Ophthalmology Business

APR 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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representatives and managed to get a 50% drop in price just by asking because the company didn't want to lose them as a client. "IT is essential in all offices utilizing EHR, and the costs are high and often unanticipated when looking into the purchase of EHR." Increasing revenue After looking at reductions in expenditure, Mr. Preece said the next step to overcome the reimbursement cuts is to try and increase revenue. This can be done by taking on more work or by diversifying the work, Mr. Preece said. Diversifying revenues can help especially if the doctors are already seeing as many patients as they can, he said. For practices that do a substantial amount of surgery and do not own an ambulatory surgery center, it wouldn't be a bad idea to consider either buying into one or building their own, Mr. Preece said. Some practices have added hearing aid services, and that can work to some degree if there is a high enough volume of patients, Mr. Preece said. Other practices have expanded into oculoplastics. Dr. Heaton's practice is increasing its optical services and adding medical retina, something they haven't done before. "If there are ways to continue to delegate and maximize our reimbursement by employing our optometrists better or hiring optometrists to handle increased volume, we want to do that," he said. Improving patient satisfaction and quality of care There are many things that can be done to improve patient satisfaction and quality of care while meeting these new government regulations, Dr. Donnenfeld said. These include adding physician extenders such as optometrists, technicians, and physician assistants. "Adding optometry to a practice is a cost effective way to improve patient care and provide physician extenders to your practice where optometry and ophthalmology can work together in an integrated model to provide quality care; the ophthalmologist spends more time in surgery and less time doing medical ophthalmology, less time doing pre- and postop care, which can be done equally well by a qualified optometrist," Dr. Donnenfeld explained. Another thing practice owners can do is add new technologies that increase efficiency in the office, he said. While the electronic health records system is a big hurdle for many practices, the information obtained from electronic health records can be used to search for patients who may meet certain criteria to offer them elective services such as cosmetic and refractive surgery, Dr. Donnenfeld said. "So you can take what many physicians perceive as a negative and turn it into a positive," he said. Many ophthalmologists are also starting to do premium IOLs, which they might not have been comfortable doing before, Dr. Donnenfeld said. New technologies like the Optiwave Refractive Analysis (ORA) System (WaveTec Vision, Aliso Viejo, Calif.) and femtosecond laser cataract surgery add precision to cataract surgery that allows ophthalmologists to enter the world of premium IOLs and achieve quality outcomes, he said. In his practice, Dr. Donnenfeld said, "We've added a dry eye center of excellence where we are treating patients who haven't received answers before. We're adding pointof-service testing like tear osmolarity and LipiView [TearScience, Morrisville, N.C.], which allows us to diagnose dry eye more accurately. We've added premium dry eye management services such as LipiFlow [TearScience]. In a similar line, we've been big believers in oral nutrition for more than a decade, and we've started working with a company called PRN [Physician Recommended Nutriceuticals, Plymouth Meeting, Pa.]. [The company] provides a premium fish oil omega-3 supplement that we believe is the best product on the market and has a model in which practices can benefit from the time and effort they spend talking to patients about dry eye disease." Adding new surgical services in the OR is another thing practice owners can do. Dr. Donnenfeld said his practice has added minimally invasive glaucoma surgery (MIGS) as part of their surgical treatment options. "We're implanting iStents [Glaukos, Laguna Hills, Calif.] in our cataract surgery patients with glaucoma, which significantly increases our revenue and more importantly provides a tremendous service to our patients," he said. Like Mr. Preece, Dr. Donnenfeld said he thinks it's important with the reimbursement cuts in cataract surgery to have ownership in an ambulatory surgery center, if possible. "This is a big opportunity for many ophthalmologists and can help recoup some of the lost revenue," he said. OB Editors' note: Dr. Donnenfeld has financial interests with Alcon (Fort Worth, Texas), Glaukos, PRN, TearScience, and WaveTec. Drs. Heaton and Miller and Mr. Preece have no financial interests related to this article. Contact information Donnenfeld: ericdonnenfeld@gmail.com Heaton: 800-762-5787, charlesheaton@heatoneye.com Miller: 310-809-2457, drkenmiller@gmail.com Preece: 801-227-0527, dpreece@bsmconsulting.com April 2013 • Ophthalmology Business 7

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