Not Enough Quality Time With Your Patients Is Bad For Both Of You

I have never been one to place the blame of my circumstances on others.  That is maybe why I am so totally happy with my life that I take full responsibility for it.  In fact, it may be a question of the chicken and the egg as far as the genesis of how all good outcomes come about.  Is it your mental state of mind or the great results that state of mind produces? I believe having a victim mentality is counter productive to healthy growth whether it's your practice or physical status.  So when it comes to your practice, it would be best for the long haul if you take personal responsibility as to it's direction.  Perhaps you thought that you do - but if you have a practice that is heavily insurance based, you may want to reevaluate.  Likewise decisions that we make on a daily basis should be the center of a well laid out plan of development, but often times are a result of circumstances that are being dictated from a third party.  

One of the things I look forward to every year is meeting up with new colleagues who are seeking advice on how to increase their profits.  These docs are usually very confused because they have played by the "rules" and yet they are just getting by.  It's also quite obvious that these practitioners are very good when it comes to diagnosing medical problems or prescribing the latest wave front designed lenses.  But, when it comes to management of their practices, they are receiving a failing grade.

My wife Chris and I will usually spend several hours with them first hearing of their difficulties and then usually offering at least ten different things they can do to change their bottom line.  Often these changes will actually enhance the care they deliver to their patients in both a material and service form.  So it's usually a win-win for them.  The first item we address is to get these docs off the mentality that the only way they can compete is to offer all the insurance plans that their perceived competition offers.  It's very telling that usually by the time we are through with the discussion, this whole scene of who is your competition will change dramatically. right before their eyes.The story we tell them here is its all right if you want to accept some insurance But, make sure it's paying you enough so that your not committing what I call "practice suicide".

Which brings me to a central point - Insurance in the best of light is not a substitute for good practice promotion.  Just because you believe that these plans will bring plenty of patients to your door is not a good reason to accept them.  The opposite is true.  Making your practice dependent on insurance plans will make you noncompetitive in both principle and practice.  The busy practice generated by insurance which is high volume and poor profit margins will lull almost anyone into a noncompetitive state.  This happens due to what I call the "insurance hangover" generated by too much of in this case a bad thing.

An insurance heavy practice is not working for that doctor, rather it's working for the insurance company which beside your patients is the only other real entity in this transaction getting any value from it.  Your practice in this scenario becomes to the patient just another vehicle to deliver goods.  These patients are not loyal to your practice - they are loyal to the insurance company.  If you haven't figured this out, then I have a little object lesson for you.  Drop the coverage and see how many of your patients return to you for care.  I can answer that from my personal experience - it's very few.  That's just the on the surface of obvious problems generated by too much insurance in a practice.

The other side of this is the care you deliver.  Playing by the rules, you get about ten minutes alone with each patient with the rest delegated.  You have to do this because they don't pay you enough to spend anymore time with your insurance patients.  That actually is the core of the problem and even the federal government is aware of this.  To treat your patients with an approach that will lead them to healthy happy lives - you have to spend the time with them to counsel and educate.  It also turns out that you need to spend time with them if you want to grow a profitable practice.  This is what I call the inconvenient truth that no one wants to deal with in Optometry school or beyond.  It turns out that this Helter Skelter way of practicing insurance based care is not healthy for anyone.  

What becomes of a doctor and his/her practice when they become largely insurance based is a noncompetitive practice grown lazy over time not spent in promoting itself and it's services to the public at large.  A practice that is so dependent on the "insurance" business it would fail instantly if that same insurance carrier pulled it's coverage.  It's kind of like those potato farmers in New Zealand who saw their business growing so large with McDonalds that whenever corporate would come by and threaten to pull it - they were forced to accept lower prices on their goods until they ended up losing their shirts in the process.  It's not a pretty picture.

I like to focus on the positives when I discuss this with my young colleagues, so I emphasize the return that is likely to come their way if they can figure out this puzzle before they become too dependent on insurance.  That return is fostered directly from the time spent educating their patients on healthy outcomes with products and services they offer to take care of their present and future visual needs.  This approach requires that they must carve out time in their schedule to talk this up.

So the first things that go are poor plans that are not paying enough in reimbursements or require to much staff time in relation to that same reimbursement.  The openings created by this in the schedule can allow for the extra time that will be applied as patient contact.  Doctors can then educate the patients about nutritional supplements, vision training, computer eyewear, specialty contacts, corneal reshaping, the latest medical breakthroughs and themselves.  They can also take a more personal hands on approach to their care which is instantly perceived by the patients as value added services.  The bottom lines go up substantially along with that satisfaction which is a long held axiom of any successful business. 


- Cary Herzberg OD FOAA

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