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Cover Focus The Mba Issue | Sep 2016

The New Practice

Transitioning to a modern-day boutique medical practice.

A couple of years ago, I took over a retiring doctor’s established solo medical ophthalmology practice in midtown Manhattan. He had been in practice in the same physical space for 40 years and employed a small, loyal staff. Although we were generationally different, we have a similar philosophy on the focus on patients and service. Because I am a cataract and refractive surgeon, my practice is quite different from the preexisting one, so I embarked on a journey to transform his former traditional, classic solo practice into a modern, high-tech, multiphysician office for today’s discerning patients.


• Updating an existing office space can lead to happier staff, more efficiency, and even easier payment.

• One of the most challenging characteristics to change in a practice is the employees’ culture, expectations, and workflows, but changes in the physical space can help employees embrace cultural changes, too.

• Technology is key to streamlining operations, standing out as a leader in the field, and improving patients’ satisfaction.

• One benefit of creating a boutique practice is that patients are less likely to argue about not having their copay or deductible, just as they would not in an upscale restaurant or hotel.


One of the most difficult characteristics to change in a practice is the employees’ culture, expectations, and workflows. While the prior staff members were always professional and patient focused, I wanted to transform the practice to a higher level of customer service. Refractive surgeons are in the hospitality business, and I wanted that sense to permeate to all of our patients.

The waiting room was renamed the reception lounge, and some of the old signage was updated. Instead of, “Please do not use your cellphones in the waiting room,” we put out multiple chargers and free Wi-Fi. Instead of, “Please do not eat or drink in the waiting room,” we offer fresh coffee and chilled spring water to our patients.

These physical changes grew into cultural ones, and our reception and phone staff began to appreciate what we were trying to accomplish. When a patient calls in with an emergency, we get them right in. If someone has a special request, we find a way to say yes. If someone walks into the office and wants to be seen, we do not just send them home with a 1-month appointment; we give the person immediate options.

By adding optometrists and a part-time ophthalmologist, we increased the number of time slots and appointments available. When I am in the OR, our clinic is busy and still taking care of patients and emergencies. We strive for quick turnaround appointments for all of our patients. Over time, this patient-first approach has led to their being happy and satisfied, which, in turn, has reinforced the staff’s new hospitality-focused approach.


Modern medicine is complex, and I am not talking about the actual clinical part. Unlike other service or hospitality sectors, which collect payment directly from their customers (ie, swiping a credit card), our third-party reimbursement system has evolved (or devolved) into a laborious and costly maze called revenue cycle management (RCM). RCM is the lifeblood of any practice that contracts with managed care and government payers and demands technological solutions.

After researching different practice management options, we brought in a modern cloud-based practice management system that could automate RCM. It enables us to optimize our schedule with automatic email and/or text appointment reminders rather than the monthly mailed postcards. By using smart technology to streamline the medical payment model, my staff can better focus on outstanding customer service.


The digital revolution has made many of our experiences more seamless and frictionless, and consumer-based technologies in digital payment, transportation, travel, and online retail keep improving. We need to do the same for our patients at the doctor’s office.

We use the Yosi app (Yosi) to have patients register and complete their intake information before the visit—on their smartphones or in the reception lounge using tablets. The software is intuitive, fast, and universally lauded by our patients. We call it “auto complete for the doctor’s office.” It scans their ID and insurance cards and automatically prefills all of their demographics. Critical to RCM, the front desk staff can then do an immediate eligibility and benefits verification. Yosi also lets patients choose their referring physician and pharmacy information by automatically completing the corresponding phone numbers and addresses from its database.

While our patients are seated in the reception lounge, they can enjoy an informational, highly personalized, waiting room video (on mute with subtitles) that mixes educational videos from Patient Education Concepts with practice-specific video snippets of media appearances and mission trips.

For our cataract evaluations, patients are handed an iPad (Apple)-based educational program (CheckedUp; iDoc) that simply and effectively describes cataract surgery and its associated refractive options. The 8-minute program is interactive and collects information on whether the patient is interested in refractive cataract surgery. We have recently added a dry eye module that can be shown separately or incorporated into the cataract segment.


In 2015, online sales in the United States reached $338 billion, and they are expected to grow to over $530 billion by 2020.1 Today, the experience of shopping for consumer goods often involves the Internet in some way, including researching product options, consulting user reviews or purchasing guides, and ultimately completing the purchase online. Beye.com was launched in 2015 to offer that e-commerce experience to the eye care market.

Visit Beye.com, and you will find information on various diagnostic, therapeutic, and surgical technologies. The website organizes products by category and provides specifications for and images of the spectrum of eye care brands. Products can be sorted or filtered by select specifications to narrow down results that meet desired criteria, or they can be compared in side-by-side charts. The straightforward presentation of information strips out marketing language to help you compare products based on equivalent capabilities and features. Manufacturers are not required to pay for basic listings, which means the site contains a more complete picture of available options, including lesser-known products from small companies. Currently, there are approximately 1,000 products listed from 200+ companies, representing 107 categories, and new products are added frequently. The site’s creators aspire to index everything from consumables to specialty capital equipment.

Every product page includes a user review section containing candid comments from peers who have used the product. A review consists of a brief written summary (100-character minimum) and a five-star rating scale. Comments are posted semianonymously and indicate the individual’s occupation and location to help you gauge what feedback is most relevant to your practice. User permissions on the site prevent industry members, or those who would not likely have genuine experience with the product, from posting. Additionally, although the site’s administrators monitor comments, they attempt to remain neutral and do not censor critical feedback. If the user reviews leave some questions unanswered, select product pages include buttons to direct message the manufacturer or schedule in-office demonstrations.

All practitioners are encouraged to share their experiences with others by posting a review. The process takes seconds and provides valuable information to peers as well as manufacturers who may consider such feedback when developing new products or features.

In addition to technical information and user reviews, Beye.com contains physician-authored articles with in-depth overviews of personal experiences and videos showing the technology in action. Videos of the device in ORs and clinics help provide a better picture of day-to-day operation and how the device fits into workflow. Interviewees are asked to explain how the product works, answer frequently asked questions, and provide advice to peers who are considering acquiring the technology. At Beye.com, the focus is on providing education in an environment free from marketing hype so that all content is editorially independent and ad free.

The website has simplified the research process and is streamlining the purchasing process as well. Beye.com has partnered with several manufacturers to make products available for purchase online at competitive prices, and the site is continually adding new vendors. The Beye.com marketplace is a multivendor online store that allows customers to make purchases from multiple companies in the same shopping cart. The transaction process is as simple as at any consumer-based online store and employs first-rate security standards to ensure personal information is protected.

As a comprehensive product resource, Beye.com is a great starting place for those looking to acquire new technologies or maximize the utility of devices they already have.

1. Mulpuru S. Brief: US online retail forecast: 2015 to 2020. April 2016. http://bit.ly/2bFd9x6. Accessed September 1, 2016.


To be a leading practice in ophthalmology, we believe that we must have the latest, no-compromise clinical technology. With the rise of patient-pay services such as premium cataract surgery, we have been able to invest in the critical anterior segment technology to offer our patients the best in class. Deciding on the right technology is critical.

When investing in a major diagnostic or other ophthalmic technology, I take a stepwise approach. First comes the literature-review phase. I read the available publications (both peer reviewed and not) about the technology. I also gather information online from the manufacturer and other sites. One useful online resource has been beye.com (see Beye.com for Your Practice’s Needs). On this digital marketplace and reviews portal, I can quickly get a look at many technologies in one space, read reviews, and actually click to purchase many items. For example, when considering a new autorefractor, one can view 56 different models in one place, including lesser-known brands from outside the United States.

Next, I talk to the sales representatives and/or industry insiders. I typically do this at the major national meetings or, better yet, at the regional meetings, where a local representative is actually manning the booth. Finally, I talk to colleagues who have already purchased it. If indicated, a site visit can really help me decide on a big-ticket item such as a femtosecond laser. Often, the company will allow an in-office trial period, which I found invaluable before purchasing TearScience’s Lipiflow and iOptics’ Cassini.


As I mentioned, my predecessor had been in this office space for 4 decades, with the most recent minor office renovations about 1 decade old. The space was neat and professional, but had an inefficient layout of rooms and a decor that was, well, not exactly my style. The older feel of the space had a Mad Men throwback look, which some millennials found appealing, iexcept that everything was well aged.

I knew the office needed updating, and I reviewed all my options: I considered moving to another space, doing a small cosmetic update of the current space, or doing a more significant “gut” renovation. For multiple reasons, I decided to stay in the familiar and conveniently located space. The biggest challenge was how to renovate the office without significantly affecting my busy practice. I interviewed several designers, contractors, and architects. When reviewing my wish list for the office, it became apparent that a sizable renovation of the interior walls, plumbing, information technology networking, electric, HVAC, ceiling, and bathrooms would be necessary.

I found an architect and contractor willing to take on the job with the caveat that it would be completed over a 12-day period while I was away on a preplanned vacation. I had some contingency plans to use another office if I needed to, but fortunately and despite a few construction hiccups, everything was completed mostly on time.


The new, modern office has been physically and culturally transformational. Working in an open, bright environment has an invigorating effect on the doctors and staff. Through its minimalist, high-end, and well-thought-out design, the practice’s environment now echoes and reinforces the practice’s hospitality philosophy and high-tech affinities.

Patients’ comfort, attention, and flow have been optimized. Some of the changes included

• reconfiguration and addition of new digital examination lanes

• a new dry eye disease diagnostics and treatment room

• an elegant and professional patient consultation/surgical scheduling room

• an expanded and open reception area workspace

• a new design-focused reception lounge

• new information technology infrastructure, computers, and a telephone system that could scale with our growth

• enhanced employee pantry/kitchen with more space, amenities, and privacy

In effect, every square inch of the space was carefully considered and optimized for a boutique practice. Some of the intangible benefits included the positive change we saw in our patients. Walking into a new, modern office environment, most of our existing patients (even some of the grumpier ones) became generally upbeat and congenial. More surprisingly, the modern and high-tech office reduced payment collection issues at reception. We found that patients were less likely to argue about not having their copay or deductible, just as they would not in an upscale restaurant or hotel. Finally, patients left their visits happy, and word of mouth spread quickly.


As a boutique practice catering to both a medical and elective cash-pay patient population, we decided early on to focus and stand out in a few areas of excellence that straddle the two payment models: laser refractive cataract surgery and dry eye/ocular surface. We have taken a uncompromising stance to achieving outstanding outcomes for our patients in these (and other) specialties. With my new practice transition now beyond its initial phases, we are proud of our high-touch, high-tech, and high-outcomes approach and strive to continually grow and improve. n

Tal Raviv, MD
• founder and medical director, Eye Center of New York
• clinical associate professor of ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York
• (212) 889-3550; talraviv@eyecenterofny.com; Twitter @TalRavivMD
• financial disclosure: an investor in Yosi

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