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“That ain’t workin’…that’s the way you do it!” Dire Straits

Last month, I described some tips regarding practicing optometry on an ophthalmology model. It’s worked for me, but not all of these ideas are for everyone. Many practices rely heavily on materials sales, for example, and may find that those sales are enhanced by additional doctor-patient time. I’ve gathered that the visit to the optometrist is a social event for patients in many of your practices, and this might not work if you must review the ninth grandchild’s photos of the school play.

The problem is that we are being driven away from materials as profit centers, with fees likely to generate an increasing percentage of revenue. From there, fees are under assault. Self-paying patients are dwindling, and vision care plan participation needs to be carefully considered. The sacrosanct “medical” reimbursements are not likely to rise, and diminishing payments are a distinct possibility. (Consider the current plans to “tier” payments based on severity of macular degeneration and glaucoma.) Yes, ancillary cash-pay services will lead to success, but it may be that not all ODs will get a chair when the music stops.

The point is that increased patient volume may need to be a driver of revenue in all but the most unusual of practices.

Here are a few more ideas on practice efficiency. Your mileage may vary:

*Don’t reinvent the wheel at each visit. Full exam with complicated refitting? Guess what…..we’ll fit you today, and we’ll dilate you at the follow-up. We’ll see you later in the afternoon next time, so we can see how the lens performs after many hours, and so that the dilation doesn’t ruin your whole day.

*Whatever your tech’s routine, The Universal Truth is that if your tech spends more time with the patient than you do, The Math Does Not Work. Gettest thou out of that exam room by learning what is important to the doctor’s exam and to the insurance carrier. No more, no less.

*Don’t waste time or money on fluorescein strips, unless you are evaluating an RGP. Instill fluorescein-anesthetic combo from the dropper bottle, wait a minute, and look. Oh, I know, the anesthetic affects the epithelium, and you’ll be homeless within a week. If you’ve practiced optometry for more than a few weeks, you’ll appreciate the efficiency and efficacy of the method.

*Re-route ALL billing questions and consumer items to staff. If you MUST get involved, do so after patient care hours. “I respect your question, but I don’t want anything to distract from the limited time that we have together today. I promise that the staff will do a thorough review with you.”

*Seeing the extra full exam or emergency takes a lot of heat off the rest of your endeavors. I’d much rather remove a foreign body or do a 6-month glaucoma exam than worry about the next patient’s acceptance of other income-generating endeavors. Those endeavors are important and rewarding, but it’s nice to have a firm base to even out the waves a bit.

Don’t let things that are peripheral to optometry interfere with your core mission, even if they are held out to you as profit centers.

The “holder-outers” know that they do offer profit centers, but the question is, profit for whom? Don’t be a low-margin kiosk for corporate profits. And, egads, don’t get involved in some multilevel marketing scheme. The least sophisticated of patient bases will smell this out in a second.

*Many will disagree, but I advise not getting involved in “screening” with our high-tech instruments. I am seeing that even in screening mode, test results are equivocal and are often incorrectly compared to the ever-absurd “normative database.”

If the patient’s chance of having the screened-for disease is lower than the chance of false-positives on the machine, you are up to your knees in statistical cow manure.

From there, retina and glaucoma services have no interest in seeing your patient who is “outside the normative database” when the clinical examination is normal. They will happily assume your patient’s care in the future, though.

*Refer out? I do so when there is a diagnostic question or a case where therapy is outside my scope of practice. Chronic conjunctivitis, thin retinas, .6 cups, etc. probably don’t have treatments that you can’t do at the primary care level. You can easily refer yourself into a bunch of empty exam chairs. See above.

*On equipment, go for technology that allows you to meet the Standard of Care. Specifically, get an OCT that allows you to manage glaucoma suspects, AMD, and Plaquenil exams LONG BEFORE tear assays and blepharitis devices. (Know these standards of care, and don’t give away these pieces of the economic pie that should be managed without referral.)

Hopefully, these points will at least provide food for thought on how you do things. The economic and professional benefits of a few small changes can be stunning in the long term!

Bill Potter
Associate Editor, Dugout Dirt Editorial for odsonfb.com. Dr. Bill Potter is the senior optometrist at Millennium Eye Care in Freehold, New Jersey. Millennium is a multi-subspecialty optometry/ophthalmology practice, where Bill has practiced for 31 years. Prior to this, he served for 3 years as a Captain and optometrist in the U.S. Air Force. Bill is a graduate of the University of Pennsylvania and the Pennsylvania College of Optometry. He serves as a member of the Review of Optometry’s Editorial Board. The Primary Care Optometry News honored Dr. Potter in 2016 by listing him as one of the “PCON 250” top leaders and innovators in his field. Dr. Potter has a special interest in uveitis and other ocular inflammatory diseases and has lectured and published many articles in this area. Most recently, Bill’s CE article on “Red Disease in Glaucoma” appeared in the March 2017 Review of Optometry.

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