That, of course, would be the receipts metric, or actual collected revenue. This is the lifeblood practice metric that determines basically everything, like whether or not the practice is growing, or if we can make payroll. Or if we’ll be able to add that staff person we’ve been wanting, swing the remodel or new building, get that piece of equipment, pay the lab bill or fund retirement this month. It’s the metric that is to the practice what acuity is to the patient.
When you get right down to it, there are only two ways to increase receipts in any business. One is to increase revenue-per-unit (in our case, revenue-per-patient), and the other is to increase volume (in our case, more patients). The thing I love about the former is that efforts to increase revenue-per-patient, provided they’re effective, yield immediate results. Strategies to increase volume of patients take days or even weeks or months to impact collected revenue. That said, you have patients scheduled in your office this very afternoon and tomorrow morning, so our efforts to increase revenue generated from those patients can (and should) literally bear fruit immediately. So let’s start there.
Revenue-Per-Patient “Treatment” #1 – Take the “Selling” out of Patient Care
I have a question for you to ponder: From the patient’s perspective, what’s the difference between patient care and sales?
For me, the answer is simple – it’s who brought it up. If I tell the pediatrician my son has a terrible pain in his abdomen (which I did, in fact, tell him some years ago), and after diagnosis, he recommends an emergency appendectomy, there is no harm and no foul. This would never be perceived as the doctor trying to sell me something, because it was I who brought it up (the terrible abdominal pain). But if my son were in for a “Well Child Exam” (which convincing him to start providing and pre-appointing caused them to build three more offices) and Doc says, “Hey, while you guys are here, why don’t we remove Dane’s appendix?... that doesn’t work. That just feels like full-on selling to me.
Of course, the difference in eye care is we often see our patients in times of perfect wellness. So, unlike nearly all other healthcare providers, something isn’t necessarily wrong. Because the patient therefore doesn’t bring it up – doesn’t have a noticed health problem happening – your treatment plan based on optimizing life outcomes pro-actively can feel, well … “salezy” Your treatment isn’t any more an act of selling than the surgeon selling surgery, it’s just that nothing terrible had to happen for you to provide your best judgement. This is the great blessing of optometry, but is also the origin of being tricked into feeling like we’re selling something (and terms like “lifestyle selling” certainly contribute to that feeling!).
I’ve never considered your treatment in any way an act of selling. I’m just not going to be tricked into that. Granted, there may well be nothing terrible happening that caused this visit to the eye doctor, but your treatment plan, like any other doctor’s treatment plan, is nonetheless an act of patient care. Literally. When we treat it that way, and simply offer our best judgement based on purpose (quality of life), a funny thing happens to revenue. It goes up!
That established, to make sure our judgement never feels “salezy,” simply give your patients more opportunities to express their need and desired treatment – to bring it up – by asking the right questions in the history. Since they’re not in for terrible abdominal pain, like my son was, ask questions like, How many hours per week are your eyes exposed to harmful blue light from digital devices? Or, Are there times you’d rather not wear glasses? Or, Are you interested learning about the newest technology for preventing your glasses from fogging-up or scratching? Seriously, who says no to that these days?
So, it’s action time. Take a few minutes this week to sit down with your staff and decide what additional treatments you’d like patients to pursue in your practice. Whatever these are, give patients opportunities to bring it up in the form of desired treatment. Form questions regarding these treatments that allow patients to hear themselves say, YES, I’M INTERESTED IN THAT TREATMENT, not unlike they’d be interested in having the abdominal pain cured or bad shoulder fixed. Then, like the good doctor you are, just do your job! … “Tom, one of the things you mentioned in your diagnostic form is that your eyes are seeing a lot of blue light, likely more than ever these days, and let me tell you why I’m concerned about that …”
Do you think when your doctor talks to you like that you’re listening? This is treatment, Doctor, not “lifestyle selling!”
Revenue-Per-Patient “Treatment” #2 – The Doctor’s Recommendation.
If we’ve been at a convention together, there’s good chance you’ve seen me jump up on a table and have you repeat after me, very robustly … “I recommend, and I also recommend!” It dawned on me thirty-five years ago that these words are, without a shred of doubt, the holy grail… the end all…of increasing revenue-per-patient. Then and now, no other single thing can have as much impact on the patient’s quality of life, nor on practice revenue, at this very moment, than those words.
When my wife had suffered two bleeds from a brain aneurism, I literally had a life changing conversation with the brain surgeon. He offered three options for how we could approach the brain surgery, along with information, risks and possible outcomes for each. As I pondered these options, I asked the question I think any of us would ask. You know the one – “If this were your wife, Dr. Dan, what would you do?”
His answer was perhaps the greatest example I could ever give of the power of the doctor’s recommendation. He said exactly this: “Tom, if this were my wife, unequivocally, one hundred times out of one hundred, I would do option three.” As long as I live, I will never forget the directness – the helpfulness when help was needed most – of that clarity of judgement.
So there you have it – the difference between what the doctor is capable of providing, and the doctor’s JUDGEMENT on the BEST thing to do – that’s the holy grail of best patient outcome AND best practice outcome. When the doctor’s judgement was a matter of life and death, I never thought for one moment that the recommendation had anything to do with sales. But for some reason, in times of wellness rather than sickness, I see again and again this kind of direct indication of judgement avoided for sake of feeling “salesy” or high pressure. Only to have the patient look at you and ask the same question I asked the brain surgeon … “What do you recommend, Doctor?” For every patient that asks you that question, five thought it but didn’t want or have time to ask (because the time was used-up on options). And the result of that can be, and likely is, a lesser quality of life for the patient and less revenue for the practice.
Isn’t that the cat’s meow? Isn’t it amazing and wonderful that in a mission-driven practice, what’s good for the patient is good for the practice? I call that Marketing Rule #6, and we’ve talked about this for decades (often when I’m standing on the table!).
I know it should be harder than this, but it isn’t. Use the words, “I strongly recommend …” or better yet, “I strongly recommend, or I also recommend …” and watch what happens to revenue-per-patient, and as a result, your Receipts metric. Watch what happens when we truly do our jobs as “the doctor,” rather than fear being perceived as “the salesperson” (and thank God the brain surgeon didn’t fear that!). What’s also super cool is we actually save time this way, and don’t spend a dime to grow the practice (spending money to grow the practice can be overrated!).
Revenue-Per-Patient “Treatment” #3 – The Baton Pass
This is another timeless strategy for increasing the revenue-per-patient part of receipts, and on which I’ve written and lectured for decades. Some call it the “hand-off” nowadays, but regardless of the terminology, it’s still a game changer.
The reason is simple: it gives the patient desired assurance (and the perceived value that comes with it) that the judgement and expertise of the doctor has passed effectively to whoever is next in ensuring the patient’s best outcome (which is, in so many words, the purpose of the practice in the first place, right?).
Let’s think about it from the perspective of the patient. When you’re seeing the doctor and multiple parties are involved in your visit, with case history questions having been asked by more than one party, you have the obvious question in your mind, right? ... “Are these guys on the same page here?”
To make that crystal clear, I like for the baton pass to occur in the presence of three parties (patient, doctor, person taking it from here), and for three things to occur in what I call the Trio of Participation:
1. Doctor repeats the recommendation (“I’ve been talking with Mrs. Jones about XY and Z, and I have recommended a couple specific things for her”). The doctor is addressing the staff person ‘taking it from here,’ but to whom is the doctor really speaking? Therefore, it’s critical the doctor clearly summarizes her recommendation before passing the baton, clearly demonstrating everyone is on the same wavelength.
2. Doctor asks (literally asks) the person receiving the baton to do something specific (“Will you please show Mrs. Jones X?” Or “Will you please talk with Tom about Y?”). This is when the patient accepts the person receiving the baton as the primary source of expertise. This is a consumer behavior weird people like me actually study!
3. The doctor makes a deliberate, structured exit (“So, Mrs. Jones, Teresa is our lens and frame specialist and will lead the way from here, and of course, you both know where to find me if ….”). Now, Doctor, GO AWAY! … Like right now!
It’s interesting how many colleagues have shared with me that they are working reduced schedules since early last spring, yet are holding fairly steady with revenue despite that. I’ve heard a number of speculations as to why this is, but I’m certain of the answer. It’s simply that we take the time (because we HAVE the time) to do things like this! Remember, every dollar grossed by the practice is not equal. Some dollars produced (revenue-per-patient dollars, for example) are more profitable than other dollars produced (dollars generated by more volume, for example). Profitability is not about how busy you are. It’s about how you are busy.
Receipts “Treatment” #4 – Medical Billing
This one has been covered as much as any topic in this day and age, but it merits mention in any conversation about growing revenue-per-patient. It’s critical to the welfare of the practice, and therefore the welfare of the patients it serves, that we charge, code and bill parties correctly for medical eye care. Doing so has significant impact on revenue-per patient, and of course, the overall Receipts metric.
So Let’s Get to It!
Again, Colleagues, the beauty of initiatives for increasing revenue-per-patient is that the impacts are immediate. They have impact on revenue, on the Receipts metric, this very afternoon. Having had this discussion, let’s get our implementation hats on and put these things in place this week to be an even better – an even more mission-based – provider for our patients; and increase revenue while we’re at it. As we’ve discussed, Rome wasn’t remodeled in a day. So let’s keep remodeling Rome together, and we’ll pick it up there next time.