How big does your optical have to be before you divide?

[Joyley]

We were really really small 11 years ago. Jobs were interchangeable. Everyone could do everything. Then we got bigger. And bigger. Then we went to Williams Group for help. They told us to divide the jobs; so we have techs (they work up the patient's) we have opticians (you know what we do) and then we have the front desk. What do they do?? I'm not being funny.
I was thinking front desk normally schedules and does reminder calls. Right? One of our doctors wants the opticians to do the scheduling. Everytime we do schedule an appointment, the front desk says we did it wrong.

I'm really wanting to know how other places work. We have two doctors, three opticians, five front desk/billing/whatever, and two techs.

Who schedules at your place? And how do the opticians get the front desk to stop answer questions which should be handled by opticians? ​

[Hayde]

I think Williams Group definitely made the right call here assigning you guys division of labor.

I'm in no position to judge since I don't know your practice. Still, if your 'Front Desk' problems were the natural outgrowth of the fact the Front Desk became the default shelf of your practice's worst HR issues, you wouldn't be the first.

Front Desk is nonetheless a hugely important task to get right. First and last impressions of your practice's "attitude" rely on these folks. They need to be batting home runs for what they do. 2 docs: 2 techs: 3 opticians sounds pretty good. +5 FT front desk staff? That sounds heavy. (Unless your front desk includes those tasked with filing insurance claims instead of your opticians--then that'd be a little more forgiveable.)

There's no substitute for competency and reliability. How does an optician get the front desk to stop answering questions out of their sphere of expertise? That question suggests to me there's a managment problem where opticians are expected to be taking responsibility for the duties of office managers. Or the new flowchart isn't being communicated by the practice owners--or it's simply being ignored.

The numbers will never matter if the office manager is a weak link. Only when they're on the ball might a front desk transform without a 'house cleaning' first.

Good luck Joyley! Interest to hear how things turn out for you.

[Joyley]

Thank you Hayde. It's difficult growing and we have been growing fast. So hiccups are expected. But what do other opticals do? Do they stop at the front desk to schedule an appointment if doctor wants to see them back before continuing on to the dispensary? (The opticians pick the patient's up from the exam lanes.) I'm hoping for solutions to making this run smoothly. How does it work at your optical?

[Jubilee]

Flow will vary office to office. We typically take care of scheduling a follow up visit when we "check out" the patient. If its the optician checking them out at a dispensary workstation, then the optician schedules the follow up as well. If you have a "cashier" or check out desk, then most offices with that set up will take care of the follow up at that time.

Do you have an office admin/manager? It sounds to me that perhaps the doctors are getting frustrated that some follow up appointments are not getting scheduled and they are trying to figure a way to make it work. I agree with the thought that you don't want to interrupt the hand off between doctor and optician to stop by the front desk. It takes away from the hand off.

Even if the opticians "file" the insurance via VCP websites, there is the reconciliation of payments coming in. If you do any medical billing, then someone will be verifying those claims and posting payments, auditing, etc. Sounds like there might be a "division" of labor in the front desk/admin side of things.

[Johns]

In any business, the most valuable personnel are the specialists. Shouldn't everyone be a specialist at what they do? Why have an excellent optician be tied up making appointments, when they could be helping patients? Our front desk staff are experts at scheduling, and the have a direct relationship with each doctor, knowing which prefers what type of exam at what point on the schedule. That's a chemistry that you don't mess with. The same goes for filing insurances, pre-testing, and other duties. Of course, thhere are ALWAYS exceptions.

My rule of thumb is that unless it's a one-man operation, and the one man (or woman) is the owner, then separate.

[Hayde]

Thank you Hayde. It's difficult growing and we have been growing fast. So hiccups are expected. But what do other opticals do? Do they stop at the front desk to schedule an appointment if doctor wants to see them back before continuing on to the dispensary? (The opticians pick the patient's up from the exam lanes.) I'm hoping for solutions to making this run smoothly. How does it work at your optical?

A previous practice I worked for aimed to have the same tech catching the hand-off taking care of the patient until they were out the door--including the pre-appointment for the following year after the materials sales are included. The intention was to eventually have the same tech doing pre-testing catch the hand-off as well in the doctor's office, but that hadn't been implemented before I moved on. (If Williams is telling you the same thing they've told us...it's the virtues of next year's pre-appointment before the pt. leaves the office.)

This leaves the front desk for catching new patient appointments. I agree with John's well-stated insight: Front Desk should be scheduling specialists--in the zone and communing with the docs.

Of course real life intrudes...there are outside patients tying up opticians, late patients jamming up traffic, medical emergency patients, etc. Everybody catches fly balls.

Routinely handing off the patient yet again from optician to front desk would probably diminish the success rate of a pre-appointment. But if the scheduling parameters are convoluted and intricate, I can see opticians frustrating your front desk as you mentioned.

Perhaps this is a solution?

Hand-off, optician sits down at his/her terminal and uses business-chat software with front desk. After the materials sales is concluded, the patient is still interacting with the optician who's taking responsibility for the pre-appoint, but the front desk is actually doing the deed as they know how to do it best. Ties up two staff members at the time, but only for a couple of minutes and with 5 of them at the front I think it certainly sounds doable.

[Jubilee]

If the appointment is a "pre-appoint" for the following year, why not just tell the patient we will be reserving space for you on our schedule, and we'll send you a letter stating that time and date. Please call us to confirm if it will be good or not.

That is what we have done for years. We send out letters 4-5 weeks in advance, and our email system sends out an email 30 days in advance. We give anyone who hasn't confirmed 3 weeks out a courtesy call. If no confirmation 2 weeks out they get pulled off the schedule. We do have a few patients who don't call.. and do show.. but for the most part people will call or respond to the email, and its less hassle all around. Generally I get the appointment done before they leave, so it prints on the receipt as well!

[Hayde]

Sounds like you have it down pat--far earlier than we did! (As time rolled on, I got pretty presumptive about it as well--patients were fine with it.)

: )

[Joyley]

Wish our scheduling was that easy! We have different appointments for different reasons. Learning all the reasons and the time for a certain type of appointments and the fact that our doctors are requesting different scheduling for said different appointments....... I'm actually confusing myself just thinking about it! It's mind blowing.

[Jubilee]

We do have some structure, prefer to keep glaucoma patients in the first couple of hours in the morning, and keep a couple of slots for emergency visits, etc.. but in general we keep things simple.

For those definitive appointment times, I was able to formulate a template in our EHR (Officemate) so that the calendar states if it is reserved for a specific appointment type.

[Joyley]

Thank you Jubilee. Another good idea I'll pass on to our front desk.

[vcom]

I would say the key to making it work is DELEGATION- everybody knows what needs to get done, but sometimes somebody needs to tell which people need to do which jobs.

In our office, (much larger than what you describe, but maybe this will help) most of us are somewhat cross trained, but all the office/front desk staff are specialized.

We have 2 'Hello Desk' staff: check in patients, verify demographics, sign HIIPA, walk to waiting area, do appointment recalls, and occasionally schedule new/annual appointments and answer phones.

We have 1 'Goodbye Desk' staffer: check out patients, collect exam co-pays, schedule annual appointments, occasionally check in patients and answer phones.

We have 1 Demographics/Insurance staffer: Verifies all patients name, DOB, Address, and insurance coverage/benefits, obtains all exam authorizations, and documents all co-pays to be collected, occasionally works Hello Desk.

We have 3 Claim Filing/Billing/Collections staff: pretty straight forward, handles all insurance claims, EOBs, Patient accounts, collections, etc, occasionally fills in whenever, wherever needed.

We have 1-2 Receptionists: answers all phone calls and directs to department as needed, schedules appointments, handles incoming/outgoing mail, scans/shreds paperwork, and more that I don't know about, occasionally fills in whenever, wherever needed.

I have never personally liked Opticians making the appointments, especially when there are so many rules, and exceptions, like we have here, and it sounds like you have there. Sometimes what the Doctor wants, and what is best for the business, aren't always the same *gasp*

Making certain staff a little bit more specialized, delegating certain tasks to certain people, keeping in mind they may need to jump around to help as needed, creates a better flow, and helps to observe where any weak spots may be in the patient flow.