To view Figure 1 of this article please refer to the print version of our September issue, page 53.
Discover Vision Centers were founded on the three Os: optometry for primary care, ophthalmology for surgery and subspecialty care, and optical shops (Figure 1). We strive to enhance the lives of our patients by compassionately providing the highest possible level of medical and surgical eye care. As a practice, we embrace relevant medical and business technology in order to improve our standard of care.
A CONSERVATIVE OUTLOOK
We work hard to be leaders in eye care and experts in the cataract, corneal, refractive, glaucoma, neuro-ophthalmology, pediatric, and vitreoretinal subspecialties. Nevertheless, our practice is conservative about its adoption of elective procedures. For instance, we have maintained a narrow focus regarding refractive surgery. Prior to 1996, our surgeons performed a limited number of RK procedures and then transitioned to LASIK without ever having provided PRK. We have offered neither intracorneal ring segments (Intacs; Addition Technology, Inc., Des Plaines, IL) nor conductive keratoplasty (CK; Refractec, Inc., Irvine, CA). Our reasoning for avoiding indirect surgical procedures is based upon our experience with RK, which worked only in a limited fashion. We also chose not to offer multifocal IOLs owing to their association with unwanted visual phenomena.
In June, our practice transitioned almost entirely to customized LASIK (CustomVue; VISX, Inc., Santa Clara, CA), because we believe the procedure delivers superior surgical outcomes, particularly with regard to nighttime driving. We also plan to offer patients the option of receiving the CrystaLens accommodating IOL (C&C Vision, Aliso Viejo, CA).
BUSINESS APPROACHComputer Systems
Our transition from a Unix (Lucent Technologies Inc., Murray Hill, NJ) to a Windows operating system (Microsoft Corporation, Redmond, WA) in 1996 entailed an enormous cost, but the immediate reduction in the time that the staff had to spend on the telephone significantly benefited our practice. As a result, staff members can logon to the databases of insurance companies in order to verify patients' eligibility and benefits and to access referrals. The desktop computer of every employee whose job requires contact with the world outside our office is Internet enabled. Additionally, our personnel manual and other necessary documents for employees reside on the corporate Intranet.
Call Center
By the time our practice had expanded to seven sites, we realized that we needed a call center. Previously, each office required at least two people to handle appointment scheduling and incoming referrals. Another reason we established a call center related to external marketing; listing all seven office numbers as contacts was cumbersome and frequently impossible. All our practice sites are now connected to our call center by a T1 line.
By consolidating our schedulers and telephone operators within our central office, we saved the time and cost of three full-time employees, who then assumed responsibilitties elsewhere in the practice. We were also able to eliminate our prior problems with sick and maternity leave because employees can now more easily cover for one another. Moreover, we are able to offer extended hours on our appointment line. Several nights each week, patients may call to schedule appointments until 7:00 PM, and many of them have appreciated this convenience.
Learning Experience
In 1996, we sold a portion of what was then our single ASC to a large, nationally known hospital system. We expected this partnership to drive more business into the ASC. Unfortunately, this decision was our worst business mistake, because we had not obtained a written commitment from the hospital administration to move business from its ORs to the ASC. Fortunately, we were able to repurchase the hospital's shares in our ASC in January 2002, but the process was difficult.
Insurance Contract
At one time, Humana Inc. (Louisville, KY) possessed in the US what is termed staff models: they owned hospitals and physician practices in an effort to control the cost of healthcare. By 1997, the company realized that this approach was inefficient and eliminated the venture. We purchased all of the ophthalmic and optometric equipment that they were selling in our locality, and we hired all their local staff. In exchange, Humana Inc. exclusively contracted with us to care for their Kansas City patients. This exclusive relationship has been a boon to our practice.
Real Estate
We occupy 100% of several of the buildings that house our practice. In 2001, the partners formed a real estate company so that they could own the buildings our practice occupies and we could therefore rent space from ourselves. The real estate company leased every office built after 2001. This venture has worked well for the practice. At the launch of a new practice site, we are able to discount the office's rent early on, when it needs more working capital, and then gradually increase it later to market rates. The real estate company benefits by having a solid tenant—especially important if the building has additional, unrelated tenants leasing space.
CONCLUSION
At Discover Vision Centers, we strive to provide our patients with excellent care by employing the most talented, amiable physicians and staff. We also seek out the technology and procedures we believe will best serve our patients. We learned early on that above-average staff and doctors are more important to growing a successful practice than is the latest technology.
