How to improve patient care and practice economics

Excerpted from page 12 of the October 2018 edition of AOA Focus.

The ­financial realities of operating an efficient, high-performing optometric practice can occasionally present an all-too-familiar ethical dilemma for practice owners and staff: How do doctors of optometry provide cutting-edge patient care while maintaining healthy practice economics?

It's a question that doctors must answer for themselves, ­finding equilibrium among the desire to not only deliver top-notch patient care using the most advanced equipment, but also to keep the practice operating in the black. That's why AOA's Ethics and Values Committee (EVC) is devoting an Ethics Forum discussion to helping doctors weigh the challenges and concerns of meeting patient needs. Consider these points from the EVC.

1. Conduct a cost-benefit analysis of new equipment.

Every practice must set and realize certain revenue goals that ensure the practice is sustainable—that's a basic reality of practice. Doctors also should ensure that their patients have access to all necessary diagnostic technologies. Professional services and product sales are the two distinct ways in which practices generate that revenue, says EVC member Satya Verma, O.D., and investing in new equipment or technology would fall under the former. Before purchasing new equipment, practices must determine how long it will take for the equipment to pay for itself. Obviously, some equipment won't be necessary for every patient and, therefore, practices must set reasonable expectations for revenue generation. "A practitioner buying new technology must have realistic expectations (for new equipment) to become budget neutral," Dr. Verma says. This is especially true for specialty equipment that is not used in routine patient encounters.

Generally, practices budget for ­fixed equipment allowances per year, says Doug Totten, O.D., EVC chair. For example, in his own office, Dr. Totten plans for 3% gross revenue going toward new equipment or technologies. "Therefore, upgrades and purchases are just part of the normal business routine," Dr. Totten says.

2. Should we incentivize revenue goals?

Aside from professional services, product sales—eye glasses, contact lenses, lens coatings, etc.—are the second way in which practices generate revenue, Dr. Verma says. Doctors must be careful to avoid unintentionally creating potential ethical dilemmas for staff­ through poorly designed incentive programs. Dr. Verma advises against sales incentive programs that may bonus individual staff­ simply for selling a certain amount of product. Alternatively, Dr. Verma suggests a revenue-sharing plan that would bonus the entire staff­ for an overall increase in revenue based on providing high-quality care and products in an efficient manner. "We need to make sure we're increasing revenue based on practice sustainability," Dr. Verma says. "If you keep patients at the core of that, ultimately you realize your goal, and patients will see that you're focusing on what's most important for them."

3. What's best for the patient is best for the practice.

As the AOA's Standards of Professional Conduct note, "optometrists have a duty to respect the right of their patients to be active participants in decisions a­ffecting their health care. This duty should be reinforced and supported through patient education and e­ffective communication." Furthermore, it adds that fees for services should be reasonable and accurately reflect the care delivered. In other words, when it comes to maintaining healthy practice economics, opting for what's best for the continuation of quality patient care is always advisable.

AOA's Ethics Forum offers answers to your questions

Review this and other hypothetical case studies pertaining to potential ethical challenges in the optometric practice—including suggestions for handling these situations based upon that AOA's Standards if Professional Conduct and Code of Ethics-on the Ethics Forum.

If you have any questions on ethics, please submit them to EthicsQuestion@aoa.org. The EVC will respond to your questions as soon as possible. If you have an ethical challenge you wish to share, please feel free to submit a case description to ethics@aoa.org. The case description will be reviewed by the EVC and may be featured in a future Ethics Forum.