Strategic planning for your practice should not be handled by external consultants; it shouldn’t be boiled down to an annual PowerPoint presentation either. Instead, strategic planning should be a way of thinking—continuous critical analysis that is ingrained in the business model and the minds of your practice’s physician leaders. This mode of strategic thinking should be communicated consistently to every member of your team.

In ophthalmology, strategic thinking should focus on improving the patient experience while maintaining a healthy work environment and excellent patient care. This will ultimately improve the bottom line because, when the revenue cycle is operating efficiently and money is collected effectively, the entire patient experience is better, and the physicians and staff members are happier.

Practices should start their strategic thinking with two analyses, best outlined by the acronyms PEST and SWOT.

PEST ANALYSIS

This type of analysis looks at the Political, Economic, Sociocultural, and Technological factors that affect a practice. These external forces define the environment within which a business sets a strategy. Leadership must understand these forces and stay abreast of any changes.

Political Factors

Decisions made by CMS can have a profound impact on ophthalmology, and on retina practices in particular. For example, at the end of 2020, the concept of the most favored nation drug pricing model threatened to change the revenue structure for Part B drugs and biologics profoundly. At the same time, CMS has proposed dramatic reductions in the conversion factor and changes to relative value units within the Medicare Physician Fee Schedule.

Thankfully, lobbying efforts by the AAO, the American Society of Ophthalmic Administrators, and other medical specialty societies stopped the most favored nation proposal and reduced the conversion factor impact—for now. Prior authorization requirements and step therapy programs in the Medicare Advantage world, however, have not ended.

COVID-19 relief programs have been complicated, but they have enabled many practices to survive. Practices that carefully evaluate the potential revenue impact of political changes such as these are better positioned to endure.

Economic Factors

The impact of COVID-19 on the entire US economy has been felt equally in health care. As many businesses were forced to close, patients lost their jobs and, often, their health insurance. Thus, there are now more people enrolled in Medicaid or commercial plans with ever-increasing coinsurance and deductibles. We must anticipate how these changes will affect the net collection rates of practices.

Sociocultural Factors

Ophthalmology continues to benefit from the aging of the population, which creates a robust demand for services. Practices must think about how they will meet that demand moving forward.

Due to the pandemic, consumer attitudes have changed dramatically toward what used to be standard health care scenarios. Patients never liked to sit in waiting rooms, but they now understand that doing so is dangerous. This mindset is likely to persist, even after the pandemic, affecting your patient loads and flow.

Patients have been deferring visits altogether to avoid exposure to COVID-19, leaving gaps in your schedule and building a backlog for the future. In addition, they may be more comfortable receiving services in a small office with limited personal interactions, and they may want procedures performed in an ambulatory surgery center rather than a hospital setting with a higher risk of exposure. These attitude shifts should be considered in your strategic thinking.

Technological Factors

Technological changes have accelerated during COVID-19. New telemedicine platforms allow physicians to remain connected to their patients even when they cannot see them in person. New technologies have also facilitated a hybrid visit model in which patient and physician exposure is minimized.

The shift to remote work has required practices to expand their IT capacity and make technology changes. In addition, ophthalmic equipment has required retrofitting with personal protection—not necessarily a cheap endeavor. Assessing and setting a course to adapt to these changes is critical.

SWOT ANALYSIS

An analysis of Strengths, Weaknesses, Opportunities, and Threats (SWOT) can help leaders design an internal response to the external factors identified in the PEST analysis.

Strengths

These are the tools or resources that will help your practice respond to the external factors within your PEST analysis. They can include anything from state-of-the-art equipment to access to capital, from leadership and staff skills and flexibility to a strong practice culture. Once you identify your practice’s strengths, maintaining them is key.

Weaknesses

These are tools or resources you lack, whose presence could help your practice respond to external factors. The pandemic has exacerbated several common weaknesses:

  • Many practices struggled or were forced to close when they lacked access to capital that was highly leveraged.
  • Practices that had resisted adopting electronic health records and voice-over-internet protocol phone systems quickly realized that these were grave weaknesses when physicians and employees began working from home.
  • Some practices lacked the leadership to multitask and respond to the changes brought on by the pandemic.

Strategic thinkers assess these weaknesses—ideally before a crisis—and work to convert them into opportunities.

Opportunities

There are constant opportunities for improvement in both patient care and practice management:

  • The ability to get paid for telehealth services allowed (or compelled) practices to focus their attention on developing that capability, which will yield results well after COVID-19. Retina specialists have been remotely evaluating fundus photos for diabetic patients for years. With expanding telehealth capabilities and regulatory changes in billing, retina specialists may be able to expand their revenue streams by developing remote testing centers and telehealth services.
  • Practices should use any downtime to train or retrain technicians, scribes, and billing staff.
  • Practices have a unique opportunity to refine the previsit eligibility and prior authorization processes to minimize patient face-to-face time in the office.
  • Now is a good time to ensure that staff members enroll eligible patients in relevant patient assistance programs.
  • Practices should evaluate the effectiveness of their remote workers and determine whether remote work will remain a cost-effective solution for the long term.

Many of these opportunities are easy to implement and can have a significant impact on your practice’s success.

Threats

Rising expenses are a threat when external forces drive practice revenue down. Managers must control costs by working smarter, not harder. Managers need to equip staff members with the tools necessary to succeed. These can include top-performing medical and computer equipment, coding resources, effective onboarding, and ongoing training.

Managers also need to create a culture of teamwork, particularly when employees are stretched thin with off-kilter work-life balances. Unfortunately, many practices do not think through the patient experience touch points, or the revenue cycle process. Keeping staff siloed in front desk, clinical, and back-office roles can pose a significant threat to practices that now need more flexible workflows.

Strategic thinking does not happen in silos. A practice’s patient experience and revenue cycle starts when the call center says hello, schedules the patient with the correct physician, and gathers accurate demographic and insurance information. It continues through to the staff that greets the patient and collects the copay or deductible, the technician who performs and documents testing services, and the physician who performs and documents the visit or procedure.

Billing processes many also pose a threat, as they can affect the patient experience; but many billing errors happen before the claim even reaches the billing office. Thus, practices must perform root-cause analysis of billing errors. Often this means adding billing expertise at the beginning of the revenue cycle. The key is to get the billing codes right the first time because the cost to collect can get extremely high.

FINAL THOUGHTS

Strategic thinking requires looking at all of the external factors that affect retina practices to determine how to respond to challenges. Practice managers should use AAO resources, sign up for listservs, and attend practice management meetings. They can use the knowledge they acquire to look inward at processes that are inefficient and find ways to reengineer them to preserve patient, physician, and staff time. If practice leaders think of each day as an opportunity for continuous process improvement, clinicians and patients will feel the difference every day.