Business, Feature, Report

Solving the practice management puzzle

Ophthalmology optometry practice management

Effective practice management can define a practice’s success. Experienced managers share their hard-won wisdom on how to work smarter across both optometry and ophthalmology practices.

Running a healthcare practice has its own set of challenges, and in the eyecare profession, sub-specialities and specific equipment bring extra layers of complexity to the practice and patient management spectrum.

Insight spoke with four experienced practice and business managers who have each carved a niche in different environments, from independent optometry, to ophthalmology and general practice.

Some common threads stand out, including making decisions about practice management software based on meticulous research and cost-benefit analysis, and the importance of reliable support from the software provider.

Changing ownership of software solutions and constant upgrades are unavoidable, and therein lies the paradox, as one practice manager has pointed out. They were considering changing their software system a few years ago to an improved version of an existing program, but, in their own words, “so many people flocked to it that support went down the tube”.

As systems become more sophisticated and better integrated, they can help improve efficiencies, and reduce double-handling and human error. Our experts discuss new technology in their practices, and the importance of anticipating trends, from incorporating artificial intelligence and automation, to what patients expect as standard.

Review and reflect 

Mr Don Granger is, by his own admission, a numbers man.

As general manager of Rolfe Optometry Group (part of Eyecare Plus) he draws on two skill sets to manage a network of independent practices in New South Wales; a background in accounting and business banking, and more than two decades’ experience in the optometry profession.

Don Granger, Rolfe Optometry Group Practice management
Don Granger, Rolfe Optometry Group.

He joined optometrist Dale Rolfe’s 10-practice network four years ago. Prior to that, Granger worked for optometrist Dr Tony Hanks for 17 years, before Hanks sold his business to George & Matilda Eyecare.

Rolfe Optometry Group, which currently employs 50 staff, has recently undergone changes at ground level which has impacted Granger’s day-to- day number-crunching.

“We had 15 practices 18 months ago, but we amalgamated four, and closed one – their growth didn’t warrant the effort. This was a pre-COVID business decision enacted during COVID. We wanted to make fewer, but larger, practices perform better. Contract for strength. Now we’re on the lookout for new opportunities for growth,” Granger says.

Measuring is key to practice management success, he says, but notes that the time and skill involved can be challenging for single-practice owner-optometrists.

“I’m from an accounting background. I’m all about numbers; weekly numbers, monthly numbers, all measured, compared and evaluated against our KPIs,” Granger says.

“Measuring regularly is key – you can see what you’ve done well, see what you can do better. You can review and reflect, compare year-on-year. Others act on historic data, but by then it’s 12 months too late. Some don’t have the luxury of analysing their numbers on a regular basis.”

Financial figures aside, Granger measures patient communication too, looking at which platforms patients are using to make bookings, and whether those patients are new or returning.

“In the past, we didn’t do online appointments, but we do now through MyHealth1st. I get to see results of online bookings and they’re growing. We’re seeing uptake among our over-60 patient population. Surprisingly, online bookings are utilised more by our existing patients than new patients, at a ratio of about 2:1. It seems our existing patients like the benefit or luxury of booking that way,” he says.

While SMS is also a popular mode of communicating with patients, especially for patient recall, Granger says his data shows email communication is hit-and-miss.

“Patients are reluctant to provide an email address because they don’t want to be bombarded with crap. We really only get about 20% of our patients prepared to give us their email address. They don’t read email. It is under-utilised but I don’t know how to get around it,” he says.

Commensurate with his years in the industry, Granger is well-acquainted with the two main local practice management software systems in optometry; Sunix, now owned by Essilor Australia, and Optomate, now owned by VSP Australia. Both systems have their shortcomings, he says.

“I think there’s a spot in the market for an improved optical practice management system,” he says.

When Insight spoke with Granger, he was dealing with an IT issue at one of the 10 practices he manages spread across the Mid North Coast, Hunter region and Central Coast.

As many practice managers can attest, bugs, corrupted data, and system outages can be par for the course of practice management software, which makes access to reliable support inherently invaluable.

Mr Aaron Kangisser, general manager at The Optical Company (now part of Healthia), advises optometry practice owners to be aware of the pros and cons when investing in practice management systems.

“Not all practice management systems are created equal. Each can have its strengths across reporting, user experience, customer profiles, customer relationship management (CRM) and supply chain, to name a few,” Kangisser says.

“All platforms should have a solid Service Level Agreement (SLA) and be focused on data security, upgrades linked to customer expectation and maintenance to keep their product as a leader. Consider what is important to you and go from there.”

Aaron Kangisser, The Optical Company Practice management
Aaron Kangisser, The Optical Company.

Kangisser has worked across The Optical Company, a group specialising in optometry services, retail and eyewear distribution with a portfolio of more than 40 practices for over 10 years, and says researching software is essential.

“Within any industry, research is paramount to identify the right platform that provides for today and into the future – plus recognising the platforms that are widely used to determine those with the best horizon support,” he says.

“Many people have experienced that a fully-bespoke option, whilst customised to needs, often results in platforms that are resource-heavy for changes and training.”

He adds: “There will always be changes, however a platform with flexibility and support of a development team to update and evolve to keep their product relevant offers businesses a strong foundation and potential for growth.”

Optometry practices know too well the perils of system upgrades – an upgrade was the root cause of the IT crash Granger mentioned earlier – but Kangisser has some tips to manage this and minimise business disruption.

“Many changes occur as part of cycled updates that are designed to address or fix issues and scheduling these upgrades to occur overnight so as not to impact trade is important,” Kangisser says.

“Major upgrades where there is downtime always comes with risk but having the ability to identify impacts and pause to continue business whilst solutions are identified for minimal impact is always a preferred approach.”

Kangisser says this involves practice platform partners working cohesively with IT, operations and finance teams so the technical, people and customer elements are factored into the planning, but also remaining nimble as the plan is carried out.

“Ultimately the end result should be to benefit businesses and the customer-facing teams in stores being empowered by the changes that are designed to streamline activity,” he notes.

Through their industry experience spanning many years, Granger and Kangisser also know the value of timely support and service from software providers. Again, Kangisser says research is paramount.

“Identifying the right partner is very important as you have to be able to have both business-as-usual and business-critical discussions, so it’s important to approach any partner selection acknowledging this will always be the case,” he says.

“Partners establish their level of service based on your needs and capacity, but good partners also understand there will be periods of increased service as platforms update; partners scale; and expectations for data shift.”

To maximise efficiencies, The Optical Company has integrated its systems.

“We have actively integrated the people and product elements working closely and effectively with our PMS provider, so that the practice management platform plays a role as a pivotal business tool. Allowing for levels of access also ensures security and confidentiality are maintained and ultimately accuracy and integrity in the data,” Kangisser explains.

Don’t get sidetracked by software 

Practice manager Ms Lara Sullivan established Bayside Eye Specialists with her husband, Dr Laurence Sullivan, in 2006 employing a part-time orthoptist and part-time receptionist. Today, she manages 17 staff and the practice supports 10 ophthalmologists.

Sullivan has renovated the Melbourne clinic three times in those 15 years to accommodate for growth and has employed two more staff since the start of 2021 to cope with a post-COVID influx of patients, and more complex diseases arising from treatment delayed because of the pandemic.

Lara Sullivan, Bayside Eye Specialists Practice management
Lara Sullivan, Bayside Eye Specialists.

A qualified nurse with a background in human resources, she is a member of RANZCO’s Practice Management Committee and is also a member of the Australian Association of Practice Management (AAPM), a not-for-profit, national peak association supporting effective practice management in the healthcare profession.

Sullivan participated in AAPM peer-support meetings on Zoom during COVID and reads practice management journals and magazines for important updates on pharmaceutical drugs and Medicare item numbers that need to be reflected in practice management systems.

“I try to be in the loop as much as possible and be on the front foot. I like to be informed so I can make the best decisions. I’m always trying to find efficiencies and reduce double-handling. No two days are the same in our clinic, and as practice manager, I need to be across everything,” Sullivan says.

“At Bayside, we have a range of subspecialties – glaucoma, cornea, medical and surgical retina, oculoplastics, strabismus and of course, cataract. Each specialty has their different requirements. We work on a four-week roster, in line with The Royal Victorian Eye and Ear Hospital, and our 10 specialists are supported by staff spread across three teams.”

In addition to five receptionists, seven orthoptists and a theatre-booking team, Sullivan also manages two typists off-site who transcribe letters dictated by the clinic’s ophthalmologists. Each team uses different software, and each software program charges a service fee.

Sullivan’s top-line advice for efficient practice management is to ensure practitioners are seeing patients efficiently, and aren’t side-tracked by their other interests.

“For example, if your software crashes, practitioners need to be seeing patients, not trying to fix IT.”

“Practitioners’ time is best spent seeing patients. It’s really important to get practitioners – be it an ophthalmologist or optometrist – focusing on core competencies. Don’t use their time on tasks not generating income, or not seeing patients,” she says.

When Sullivan established the clinic, she researched the available practice management software and concluded Zedmed was the best at the time.

“There are a few different software programs on the market including Zedmed, Best Practice, VIP, and some clinics use Genie Solutions, Clinic to Cloud or MedicalDirector. They all have their pros and cons,” she says.

“We use Zedmed because I thought they were the best 15 years ago, and we’ve made it work for us. Most upgrades introduce bugs. I try not to be an early adopter. Once you’ve invested in a software it’s difficult to move, not just because of the financial investment but in doctor and staff training too. It’s essential to have excellent and instant IT support. We are very happy with Vibe. Prior to working with them we spent a huge amount of time chasing a ‘proper’ fix for any issues.”

To communicate electronically with GP’s, Bayside Eye Specialists uses Argus and GoFax, while Oculo helps to communicate with optometrists.

“There are other software programs available, such as HealthShare, but each charges a service fee. Most GPs in our catchment area use Argus, so we went with them,” Sullivan says.

“We are heavily Zeiss oriented with our equipment so we also have Forum, which is helpful when counselling patients. We use Quickbooks for accounting, and KeyPay for rostering and for staff to clock in and out. We also use HotDoc to send SMS reminders to patients, and the patient registration details to be completed by new patients. My end-of-month reports are drawn from a number of softwares,” she says.

Before installing and providing training on new equipment or software, Sullivan recommends doing a cost-benefit analysis.

“Consider if the investment will be time-saving, how frequently it will be used, and, in the case of equipment, does it correspond with an MBS item number.”

Sullivan says all ophthalmology practice management systems integrate with Medicare and health funds, although Bayside staff still must individually call the health fund of every patient to ensure they’re covered for the relevant surgery or procedure. More recently, the clinic has adopted e-prescribing technology as part of its aim to streamline processes and reduce paper.

“This technology was fast-tracked in Victoria because of COVID. We’re using eRx Script Exchange. If, for example, a patient requires cataract surgery, our ophthalmologists can generate a theatre booking and simultaneously generate a pre-operative prescription in Zedmed,” she explains.

“The software then sends a QR code script directly and immediately to the patient’s phone, which the patient can then take to a pharmacy. It saves the cost of printing scripts, postage costs of stamp and envelope to mail a prescription, and saves time going through Australia Post. It streamlines double-handling and reduces human error.”

Integration of systems 

Practice manager Ms Kylie Payne met Sullivan last year when Payne was hosting weekly networking meetings for practice managers on Zoom during COVID in her role as state president of AAPM’s Victorian committee.

Payne is business owner of Interconnect Healthcare, a Victorian-based organisation supporting healthcare businesses, owns Kerrie Road Family Medical Centre in Glen Waverley, and manages three other clinical practices.

Kylie Payne, AAPM Victoria Practice management
Kylie Payne, AAPM Victoria.

Despite her medical background, Payne believes practice management, regardless of speciality, has the same fundamental principles that managers need to be across.

“At a practice management level, you need to have great communication with directors and owners, and clear budgets and targets so everyone is on the same page,” she says.

“A practice manager is no different to the CEO or general manager of any other business; you’re responsible for building maintenance, IT and software, payroll, managing clinicians and staff – it’s a balancing act.”

Payne shares the same views as Sullivan in terms of software selection. She speaks from experience, having gone through the process of evaluating key products on the market to replace a practice management system which had been in place for 20 years.

“Once you’ve got a patient management system, try not to change it if you don’t have to. It’s a big investment in cost and time to re-train staff – accounts, admin, clinicians – it’s really challenging. No software program is perfect. You need to find ways to work around what’s not 100%.”

Payne uses Best Practice and HealthLink, a secure messaging service that exchanges private patient information between different healthcare providers and their software systems.

She also utilises HealthShare, a free, up-to-date directory of Australian private practising specialists and allied practitioners, which is also integrated with Best Practice, and HotDoc to manage online bookings, and patient reminders and recalls.

“The IT-space is such a huge area of practice management; every area uses a different platform. It’s getting more specific,” she says.

Payne is also operating e-prescription technology through the practices she manages, integrated with the practice management software.

“Best Practice and eRx Script Exchange are integrated. Although this technology (eRx Script Exchange) was fast-tracked as a result of COVID, it’s not without controversy,” Payne says.

“Software vendors are planning to introduce a cost to the practice per script. This was going to be introduced early this year but has been pushed back to later in the year. It threatens to be a significant increase in operating costs, especially for smaller clinics, for what was previously a cost-neutral task.”

As part of Fast Track ePrescribing, there are two options to send eScripts to patients; SMS and email. There is no charge for email messages, however, during Fast Track ePrescribing, the Department of Health is covering the cost of eScript SMS messages. Once full conformance is achieved, the Department of Health will cease funding eScript SMS messages.

While optometry practices don’t have a need for e-prescription software to directly send patients QR-code scripts, Kangisser – The Optical Company’s general manager – says changes in practice and patient management are constantly on the horizon.

“There are always changes based on the need of customers; efficiency in practice; and expectations based on categories outside optometry for what customers will come to see as standard, regardless of industry,” Kangisser says.

“Automation of processes to ease administration and keep a level of consistency have only been aided by the increased digitisation of everyday lives. It’s important to also adapt changes based on your customer and capacity. It’s always better to implement for success than just be reactive to every change as that creates uncertainty for the people utilising the system daily, plus increases risk of a great addition being overpromised and under-delivered to the customer.”

More reading

A new way of connecting your digital health services is coming

Active ingredient prescribing – eight weeks on

Eliminating inefficiencies and never-events in cataract surgery