Three Major Labor Cost Concerns in Ophthalmology and Solutions for Each
Scott Honda
University of Phoenix
MHA/543
November 23, 2020
Dr. Lawrence Fergus
Three Major Labor Cost Concerns in Ophthalmology and Solutions for Each
Ophthalmic private practices and the administrators are continually navigating treacherous waters of various labor costs eating away at their bottom line. Each year, practice administrators are tasked with evaluating reimbursement and government oversight changes while understanding the impact social media will have on patient volume. The following will explore how reimbursement cuts, government oversight, and social media have impacted ophthalmic clinics' labor costs while identifying how ophthalmic administrators have responded and how future changes will affect these solutions.
Government Oversight
One of the significant expenses to many ophthalmic clinics has been the requirement to purchase, implement, and utilize an electronic medical record (EMR). The change from paper to electronic format has taxed many clinics to hire scribes to maintain patient visits per physician. 79% of ophthalmic practices have adopted an EMR system, with a general perception of increased costs and less number of patients, while scribes have increased 43% from 2011 to 2016 (Lim, et al., 2018). Early adopters of EMR received government incentives, which helped pay for the EMR and implementation but lacked the long-term effects of increased staffing costs.
Industry Solutions
Dual scribes and scribe utilization are current options to help mitigate the cost of EMR and the decrease in patient visits. A scribe can help improve the physician's speed by allowing the physician to concentrate their time on the patient rather than the computer. A recent study published by Annals of Internal Medicine revealed physicians spend 74% of their time on EMR, documentation, ordering, and a short amount of time focused on the patient (Willis, 2020). Implementing scribes alleviates this sort of physician time spent on computer data entry. Dual scribes allow physicians to place their focus on the patient while having a scribe at all times. Dual scribes allow physicians to achieve the same patient loads before EMR implementation, but they can increase patient visits if utilized and trained correctly. A second scribe may be deemed an increase to the labor expense; however, two or more patients to the physician's schedule far outweigh the labor cost.
Reimbursement Cuts
One of the significant cuts to reimbursement in 2019 was a decrease of $100 for cataract surgery by the Centers of Medicare and Medicaid Services (CMS). Many ophthalmic clinics' gross revenues are based on reimbursement from cataract surgery. A $100 cut in reimbursement can easily reach $100,000 in lost revenues, while the labor costs and office expenses continue to increase.
Industry Solutions
Fee-for-service options and micro-invasive glaucoma surgery (MIGS) are three options for recouping lost revenues. A premium cataract is an out-of-pocket option for cataract patients allowing for a combination of laser-assisted eye surgery and multifocal lens implant. A premium cataract service is considered one of the highest yield ways to improve practice revenue services (Seibold & Kahook, 2019). MIGS is a reimbursable procedure in conjunction with cataract surgery for glaucoma patients.
Social Media
Social media has impacted healthcare significantly, especially private practices such as ophthalmic clinics. Negative reviews and the lack of social media influence can drive both new and established patients away and to competitors. Implementing a social media presence may add additional marketing costs to ophthalmic practices. A recent survey found that 39.4% of ophthalmologists use social media for professional use (Al-Khersan, et al., 2020). The lack of social media presence is a missed opportunity that could lead to a significant competitive advantage for ophthalmologists.
Industry Solutions
Utilize human resources and staff to help manage social media posts rather than outsourcing job duties. Creating a social media team may allow for some additional job opportunities for employees. The revenue from attracting new patients through social media can be highly advantageous and more cost-efficient than advertisement purchases.
Future Outlook
One of the more significant restructures for 2021 is how CMS will redefine the evaluation and management service (E/M) code. In ophthalmology, this means a complete change to documentation and eye code utilization. Two significant changes will come from this change:
1. The immediate impact on ophthalmic technician's time with patients will be documenting history and exam elements, which will allow for either less technician workforce or increasing tech patients per hour.
2. Training physicians and scribes on proper documentation of the assessment and plan and using an E/M code versus an eye code.
Disregard of either of these two changes will cause overutilization of technicians and loss in exam gross revenues.
Conclusion
Government oversight, reimbursement cuts, and social media have significantly impacted ophthalmology by increasing the labor expense. Properly managing and utilizing labor is key to increasing overall revenues. It becomes evident that adding employees can have a significant impact on increasing overall gross revenue. Maximizing opportunities by adding social media, fee-for-service premium cataract options, or MIGS implantation services can overcome the labor expense's ongoing increases. The new changes in 2021 will significantly impact no workflow, documentation, and coding that can decrease labor costs or increase proficiencies.
References
Al-Khersan, H., Lazzarini, T. A., Fan, K. C., Patel, N. A., Tran, A. Q., Tooley, A. A., . . . Sridhar, J. (2020, September 18). Social media in ophthlamology: an analysis of use in the professional sphere. Sage Journals: SAGE Journals: Your gateway to world-class research journals
Honda, Scott H. (2020, November 22). Three major labor costs concerns in ophthalmology and solutions for each. Café Pharma:
Lim, M., Boland, M. V., mcCannel, C. A., Saini, A., Chiang, M. F., Elpley, K. D., & Lum, F. (2018, December 28). Adoption fo electronic health records and perceptions of financial and clinical outcomes among ophthalmologists in the United States. NCBI: Adoption of Electronic Health Records and Perceptions of Financial and Clinical Outcomes Among Ophthalmologists in the United States
Seibold, M. L., & Kahook, M. M. (2019, December 1). The 2020 cataract surgery cuts what's coming and what can you do? Ophthalmology Management: https://www.ophthalmologymanagement.com/issues/2019/december-2019/the-2020-cataract-surgery-cuts
Willis, K. (2020, January 14). Study: doctors spend majority of appointments on electronic devices, but it's not what you think. Atlanta News, Now: Study: Doctors spend majority of appointments on electronic devices, but it’s not what you think
Scott Honda
University of Phoenix
MHA/543
November 23, 2020
Dr. Lawrence Fergus
Three Major Labor Cost Concerns in Ophthalmology and Solutions for Each
Ophthalmic private practices and the administrators are continually navigating treacherous waters of various labor costs eating away at their bottom line. Each year, practice administrators are tasked with evaluating reimbursement and government oversight changes while understanding the impact social media will have on patient volume. The following will explore how reimbursement cuts, government oversight, and social media have impacted ophthalmic clinics' labor costs while identifying how ophthalmic administrators have responded and how future changes will affect these solutions.
Government Oversight
One of the significant expenses to many ophthalmic clinics has been the requirement to purchase, implement, and utilize an electronic medical record (EMR). The change from paper to electronic format has taxed many clinics to hire scribes to maintain patient visits per physician. 79% of ophthalmic practices have adopted an EMR system, with a general perception of increased costs and less number of patients, while scribes have increased 43% from 2011 to 2016 (Lim, et al., 2018). Early adopters of EMR received government incentives, which helped pay for the EMR and implementation but lacked the long-term effects of increased staffing costs.
Industry Solutions
Dual scribes and scribe utilization are current options to help mitigate the cost of EMR and the decrease in patient visits. A scribe can help improve the physician's speed by allowing the physician to concentrate their time on the patient rather than the computer. A recent study published by Annals of Internal Medicine revealed physicians spend 74% of their time on EMR, documentation, ordering, and a short amount of time focused on the patient (Willis, 2020). Implementing scribes alleviates this sort of physician time spent on computer data entry. Dual scribes allow physicians to place their focus on the patient while having a scribe at all times. Dual scribes allow physicians to achieve the same patient loads before EMR implementation, but they can increase patient visits if utilized and trained correctly. A second scribe may be deemed an increase to the labor expense; however, two or more patients to the physician's schedule far outweigh the labor cost.
Reimbursement Cuts
One of the significant cuts to reimbursement in 2019 was a decrease of $100 for cataract surgery by the Centers of Medicare and Medicaid Services (CMS). Many ophthalmic clinics' gross revenues are based on reimbursement from cataract surgery. A $100 cut in reimbursement can easily reach $100,000 in lost revenues, while the labor costs and office expenses continue to increase.
Industry Solutions
Fee-for-service options and micro-invasive glaucoma surgery (MIGS) are three options for recouping lost revenues. A premium cataract is an out-of-pocket option for cataract patients allowing for a combination of laser-assisted eye surgery and multifocal lens implant. A premium cataract service is considered one of the highest yield ways to improve practice revenue services (Seibold & Kahook, 2019). MIGS is a reimbursable procedure in conjunction with cataract surgery for glaucoma patients.
Social Media
Social media has impacted healthcare significantly, especially private practices such as ophthalmic clinics. Negative reviews and the lack of social media influence can drive both new and established patients away and to competitors. Implementing a social media presence may add additional marketing costs to ophthalmic practices. A recent survey found that 39.4% of ophthalmologists use social media for professional use (Al-Khersan, et al., 2020). The lack of social media presence is a missed opportunity that could lead to a significant competitive advantage for ophthalmologists.
Industry Solutions
Utilize human resources and staff to help manage social media posts rather than outsourcing job duties. Creating a social media team may allow for some additional job opportunities for employees. The revenue from attracting new patients through social media can be highly advantageous and more cost-efficient than advertisement purchases.
Future Outlook
One of the more significant restructures for 2021 is how CMS will redefine the evaluation and management service (E/M) code. In ophthalmology, this means a complete change to documentation and eye code utilization. Two significant changes will come from this change:
1. The immediate impact on ophthalmic technician's time with patients will be documenting history and exam elements, which will allow for either less technician workforce or increasing tech patients per hour.
2. Training physicians and scribes on proper documentation of the assessment and plan and using an E/M code versus an eye code.
Disregard of either of these two changes will cause overutilization of technicians and loss in exam gross revenues.
Conclusion
Government oversight, reimbursement cuts, and social media have significantly impacted ophthalmology by increasing the labor expense. Properly managing and utilizing labor is key to increasing overall revenues. It becomes evident that adding employees can have a significant impact on increasing overall gross revenue. Maximizing opportunities by adding social media, fee-for-service premium cataract options, or MIGS implantation services can overcome the labor expense's ongoing increases. The new changes in 2021 will significantly impact no workflow, documentation, and coding that can decrease labor costs or increase proficiencies.
References
Al-Khersan, H., Lazzarini, T. A., Fan, K. C., Patel, N. A., Tran, A. Q., Tooley, A. A., . . . Sridhar, J. (2020, September 18). Social media in ophthlamology: an analysis of use in the professional sphere. Sage Journals: SAGE Journals: Your gateway to world-class research journals
Honda, Scott H. (2020, November 22). Three major labor costs concerns in ophthalmology and solutions for each. Café Pharma:
Lim, M., Boland, M. V., mcCannel, C. A., Saini, A., Chiang, M. F., Elpley, K. D., & Lum, F. (2018, December 28). Adoption fo electronic health records and perceptions of financial and clinical outcomes among ophthalmologists in the United States. NCBI: Adoption of Electronic Health Records and Perceptions of Financial and Clinical Outcomes Among Ophthalmologists in the United States
Seibold, M. L., & Kahook, M. M. (2019, December 1). The 2020 cataract surgery cuts what's coming and what can you do? Ophthalmology Management: https://www.ophthalmologymanagement.com/issues/2019/december-2019/the-2020-cataract-surgery-cuts
Willis, K. (2020, January 14). Study: doctors spend majority of appointments on electronic devices, but it's not what you think. Atlanta News, Now: Study: Doctors spend majority of appointments on electronic devices, but it’s not what you think