MAKE LIFE CONVENIENT FOR DOCTORS The River Drive Surgery and Laser Center accepts every insurance plan and stocks every intraocular lens surgeons desire.

If we're not the busiest cataract surgery center in the country, then we're right up there in the top 5. The 42 ophthalmologists who have privileges at our center performed about 13,500 eye surgeries last year in our 5 ORs. We probably do many of the same things that you do to run a lean and mean center, like letting our patients keep their clothes on during surgery, and rewarding our busier and faster surgeons with double-room block scheduling. But we also do a few things here at River Drive Surgery and Laser Center to boost efficiency and drive volume that perhaps you haven't considered yet. Let me share some of the secrets to our success with you.

1. Huddle at the start of each day. Hadley Phillips, MD, our center's majority shareholder, is an outstanding surgeon and an astute businessman. Dr. Phillips and I meet for 10 minutes each morning in my office to review and plot the day ahead. We carefully scrutinize block time scheduling and the day's staffing — we want to be fully covered, but we don't want to pay overtime to idling staff. We anticipate doctors' needs, and make sure we have all the right equipment and implants in place. If we have a fast surgeon on the schedule, we'll compress the schedule in order to get him 2 rooms — or even 3, if he's extremely fast. If we have a slower surgeon doing a few glaucoma procedures, we'll be sure to schedule that doctor in 1 room.

2. Make your facility irresistible to surgeons. You can never have too many docs bringing cases to your facility; 27 of our 42 surgeons own a piece of the center. So the next question is: Is your facility a desirable place for surgeons to bring their patients? Give your docs the best service, including:

• State-of-the-art technology. Invest in the best instruments and equipment with the most advanced technology. We lease 2 different femtosecond lasers. Many surgeons come to us just to have access to our lasers and to offer their patients laser cataract surgery. We do 150 to 200 femto cases a month.
• Expert staff. Use only ophthalmology-trained anesthesiologists and expert nurses.
• Compassion. Treat patients like they're family.
• Never say no. We let docs implant whichever IOLs they want. Stocking so many brands of intraocular lenses makes for an inventory nightmare, but we want our docs to use whichever lenses they want. We're contracted with virtually every insurance carrier in our area, so surgeons never have to worry about us not accepting their patients' health insurance plans.

3. Ensure rapid turnover. Perhaps more than any other specialty, cataract surgery relies on ultra-fast room turnover. Getting your doctors from one case to the next case is critical to profitability. We have 5 ORs. We schedule 6 surgeons a day: 3 in the morning and 3 in the afternoon. Some get double rooms, depending on their speed and their caseload. Stay on top of your surgeons. Make sure they deliver the patients they promised you. We watch over our block schedule like a hawk, monitoring it daily, weekly and monthly. If a surgeon told you he'd have 10 cases next Tuesday but he only has 6, adjust your staffing accordingly and condense the schedule. Per-diem nurses give you staffing flexibility, but a 2-hour void between the morning and afternoon schedule can kill your profit margin.

4. Stock up on supplies. Nothing can grind your day to a halt like having to postpone a case because you don't have enough instruments. Never delay a surgery because you don't have the needed instrumentation ready. We're well stocked with both top-notch ophthalmic instruments and 4 autoclaves. We do wrap loads at the end of the night so that everything's prepared for the next morning's cases.

It helps that we're a single-specialty facility. We don't have to worry about mixing instruments during reprocessing. For example, you can't mix eye instruments in a GI bath. It also helps that we have a certified reprocessing staff. We avoid immediate-use sterilization (flashing) at all costs. That meant we had to purchase additional instrumentation to accommodate longer reprocessing times necessitated by a full cycle of steam sterilization plus drying time. But we looked at that expense — and that of the purchase of the closed steam sterilization trays — as an investment that helps cement our leadership position.

WELL-STOCKED Never delay a surgery because you don't have the needed instrumentation ready.

5. Partner with vendors. Think of your vendors as your business partners. If you treat them right — meaning, if you're a good customer and you pay in full and on time — and negotiate well, your vendors can be great assets. For example, they can overnight you needed supplies, pick up returns, and offer you free shipping and handling, which alone can be a huge saver. One thing more: Never say yes to the first offer of a contract renewal. If the vendor comes in with a price increase, ask if they can come in the same or even a little lower. They'll say no at first, but if you hold your ground, they might call a few days later and meet your price. There's always room for negotiation. Never get too comfortable with contracts and vendor relationships.

6. Prepare patients before they arrive at your facility. From when they can no longer eat to whom they'll meet, it's your job to let patients know what they can expect at your facility before they arrive for surgery. The fewer surprises they have, the better flow you'll have. We employ a "customer service rep" who greets patients as soon as they arrive in the waiting room. Our surgical concierge answers questions and puts patients at ease. Patient satisfaction surveys continue to provide suggestions for constant improvement. Stellar patient care remains our top priority.

7. Stir surgeons' competitive fires. We hold quarterly owners' board meetings. At one of these meetings, we present each surgeon's annual cost-per-case data for the whole group to see. It's a lot of work on our part figuring out which lenses they used, their OR times, the reimbursements for the cases they booked, and the instruments and supplies that were on the field. But it's well worth it. Surgeons are competitive by nature. They strive to achieve great surgical results and outcomes as well as better efficiency. Soon after board meetings, we notice a dramatic drop in our case costs. Surgeons might use more reusable blades rather than disposables. And they might forgo breaking for lunch or taking a phone call when an OR is waiting for them.

8. Install a camera monitoring system. Sometimes you feel like an air traffic controller when you're running a busy cataract surgery center. Maybe that's why we have video cameras throughout our center and a 16-grid video system in pre-op, post-op and in my office. Ten of the grids show what's going in the OR. On each monitor, you can track where each patient is in surgery and anticipate what's next. For example, we can see how many of our 10 pre-op bays are open. And as soon as we see on the monitor that the IOL has been implanted, we alert the turnover team. The video system eliminates a lot of running back and forth and needless shouting.