| MANAGING
STAFF COSTS
Hiring
the right number of staff and paying staff at the right level are
both key factors in managing staff costs and office overhead.
What
is the optimal number of staff?
The optimal number of staff is an elusive number since so much depends
on practice type and practice style. We have seen practices run
cost effectively with a ratio of fewer than three staff per ophthalmologist
as well as with a ratio of as many as eight staff per ophthalmologist.
Categories
of Staff
Staff is traditionally divided into three basic categories.
-
Back office (clinical staff, techs, supplies, contact lenses,
refractions, assisting with patients)
- Front
office (reception, appointment scheduling, co-pay collections,
authorizations, patient registration)
-
Business office (billing and receivables management, accounts
payable, payroll)
Considerations
for Back Office Staffing
In theory, having more staff can help move patients faster through
the examination process. Make sure, however, that having more staff
is an enhancement rather than a stumbling block and that you have
the space to move patients through the exam. Ask yourself the following
questions:
1. Do you have at least two lanes available for each ophthalmologist?
2. Do you have space for refraction and dilation separate from
those lanes?
3. Do you have a "traffic officer"and procedures for regulating
traffic flow?
4. Do you have enough staff to support the work of the back office?
That is, do you have someone besides the back office techs to
do surgical scheduling, contact lens ordering and fitting, and
supplies ordering?
5. Do your practice’s physician schedules provide all-day work
for the back office staff, or are there lag times and underutilized
staff? If this is the case, can you create job shares to fully
(and appropriately) utilize such staff?
Considerations
for Front Office Staffing
The "hello" and "goodbye" desk is often staffed by the same employee
or by staff also responsible for back office or business office
tasks. This staff sharing can backfire when the front office staff
have to deal with time-consuming efforts to obtain authorizations
or with privacy issues at the same time as collecting co-payments,
etc. You want to make sure that the shared use of front office staff
does not create a negative impression on patients or detain them
from leaving the office at the end of an appointment.
Considerations
for Business Office Staffing
1. Are bookkeeping and payroll outsourced? If not, you will need
to support these services. Have you evaluated the cost of outsourcing
versus the cost of keeping this function in-house?
2.
Is your computer system efficient enough to support the work of
one or more full-time employees (FTEs)? That is, does the computer
capture demographics, generate bills, submit claims, easily produce
aged reports, etc.? Remember, even if you have only one FTE for
the front office, you still want a check-and-balance to protect
you against the same person routinely entering payments and charges.
Keep in mind that understaffing the billing office might be a
false economy since failure to manage receivables and claims submissions
can be more costly than the cost for staffing.
Staff
Salaries
The biggest challenge in hiring new staff (aside from identifying
and hiring the highest quality people) is determining the salary
range that will attract and retain the best quality candidates.
The wide variance in salaries from community to community deflates
the value of national salary surveys. You need to supplement those
national surveys with local information from other practices, community
colleges, training centers, and local and state medical societies.
Analyzing
Staff Costs
Begin by analyzing staff costs in order to allow you to apportion
your staff among the various practice revenue centers (Medical-Surgical,
Optical Dispensing, Contact Lenses, Refractive Surgery, Cosmetic
Surgery, etc.). Most practices will allocate percentages of each
staff member’s time to the various revenue centers. You’ll need
to track the staff cost for each line of business, both by total
dollars and as a percentage of the line’s income. The following
table represents hypothetical numbers to demonstrate this concept.
Business
Line
|
Total
Staff Cost
|
Income
|
Staff
Cost as a % of Income
|
Staff
Cost as a % of Income (Last Year)
|
Medical-Surgical
|
$192,360
|
$854,935
|
22.50%
|
24.20%
|
Optical
Dispensing
|
$34,937
|
$226,865
|
15.40%
|
18.55%
|
Refractive
Surgery
|
$28,125
|
$270,000
|
10.42%
|
15.00%
|
Contact
Lenses
|
$9,000
|
$60,000
|
15.00%
|
16.50%
|
Total
|
$264,423
|
$1,411,800
|
--
|
--
|
%
of Total
|
|
|
18.73%
|
19.95%
|
The
Medical Group Management Association (MGMA) as well as the Association
of Technical Personnel in Ophthalmology (ATPO) publish survey data
annually on overhead costs, by category, as a percentage of income.
This data may need to be adjusted for your specific practice circumstances
to accommodate variations in practice size and in patient or service
mixes. Contact MGMA or ATPO
(for a direct link to the survey) at http://www.atpo.org/PRODUCTS/SURVEYAD.htm.
Ron
Rosenberg, PA, MPH, Author Practice Management Resource Group
Irene Chriss, Editor Director, AAO Practice Management Dept.
|
