As I mentioned in my last post, the partners were definitely ready for a dialogue on managing practice metrics. Colleagues have continued lighting-up the Help Desk with great comments, questions, realizations, etc., and so quite literally by popular demand, let’s continue our discussion about managing the “vital signs” of your practice.
As we’ve been having good discussion on metrics, it occurred to me some of the dialogue might be helpful for the broader group. So I’d like to share some conversation of the past few days with you, offering a “Blogger’s Note” to the discussion here and there and a few additional thoughts to conclude our metrics discussion for the year.
1. Colleague Question:
“Hi Tom! We’re doing our metrics and have a question on Capture Rate. If we wrote a prescription the patient didn’t fill at that time, but then came back and filled it weeks or even months later, does that count toward our Capture Rate?” …
Tom’s Reply:
“Absolutely. That’s a capture all day long! Like most metrics, Capture Rate can be figured different ways. But no matter how you this metric, a prescription filled by the practice, regardless of when it was written, is a capture.
That said, what if a patient that didn’t fill that prescription those months (or a year) ago comes in at recall time and we again write the prescription, but this time, we fill it? In that case, for purposes of calculating our Capture Rate metric, we have a new prescription written, AND a prescription filled or captured. Last time we saw that patient and wrote the prescription, but she did not fill it, this was a prescription written but not a capture. Make sense?
2. Colleague Question:
“Hey Tom, we would really like to start doing the MetCHECK, and will jump on board in January. How do most clinics record their Rx’s captured and written? We have many staff here who are emailing and sending Rx’s out. Do we tell staff to record it when they send one out?
Tom’s Reply:
“To keep the Capture Rate metric, we need a few things in place:
1. A way to accurately know how many spectacle Rx’s we write in the practice within a given time period. This may take an additional indicative step by the doctor or technician as the exam is being conducted. Obviously, most patients have some kind of prescription, but we need to make sure we indicate in an appropriate (and countable) way that it was actually written. This Rx is included in the “Prescriptions Written” number. This Rx does not get included in the “Prescriptions Filled” number, however, whether or not we send it out to a patient, unless we actually fill that Rx in OUR practice. And thus, the answer to your good question.
2. A way to accurately know whether that Rx was filled by our practice (any location if we have multiple locations). Remember, a patient might fill an Rx weeks or even months after we write it, but we still log that as a captured Rx the day we fill it. So regardless of when, we need to make sure if we captured the Rx (filled it), we record that as a prescription filled.
3. A person assigned to keep this metric. I recommend someone that spends most of her/his time in optical pursuits as the “keeper” for this one. You can determine as a team the best way to log the captured Rx’s – using the software if able, or with an old-fashioned tick sheet method.
4. A designated time to report the metric (and the other metrics) to the team and have meaningful dialogue on impacting. This is the key! This is what allows the team to respond and be part of our growth solutions.
*Blogger’s Note – If you’ve listened to the new SUMMIT TALK Podlecture (on the Summit site now), you heard that great leaders tend to develop a culture of initiative. This is exactly how we do that!
“So, if you send an Rx out to a patient for them to fill elsewhere, in other words, we did NOT fill this Rx ourselves, it is not a captured prescription. If they take it with them, call from their winter home in AZ and ask for it so they can get glasses while they’re away for months on end, understandable as that reason is for them requesting it, we do not count that as a capture. Only the ones we know WE filled or are in the process of filling.”
*Blogger’s Note – We always record a prescription written at the time we write it. So when we did that patient’s exam, and we wrote a prescription accordingly, we record this as an Rx written. We do not record this as a capture, however, unless we actually fill this prescription in OUR PRACTICE (any of our practice locations) for this patient before she has her next exam and a prescription is again written/recorded.
3. Colleague Question:
“Hi Tom, I was wondering if you have any updated averages for optometry practices’ annual growth percentage for both gross income and patient exams nation-wide (or at least Summit-Wide). We are looking at putting together our goals for next year, and any information would be helpful! Thanks!”
*Blogger’s Note – First, may I say I’m THRILLED this practice team is working on its 2021 written goals! The endeavor of keeping metrics is rendered as wasted time for your team, at least in large part, if we’re not comparing actual outcomes to objectives we have set specifically for OUR PRACTICE (and not just measured against often meaningless benchmarks). Can you tell this one touches a nerve? So, with that out of my system, we continue…
Tom’s Reply:
“In my opinion and experience, there really isn’t much usefulness in a benchmark for practice growth. This is because a benchmark lumps together such diverse situations. This morning, I had a conversation with two owners (father/son) of a seventy-three-year-old practice three generations of the family have owned (grandpa, dad, son). A growth average for them these past few years is 6% - 7%. Recent years after the son joined the practice, however, it was more like 15% - 18%. And before the son joined the practice, it was flat for a time, and before that, down a bit when Grandpa retired. Now, they’re getting ready to move the practice and significantly add to the space. I would now expect a significant increase in growth rate after the move to the new digs – perhaps 15% – 20% would be a reasonable objective now.
These things being said, here are the questions I find useful when setting your growth objective in this chronological order of consideration:
What has been our long-term historical growth rate
What has been our growth rate the past 2 – 3 years?
What is our OBJECTIVE? Literally, what would we LIKE TO SEE as our growth rate? (It all starts with motive!)
What are our main opportunities right now, and our obstacles or possible hold backs?
These things considered, in our best judgement, what is the growth rate that walks the line between pushing us and being realistic? That, then, is your objective for the coming year.
So, for an established practice such as this one, I might expect to see an objective for growth between 6% and 12%. If we’re adding something major in terms of assets for generating revenue, we likely set our sights higher. The practice I mentioned above does a lot of VT. A nearby ophthalmologist just retired for fear of getting COVID, did not sell the practice, and is literally sending all his pediatric patients to the practice. In my mind, this changes the growth objective considerably, and totally unexpectedly, I might add. Point being, we need to be prepared to make adjustments – to coach from the bench if you will.
If it would be helpful, and if you guys want to provide some quick answers to the questions above (your best estimate is fine if you don’t have certain info handy), I’ll be glad to offer some thoughts on what might be a solid objective for the practice’s overall growth rate in 2021. Sound good?”
4. Colleague Question (sent to the doctors in his practice after receiving the MetCHECK Metrics Report)
“These are the (metrics) numbers for Summit docs. In our practice, we are above the average on all our stats except Revenue-per-Patient. We lag there quite a bit. The $40 vision plan exams hurt that number, as does lack of multiple pairs. There are a number of ways we can increase that, including more medical eyecare ($140 exams instead of $40 exams). Don’t know about you, but I think we’re worth that!”
Tom’s Reply:
“Your points here are well made, and I really appreciate you sharing them. In fact, it might be helpful to share them with the Summit Partners!”
*Blogger’s Note – Funny how we tend to look for ways to impact a vital sign the moment we start measuring and reporting it. Exactly why managing metrics as a team literally biases the practice to grow. And for the record, I agree with our colleague – they are indeed worth that!
5. Colleague Question:
“Hi Tom, I had a question on Receipts. Is this metric relevant for us to benchmark as a group given some practices or locations have more doctors than others?”
Tom’s Reply:
“You make a great point! It is especially important with Receipts that we see what direction we’re trending in our individual practices. So we definitely want to keep that metric. That said, this is not a metric for which we look to a benchmark that would be relevant for an individual practice’s comparison. The average on this one does tell us something about the make-up of the Summit practices, and the direction we’re trending as a group, but isn’t meant to be a benchmark for direct comparison to our individual practice.”
OK, Colleagues, there’s a bit of the dialogue the past few days, which I hope is helpful for you and your team as you think about a new year on deck. Now a few closing thoughts on our conversation about metrics.
• In keeping any-and-all metrics, our results ebb and flow as we go along. Something unusual might happen now and then that skews a given outcome briefly, but over time, the graphs will show us exactly what we really want to know: How is this vital sign trending in our practice, and what is our task at hand to continue a favorable trend, or discontinue an unfavorable trend, accordingly?
• For your individual practice, the specific way you choose to calculate a given metric is not all that important. Don’t get all caught-up in whether a colleague figures the metric exactly the same way as you. Just make sure you calculate, and your team reports, the metric the same way every week, which again, tells us all we really want to know about this: How are we trending and what will we do? … like any good “exam” would indicate, right? Remember, it’s all about the direction of the graph.
• That established, for our considerations Summit-wide, it’s important we pick one way to calculate the “group metrics” we’re keeping and watching together, and do so the same way every week/month. Given our unusual opportunity to have a benchmark much more meaningful than a national average, we want to make sure we’re apples-to-apples amongst the Summit practices for our selected vital signs.
• Remember, the first and best way to grow a given outcome in your practice is to define an objective and start reporting our results relative to that objective. Whether being kept Summit-wide or not, if it’s your objective to grow that production metric, start “stating,” graphing and reporting it as a team. And watch what happens!
Well, Colleagues, that’s a wrap for 2020. I again want to thank all partners participating in MetCHECK to date and encourage all of us to jump on board with this in the New Year. We’ll have better practices for it, and the more partners that participate, the more accurate and reliable will be our indication will be of how we’re trending – individually, and as a group. As I mentioned last time, Rome wasn’t built, nor was it remodeled, in a day. So let’s keep on remodeling Rome together, and jump on board!
And now a TOAST, Colleagues:
Here’s wishing you and your loved ones, and your team and their loved ones, a healthy, joyful and merry Christmas and Holiday Season. And in the New Year, I wish you wonderful prosperity, and the joy of great, purposeful work together!