Oct 24, 2024
Apr 3, 2025
Written By Elizabeth Cifers
The need for retina specialists in the U.S. is growing. Over the past 5 years (2018-2023), the size of the retina market has grown 3.5% per year on average.¹ With a growing elderly population² comes an increased prevalence of retinal disorders, which predominantly affect this demographic. Now more than ever, a proactive approach to practice growth and profitability is paramount.
When considering strategies to accommodate a growing retina practice or looking to meet market demands, assess the efficient use of existing resources before recruiting new physicians or support staff, expanding your facilities, or purchasing new equipment. You may be able to adjust schedules, clinic layout, or processes to solve some of the challenges of growth. Additionally, the increased efficiency of existing resources sets a firm foundation for the future of your practice.
Furthermore, the cornerstone of practice profitability is compliance, for it is through compliance that practices are reimbursed at all. Before adding new resources to your retina practice, smooth any rough edges in documentation, coding, and billing. Throwing more burden onto a struggling or inefficient system will only overload it, creating even more significant revenue inefficiencies. Instead, pave the way to success in your retina practice via proper documentation, coding, and billing.
How does your retina clinic flow? Are you maximizing your resources? The most valuable resource of every retina practice is the time of its physicians. Growth plans should center around making the most of your physician’s time. Decisions about clinic layout, equipment, and scheduling should support keeping the physician(s) in the clinic seeing retina patients.
Retina patients are a mix of old and new, non-emergent and emergent. Your schedule combines recurring injections that can fill the books, new patient appointments that, while crucial to practice continuity, can be hard to fit in, and emergency situations that threaten to derail the schedule. Positioning your retina clinic for growth means optimizing your schedule to fit appointments without going off the rails.
To accommodate new patient appointments, you can keep a few slots open in the early to mid-morning and early afternoon for same-day scheduling. Additionally, these slots can double for emergency patients in a pinch. Consider trying some of these schedule arrangements if you haven’t already before deciding to add more resources to handle the patient load.
While flexibility is a strength in a retina practice, it can be taken too far. For example, practices can develop the habit of disregarding the order of appointment times and taking patients back for work-up as they come in rather than according to schedule. This habit needs to be broken if your clinic will lay the groundwork for growth.
Retina appointments almost always include diagnostic testing. If testing is a sticking point at your retina practice—producing long wait times, decreased patient satisfaction, and a logjam slowing down the clinic flow—look for efficiencies in your diagnostic testing processes before purchasing new equipment.
Other opportunities for testing efficiency include having work-up technicians dilate patients and considering how equipment placement in the clinic affects flow. The efficiency of the entire layout of your retina clinic should be considered when preparing for increased patient demands. Assess whether patients move through the clinic in a single, continuous direction by doing a walkthrough in their shoes. If there is back and forth, seek to eliminate it, moving exam lanes and equipment and changing the purpose of spaces as needed to help with the efficient flow.
Poor documentation and coding are leading causes of denied and delayed medical claims and recoupments, including retina claims. Simple mistakes can result in hundreds of thousands of dollars lost for your retina practice. Error patterns can be identified and corrected through routine chart audits, training, and process improvements before a payer catches them. Oftentimes, fixes are easy and can be implemented immediately. If you want to increase revenue at your retina practice, mending the hole in your pocket by improving your medical documentation and coding is a fruitful place to start.
The golden rule of medical documentation is this: not documented, not done. When changing from one drug to another, there is a significant opportunity for documentation errors in retina practices and consequent revenue loss. A retina physician may have a medical reason in mind when wishing to switch drugs for a patient. However, the payer will see the reason as nonexistent (or worse for convenience) if the logic isn’t clearly outlined in the documentation.
Medical documentation should be clear and concise. It doesn’t need to be long; it should contain only what’s necessary to support the medical necessity of the claim. Watch out for critical errors like 1) EHR cloning without updating the chart to reflect the latest visit accurately and 2) over-documenting to support billing for higher levels of services than were provided. Improving poor documentation is a worthwhile effort over the life of the practice.
Billing is another territory where efficiencies or inefficiencies can significantly impact practice profit and promote or stifle growth. While everyone from the front desk to the physician has a role in the revenue cycle, not only the billing department, it is essential to have the right people in practice billing roles. These people keep the revenue cycle moving and cash flowing in your practice.
A biller should have a sense of urgency about turnaround times—supported by training in solid practice policies, standards, and procedures—and a strong working knowledge of and understanding of compliance. They should have excellent research skills and stay current on all relevant payer guidelines and requirements. A large part of the job of a biller is handling the denial of valid medical claims. The best practice is to respond promptly, accurately, and comprehensively. Billers should also be willing to pick up the phone if they’re not getting a resolution to the denial.
Key revenue cycle analytics can identify billing inefficiencies. The revenue cycle begins with the appointment and closes with payer reimbursement and patient billing for a fully paid claim. Ideally, each step of the cycle is as short as possible. Analytics like Charge Entry Lag and Billed Charge Lag can tell you if billing processes need to be tightened up. Metrics like Claim Denial Rate can clue you to documentation and coding errors that may require investigation.
Putting your house in order is one of the best things you can do to position your retina practice for growth. You may discover hidden resources or efficiencies that prevent you from making extraneous expenditures. You will also be better able to make business decisions because you will have a clearer picture of the dynamics of your practice. Focus on clinical efficiency, compliance in documentation, coding, billing, and revenue cycle efficiency. These areas have a lot of potential to make or break the success of your practice now and into the future.
If you’re currently facing the unknowns of growth potential and weighing where to start, now is the best time to recruit an expert in the business side of retina—efficiency, compliance, documentation, coding, billing, and the revenue cycle. Retina practice consultant Elizabeth Cifers, MBA, MSW, CHC, CPC, has decades of expertise in these areas, including 13 years as a retina practice administrator and a position at a leading eye care consulting firm. She has the tools and keen eye to uncover issues impacting profit and growth. Schedule a free initial consultation today: https://calendly.com/elizabethcconsulting/free-consultation-call.
Source(s):
¹IBISWorld. Retina Specialists in the US – Market Size (2010-2030). IBISWorld. Updated: January 30, 2024. https://www.ibisworld.com/industry-statistics/market-size/retina-specialists-united-states/
²World Health Organization (WHO). Ageing and health. WHO. Published: October 1, 2024. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
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