Building a Medical Practice of the Future

1. Building a Medical Practice of the Future J. James Thimons, O.D., FAAO Bud O�Leary, O.D.

2. Do your homework! Who is the competition? OMD�s OD�s HMO�s Hospitals Partners?

3. Practice Growth 1. Same Store 2. Merger 3 Acquisition 4. Practice �Extender� 5. Nursing Home 6. Students / Trainees

4. Practice Growth Community Outreach Go where the patients are! Latino Afro-Carribean African American Diabetic Centers Senior Centers �Doc in the Box� Taking Call

5. Do Your Homework! What is the Competition Technology Who has what? Availability �Home Shopping Network� Regional Health Consumers Trends Web Site Reviews

6. Do Your Homework! Practice Analysis Myth vs: Reality of Medical Practice How many Cookies are really in the Jar? Assessing Practice Potential Diagnostic Codes, VF/2 Understanding Metrics Quarterly assessment Visual Fields, Photography, Gonioscopy, Images Procedures Referrals/ New Patients

7. What Is the Right Technology for You? Speed vs: Functionality Cost vs: Potential Income Lost revenue Recovery Staff vs: Machine Location! Location! Location!

8. What is the Right Technology for You? Visual Fields Full Threshhold Rapid Algorithim Portability Photography �eight track vs: I-Pod Best Systems Imaging GDx HRT OCT Time Domain vs: Spectral Who has the Best System?

9. Do You Really Know Your Staff? Shop �yourself� Technology Lunch & Learns Incentives for Success Is 95% good enough No Shows Cx- Reschedules B&C First Time Success!

10. Keys to a Successful Medical Practice Establishing the Relationship Being There for Your Patients Teaching New Technology Before it Happens Office Education Systems Going �off label� How to make �samples� Work for You

11. Keys to a Successful Medical Practice Managing the Process It all Begins at the Front Desk It all Ends at the Front Desk Office Based Marketing It�s All in the Details Avoiding the �Black Hole� In the End �The Doctor is Responsible�

12. Keys to a Successful Medical Practice The Front Desk is the Key to Success �Flagging� Missed Appointments Rescheduling Cancelled Appointments Getting that next Appointment Getting Questions Answered Transportation Management Teaching the Patient Success Do Not Forget The Most Important Question: Can I Get an Appointment for Anyone else Today?

13. Ten Absolutes for a Successful Medical Practice! Dress for Success 24/7 Access No one leaves without an appointment Know Your Metrics Invest in the Future �Metric� tools don�t work on US engines Confidence goes a long way Samples are for Beginners Great Care always generates Great Income Knowledge creates Volume- Volume from Knowledge Creates Success

14. Setting Revenue Expectations Patients per Hour Patient Mix New vs: Follow up Comprehensive vs: Expanded Commercial vs: Medicare Medicaid A Day in �Cement� Help your Staff Understand When is too many patients too much!

15. Maximizing Your Income! Delegate! Delegate! Delegate! Be Omnipresent/ Not Intrusive Do You Really Need Lunch? Start Earlier than you Think Works! No Phone call is more than 3 minutes! Create a Lieutenant for your Clinic

16. CPT Coding vs Billing Same Store Real vs: Perceived Cost Service What to Look for? What is a Good Price? Are you Large Enough?

17. Ordering Diagnostic Tests Your chart should contain: 1. Your order for the test, including indications for testing (patient complaints, suspected disease, continued care of a chronic disease) 2. The date the test was performed 3. A description of the reliability of the test 4. Objective findings (test results) 5. Assessment, including diagnosis (if any) 6. Your plan; how will the results affect your treatment options (if at all) 7. Your signature to identify you as the service provider and show that you looked at the test

18. �Interpretation and Report� The Three �C�s If the procedure �Requires an Interpretation and Report� you must do it! It is not optional! Clinical Findings Comparative Data Clinical Management

19. Clinical Findings Succinctly summarize you clinical findings, ideally on a separate sheet or discreet from the body of your exam notes. Note if the test is reliable.

20. Tests that Require Interpretation and Report Ophthalmoscopies 92225,92226 Visual Fields 92081, 2, 3 Fundus photography 92250 Scanning laser 92135 External ocular photography 92285 Corneal Topography 92025 Sensory Motor 92060 Serial Tonometry 92100 Tonography 92120 Provacative testing 92140 Flourescein Angio 92230, 35, 40 Ant seg photography 92286, 7

21. Case #1: POAG 77 y.o. BF, CMS, Bankers Trab OU, Propine bid ou, T.5% bid ou ONH: .9 x .8 OU Tg: 22 OD, 21 OS Gonio: TM 360, 2- pig, ALT 360 OU CCT: 497 OD, 505 OS VF: deep loss OD>OS

22. Medical Decision Making Advanced POAG, VF defect, NS Lower, consistent IOP�s needed Plan: Continue T.5% bid d/c Propine, add Lumigan QHS OU RTO: 4 weeks, IOP f/u

23. Coding the visit Hx: detailed Examination: Expanded problem focused Medical decision making: Moderate Multiple Dx and Mgmt options Moderate complexity Moderate risk 99214