Multiple-Location Practices: 7 Ways to Leverage Them

1. Multiple-Location Practices: 7 Ways to Leverage Them New technologies make it easier than ever for offices that are far apart to share resources, records, and information. But owning and running a multiple-location practice also compounds the administrative, financial, and regulatory challenges that practices of all sizes are now facing. Whether your eye care practice is just opening location number two, or struggling with location number ten, we’ve found seven major ways to make your operations more effective, efficient, and profitable. 1. Forge Connections Multiple-location practices used to wrestle with getting the right health records to the right location at the right time. “Patients don’t always go to the same offices, so in the old days, they would pull the charts the day before and the doctors would actually carry the charts with them to the other office,” remembers Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, AAPC Fellow, vice president of Stark Coding & Consulting in New Jersey. But now, if you have good EHR and PM systems, you can securely access all patient records wherever you are. With physicians and staff bouncing from location to location, and patients sometimes visiting more than one location, you must ensure that your EHR and PM software is securely accessible from anywhere. Many experts now recommend a cloud-based system over an on-site server. Physical servers “won’t always have the IT support or technology to connect everybody in remotely,” Cobuzzi warns, and they aren’t always adequately protected against cybersecurity threats. 2. Staff Smartly Staffing is always the biggest challenge for a busy practice, no matter how many locations it has. Many practices struggle to find reliable, self-sufficient employees in the first place; retaining them when their skills are in such high demand is even harder. Multiply those staffing needs by more than one location, and it’s easy to feel overwhelmed (and understaffed). The clearest way that multiple-location practices can solve staffing problems is to train and promote candidates from within. Forget about the time-consuming work of finding the right outside professional to fill a mid-level position. Simply step your current staff up a ladder of experience inside your practice. That way, whenever a job opens up at one of your

2. locations, an internal employee will be available to fill it. As long as you keep your entry-level positions filled with solid candidates (we know that’s a challenge all its own), and as long as you invest in employee education and development, you’ll build your own pipeline. “If you have an employee in your front office who is hungry, wants to excel further in their career, and is reliable, promote them, train them, and encourage them!” says Tina Allen, operations manager at Eye Surgeons of Indiana, a multi-location eye care practice in Indianapolis. “These employees already know your business and there is less of a learning curve.” This system is also a great way to retain your most talented staffers: “Employees need to feel like there is opportunity for growth within your organization,” Allen says. Otherwise, you’ll always be struggling to keep your existing employees and recruit new ones. 3.Create a Central Plan Most practices assume that every outpost of a multiple-location practice must look and operate exactly the same. Newsflash: they don’t! For example, one location might have fewer hours or patients than another, depending on the needs of its community. This variety can offer an important economy of scale for your multiple-location practice: centralizing certain operations. Priority #1: Coding and Billing “You’ll have someone who can enter charges at each checkout desk,” says Cobuzzi, “but it’s unrealistic and wasteful to have a coding and billing operation at each office. Usually the practice has one centralized office. It might be in the main office or, as some practices are doing now, they rent cheaper space for their coding and billing office, because physician space is very expensive.” You’ll save money by hiring fewer coding and billing specialists, and you’ll also get the added benefit of implementing more consistent processes. Each location doesn’t need to make up its own separate system from whole cloth – instead, all charges are submitted in exactly the way the main billing office decides is best. Office administrators can concentrate on cultivating a top-notch patient experience, not on learning the complicated nuances of coding and billing ops. Priority #2: Phone Ops One candidate for centralizing you might not have considered: fielding phone calls. Front desk personnel may assume that answering calls is an

3. absolutely essential part of what they do, but it actually takes away from face-to-face interaction with patients. “Instead of having the calls come into the front desk, interrupting what it’s doing, try having the calls come into a centralized operator phone bank,” Cobuzzi recommends. She knows of one Detroit practice where “they have a small room with four operators, and they just handle phone calls and make appointments and forward the prescription renewals instead of bothering the front desk. It’s on site in the main office at this particular practice, but it doesn’t have to be.” An added benefit? Front desk staff is often thought of as entry-level, but that’s not always the case. They need plenty of training and experience to provide the best in-person experience for patients. In contrast, just about anyone can learn to answer telephones. So operators are usually entry- level, much easier to find, and much less expensive to train and pay. Also, if streams of phone calls aren’t distracting your front desk staff, they’re less likely to make mistakes that frustrate patients or put PHI in jeopardy. 4. Set High Standards You probably already know that you can save time and money at your practice by setting up standard operating procedures for every task you perform. But this system is especially useful at a multiple-location practice. With so much more to manage, including staff members possibly rotating among locations, standardization makes quality control and seamless operations possible. “The receptionist will be more successful if all of the front desks are set up the same way and the check-in processes are identical [among] offices,” says Holloway. “Having a uniform operations strategy also allows staff members to reduce errors, especially when the office gets hectic.” Compliance in particular gets easier when standardized. Instead of worrying that the added complexity will let important compliance matters fall through the cracks, you can be confident that every location is following regs correctly if they’re all doing things the same way. 5. Master Complex Scheduling A multiple-location practice can give you a real competitive advantage in today’s market, but that doesn’t mean it doesn’t face real challenges too. It can be much harder to schedule doctors, techs and opticians and ensure your staffing levels are correct, especially if staff members travel among locations on a daily basis.

4. “One doctor may be at location one on Mondays and Wednesdays, and location two on Tuesday mornings, and location three on Tuesday afternoons. Depending on how the doctors are staffed, it can be hard for them to manage their days,” notes Cobuzzi. It gets harder when a patient wants a specific location and doctor. That doctor may not be at that location at the time they want to come in. “It’s hard enough getting patients the appointments they want anyway, but having multiple locations makes that harder,” she elaborates. Untangle the Maze of Schedules Start with each physician’s support staffing needs, advises Holloway. “Some practices elect to have a dedicated team for each physician, and that team then travels to different locations with their doctor,” she explains. “Other practices choose to have all of the staff trained to work with all of the physicians, allowing staff to be more interchangeable between physicians and offices,” she continues. “Ultimately, staffing for each location needs to be aligned with the number of physicians and patient volume for each location.” “Cross-training is critical to having an agile workforce. When the team is knowledgeable and can work in more than one position in the office, we have better options to cover vacations and unplanned absences.”—Elizabeth Holloway, BSM Consulting The more flexible and consistent your support staff is, the easier it is for your physicians to jump between locations. Investigate “where [you] can consolidate or share personnel, or train staff to move effectively between locations and functions,” suggests Holloway. “I am also an advocate of training staff such that they can work with more than one physician,” she says. 6. Facilitate Communication Communication is one of the biggest challenges that multi-location practices face. How do you keep everyone on the same page when they work many miles apart? “Communication between offices, physician partners, management, and staff must be frequent and consistent,” Holloway recommends. If you’re having an all-staff meeting, you should actually invite all of your staff! Not possible or practical to assemble everybody in one location? Make sure to set up a videoconferencing service so that that everyone feels included.

5. In-person meetings are great, but they aren’t always an option. For everyday communication needs, practices with many locations depend on electronic communications. “Every Monday, management sends out a ‘weekly communication’ email that includes information about who is out of the office, upcoming training sessions, MIPS reminders, tips on how to improve our patient experience, [and] new projects on the horizon,” says Allen. If all of your locations are receiving regular electronic updates—and asked to contribute when appropriate—it’s more likely those locations will feel like a part of the whole, even if they’re physically distanced from the main office. 7. Maintain Continuity Most multi-location practices have a hub office – usually, their original location – that contains their central administration. This office likely has more staff, longer hours, and more and better equipment. This can present a challenge to patients who are accustomed to a satellite location but need a service that is only offered at the main location. “You could have a visual field test at the south side location, but your IOL Master is on the north side. If you’re going to do cataract surgery, you need that IOL Master, so the patient would have to drive,” Holt explains. “Trying to explain that to patients can be difficult at times. Eventually, you want to try to outfit all locations just like your main location, because not every patient can afford to travel.” Tailor Products to Each Location Conversely, having different equipment and products at different locations isn’t always a bad thing. “You see it all the time with multi-location practices,” Holt offers. One optical shop may have the higher-end eyewear brands. Another will have the more affordable brands. They can each tailor their inventory to the location’s primary demographic. Your business district location and your working-class neighborhood location shouldn’t stock all the same options, for example. Different customer bases have different affordability issues. “I’ve seen some practices that have both high end and low end, because they only have one location,” says Holt. “I’ve seen patients struggle when you have, say, a Prada frame and a Calvin Klein frame, because the price points are very different. If they really like the Prada frame, how are they going to be able to afford it?” This can lead to lower patient satisfaction. Patients may leave your practice feeling disappointed—even though your practice did nothing wrong. By molding your offerings to each location’s demographics, you can use your multi-location practice to better serve your patients.

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