My Practice is Growing Even Though I Only See Patients 3 Days a Week

by | Jan 3, 2023 | Moving the Needle with Metrics

What was your biggest challenge in 2022?

When I was thinking about my biggest challenge this year, it’s similar to the challenge I’ve had during all 9 years my practice has been open. That’s how do I work smarter, and not harder? That’s kind of my mantra. I am not a doctor who wants to see patients 5 or 6 days a week, all day long. I want time to work on my practice as much as in my practice, so for me, it’s a question of how I maximize my time. I think that’s really hard for a lot of doctors to do, is to figure out that we know we have to respond in a medical management mentality and we have to do it better than anyone else.

How did you work toward that goal?

The first thing I did was to get an idea where my practice was so I knew what things I could impact to actually move the needle. Understanding where my practice is – my revenue, my payroll, etc. was important. One metric I really focus on is Revenue per Exam. That’s a great one when you’re thinking about how to maximize the patients you’re already seeing, versus working on seeing more and more exams. So making that better was a major priority for me.

In reviewing your metrics, what went really well in 2022?

The biggest thing that had an effect at my practice was really focusing on those services and products that are outside the scope of insurance. We spent time building those self-pay procedures: dry eye procedures, myopia management, lens categories that aren’t covered, and so on. I can’t really increase our Revenue per Exam by concentrating on the traditional “here’s what insurance covers” approach. I had to find other things to work with my patients on, and getting their buy-in on those products and services.

How did that approach impact your patient?

Before 2022, our Revenue per Exam was about $400 per exam, a little above industry average. Looking back over this year, however, it’s grown to between $525 and $550 per exam. So that huge increase has taken us from an “average” practice to a practice that’s in the 85th or 90th percentile.

What does that mean for you personally?

That growth in the RPE means that I don’t have to pack more patients into the number of days that I see them, and I don’t have to spend more days in patient care than I want to. The sweet spot for me is about 3 days per week, and there is a limited number of exam slots in that time. If I am not willing to increase the number of exam slots and patients that I’m seeing, I can still continue to grow my patients. I am seeing practice growth – between 20% and 25% in revenue this year – and I’m really not seeing more patients. The big difference has just been that Revenue per Exam number.

How does your staff respond to this particular initiative?

My staff has given excellent buy-in for this. I put some systems in place to make sure they were being rewarded as we grew. Back at the beginning of 2022, I started a bonus system, that I like to consider profit-sharing. I set a revenue goal at the beginning of every quarter, based on the revenue results I want to see during that quarter. For every month that they hit the target, they get a bonus. There’s also a quarterly goal that carries a bonus as well, and I share 5% of anything above that quarterly goal equally with the staff.

I make sure that the goals are challenging, but attainable, and I share tips or strategies with each staff member to help them understand how they can contribute. In doing that, they have gotten really excited to meet those goals. It really brings them into the decision making process and gets everybody invested in wanting to grow together.

What are you planning for 2023?

This is going to be a big year for us. We’ve been in the process of buying and renovating a new practice building. We’re going from about 1400 square feet, into 4400 square foot clinic. We’ll have 5 exam lanes instead of 2, a dry eye suite, and our optical is going to have more than double the space it has now. So we’ll be focused on growing into that space, and I think we do it by continuing to do the things we are doing now.

A big focus for me is patient education. That’s one reason I really don’t like to spend less than 30 minutes per exam. I think that careful attention to education is a big part of why we are successful; we take the time to learn patient concerns, answer those concerns, and making sure that patients understand why we recommend the solutions that we offer.

Do you have any advice for practitioners planning for 2023?

As you’re looking forward to 2023, take some time to reflect on your practice as it is right now. Take some time to figure out what’s working and what’s not, not just from a revenue standpoint, but also from a personal standpoint. you owe it to yourself to figure out what is and what is not working for you, and then working on changing those things.

I think too many times we get stuck believing that things just “are what they are” and we don’t have the power to change that. I disagree. I think if there are aspects of your practice that you’re not happy with, it’s on you, and they’re 100% changeable. Nothing is written in stone. There’s not just one way to practice, there’s a million ways to practice, and we can be successful at whatever way is going to work best for us.

So take the time to reflect on what really lights you on fire, and plan to do more of it. Find out what’s causing those feelings of burnout, and do less of it, or find someone else to do it. Hire an associate or outsource the things that don’t bring you joy. When you get it dialed in, go all out and build the practice you want to have.

About Dr. Hornberger

Samantha Hornberger, OD is a solo practitioner with a single-location practice in her home town of Lawrenceburg, Indiana. Bright Family Eyecare has just expanded with its first associate provider, and currently has a team of four full-time and one part-time staff. With two exam rooms, the practice has generated enough growth that they will be moving into a new location with more than triple the square footage and five exam lanes during 2023.

Dr. Hornberger has been using metrics seriously for about a year now. The KPI (Key Performance Indicator) she follows most carefully is Revenue per Exam. She began really focusing on her metrics because she felt like she needed a clear picture of where her business was before she could have the impact she wanted to have.

“There’s more than one way to practice, and we can be successful at whichever way is going to work best for us as individuals.”

By Samantha Hornberger, OD

Advocating for optometry and excellent care.


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