Top 10 practice management mistakes


During a presentation at SECO, Mark Wright, OD, FCOVD, outlined 10 common practice management mistakes that are affecting your patients’ experience and your bottom line.

Atlanta-During a presentation at SECO, Mark Wright, OD, FCOVD, outlined 10 common practice management mistakes that are affecting your patients’ experience and your bottom line.

1. Dropping the handoff

Dr. Wright says there are five ways to handle the handoff from the doctor to the optical staff:

1. Optician is with the patient the whole time from check-in to the optical.

2. Optician is called into the room before the case consultation.

3. Optician is called into the room after the case consultation.

4. The handoff to the optician takes place in the optical department.

5. The handoff is handled through the file holder.

“Based on how you do that, it will dramatically impact your treatment plans completed,” says Dr. Wright. If your treatment plan isn’t completed, that means either your patient decided not to go with your recommendation or-worse yet-took your recommendation and filled it somewhere else.

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The first option-keeping the optician with the patient the entire visit-is the most effective because it gives the optician time to bond with the patient, says Dr. Wright. After completing every step of the eye exam, the doctor, the optician, and the patient go over the recommendations together, which increases the likelihood that the patient will then complete the treatment plan.

“No matter what you, the doctor, do in the exam room, when the rubber meets the road-when the decision is actually carried out, it’s in the optical with the optician,” he says. That means that the last two options in which you conduct the handoff in the optical as opposed to the exam room are the least successful.

He also recommends that the OD sit beside the patient while describing the treatment plan with the optician sitting on the other side, with neither at more than a 45-degree angle.

“If the optical staff is not a part of the conversation at that point, I am going to bring them into the conversation,” says Dr. Wright.

When you bring the optical staff into the conversation, emphasize the value of the vision solutions you’re offering-the high-tech lenses, the best manufacturing, and the high-quality frames.

Next: Managing by emotions instead of trends


2. Managing by emotion instead of trends

“The average growth in the average practice was 4 percent in 2014,” he says. “The average rate of inflation for the last three or four years was about three percent-so that’s a 1 percent increase. It’s important for you to understand that.”

So, if at the end of the year, your practice numbers are the same in 2015 as they were in 2014, it’s actually a loss due to inflation. You have to grow your practice at least at the rate of inflation, says Dr. Wright.

Related: 4 steps to adjust staff salaries

In order to do that, you must measure to manage.

Dr. Wright says it’s important to manage by the numbers and not by emotion. A few of the numbers you want to mange inside the practice include:

• Dollars collected  (“We can all agree that dollars billed is an imaginary number-dollars collected is what you put in the bank,” Dr. Wright says.)

• Number of exams

• Number of complete exams

• Number of new patients

• Dollars collected per exam (“In today’s managed care world and in the coming Affordable Care Act world, if you do not understand this number, you are going to get hurt, absolutely hurt economically because you will get into a hole very quickly,” he says.)

• Dollars collected per complete exam

• Capture rate

• Expenses


According to Dr. Wright, your expenses should break down roughly like this:

• Cost of goods: 25 percent

• Staff payroll: 20 percent (18 percent for new practices to 22 percent for older practices)

• Doctor payroll: 20 percent (total for all doctors in the practice)

• Overhead: 10 percent

• Marketing: 1 to 2 percent

• Occupancy: 8 percent

• Clinical equipment: 1 to 2 percent

Next: Lack of written goals


3. Lack of written goals

“If you don’t have written goals, you’re just wishing that your practice is going to do better,” says Dr. Wright.

In order to set goals, decide what you want your practice to be in three to five years and then set your number goals necessary in order to meet that goal.

“Most practices live in crisis management. You spend every day putting out fires all day long,” says Dr. Wright. 

Dr. Wright challenges ODs to spend one half day per week working on practice strategy. He recommends stepping away for three hours each week to focus on how to improve your practice and work toward those big-picture goals.

“Fear is the greatest paralysis in a practice,” he says. “Work on your practice, not in your practice.”

Related: Avoiding legal trouble with your practice 

4. Poor staff management

Dr. Wright says he consistently hears from ODs that staff is among their top three concerns at their practice.

“Your staff represents you. Your staff is the number one reason why patients leave your practice and don’t come back,” he says.

All staff problems can be categorized as either a head problem or a heart problem. Head problems are educational and can generally be addressed through more training. Heart problems are a bit more difficult-if a staff member doesn’t want to do the job she has been assigned, it’s not going to work no matter how much training you provide. If you cannot shift her into a position for which she would be better suited, it’s time to let her go, says Dr. Wright.

“If you keep that person on, she will damage your staff, she will damage your patient care,” he says.

But this is an employer’s market, not an employee’s market, so build the best staff for your practice now, says Dr. Mark Wright.

Next: Improper billing


5. Improper billing

Dr. Wright says that a recent study found that the average doctor leaves $100,000 on the table every year due to inadequate billing. Some ODs code lower in order to avoid an audit-but guess what? Dr. Wright says coding lower will flag you for an audit because you will be marked as an outlier.

“Code appropriately for your 99000 and 92000 codes. The most common mistake made in the 92000 codes is that you must make at least one general medical observation about your patient,” he says. “If your documentation does not show at least one general medical observation, they’re going to ask for the money back. That’s what the auditors are looking for.”

Related: 7 financial challenges ODs will face in 2015

6. Under prescribing

ODs need to offer vision solutions for home, school, work, and play to every patient, but most aren’t.

“Those four arenas need to be in your case presentation. ‘Here’s how we’re going to improve your quality of life at home, school, work, and play,” says Dr. Wright.

He says doctors have to stop assuming patients can’t afford certain options. If it’s the best option to meet your patients’ needs, recommend it. Prove that it will improve their quality of life.

“Too many eyecare professionals are trying to be the patient’s banker instead of the patient’s eyecare professional,” says Dr. Wright.


7. No exit strategy

“If you don’t do anything else, I want you to come up with two written exit strategies,” says Dr. Wright. There are two types: vertical and horizontal.

The vertical exit strategy is in place should you choose to walk out of the practice, transition the practice, do something different, etc.

“It is not fair to your patients and it is not fair to your partners if you do not have a written exit strategy,” he says.

The horizontal exit strategy is in case of death or other major crisis-an emergency plan for selling, closing, or transitioning the practice with all the proper documents in place.

Next: Failure to pre-appoint 


8. Failure to pre-appoint

Dr. Wright says that pre-appointing is the best way to get your patients back in your chair to follow up and for a yearly exam. You are able to give them an exact date and time they will return before they leave your practice instead of waiting on them to decide on their own to schedule an appointment.

Related: Online appointing to surge

“Twenty percent of your patients will say ‘I don’t know what I’m doing next week, let alone next year.’ But I’m going to build my practice for the 80 percent-not the 20 percent,” he says.

9. Hiring for skills instead of personality

“You cannot change someone’s personality. I can train the skills,” says Dr. Wright. “The mistake most practices make is that they’re looking to hire an optician-I’m not. I’m looking to hire someone with the right personality to fill that job.”

If that person has both skills and personality, that’s great, but if he is lacking in skills, it’s not a deal breaker, he says. If he has the technical skills without the personality, it’s not going to work.

Next: Not knowing your patients


10. Not knowing your patients

Dr. Wright suggests offering an anonymous survey to every patient. The first question should be, “On a scale of 1 to 10, how likely are you to recommend our practice to a friend?” The answer to that question will tell you a lot about your practice. Anyone who rates your practice from zero to six are your detractors. Anyone who rates your practice as a seven or an eight are the passives. “They gave you the most milktoast answer in the world,” says Dr. Wright. But your nines and your tens are your promoters, and those should far outweigh your detractors.

The other questions you should ask include:

• What did you like about your eyecare experience today?

• What would have improved your eyecare experience today?

Knowing where your practice excels can help your marketing efforts, while knowing the weaknesses will show you where you need to improve. 

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