Ophthalmology Business

DEC 2016

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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December 2016 • Ophthalmology Business 21 attention to the infrastructure on an ongoing basis; we would be working against our own best interest if we reinvented the wheel every time we wanted to add a new diagnostic or when a new drug came out. In addition to quarterly full-day training seminars involving every member of the staff from each loca- tion, we also have monthly meetings among team leaders to review how well we are doing and to identify gaps. Dry eye in practice Every patient that comes into one of our clinics is administered the SPEED questionnaire by one of our techni- cians, each one of whom has been empowered to initiate further testing based on results. This may be the single most important thing we can do for dry eye patients; it is a practice that is low cost with a high rate of re- turn. Any patient with a score greater than zero who has a chief complaint that includes a dry eye symptom or who was previously treated for dry eye will be identified for further evaluation. We have a number of advanced diagnostics that help determine what factors are playing a role, including tear osmolarity testing (TearLab, San Diego), the InflammaDry point-of-care test (Rapid Pathogen Screening, Sarasota, Florida), and LipiView (TearScience, Morrisville, North Carolina). We re- cently added scatter testing using the HD Analyzer (Visiometrics, Barcelo- na, Spain). We think these diagnostics are important for many reasons. First of all, recent evidence suggests that dry eye is multifactorial and that under- standing if aqueous deficiency or meibomian gland disease is involved is only part of the story. We have learned that blepharitis and a num- ber of other masquerade syndromes may either mask signs and symp- toms of dry eye or they may coexist and serve as triggers to exacerbate and worsen a patient's condition. If we gather baseline data, we will and are relying on our profession to diagnose and "protect" their ocular health. In fairness to the patient, our practices can and should be per- forming work-ups to understand the nature of the problem. Then, if we are not going to treat these patients, we owe it to them to refer out to someone who will. An educated staff is the best way to educate patients When dry eye is considered a core service and treated as a primary dis- ease, it is already a part of the prac- tice's revenue stream. Where many practices get tripped up is in the fact that many therapies and diagnostics are not covered by insurance. Part of the issue many practices face is a failure to educate patients about the benefits derived from treatments and diagnostics. These benefits should be presented regardless of the financial status of the procedure, product, or therapy. For instance, Bowden Eye in Florida has found Prokera (Bio-Tissue, Doral, Florida) to be beneficial in our severe dry eye patient base. This is an easy product to educate patients about, and they find it fascinating. By precerting the coverage and edu- cating the patient about the benefits of use, the patient gets to decide based on the physician's recommen- dations. Regardless of one's carrier rec- ommendations, a practice should develop a standard of care that is best for the individual practice and the patient and allow the patient to pay when the insurance will not be fol- lowing proper reimbursement steps. Education truly is key. As with many things in eyecare, properly educating patients about treatment benefits is a direct result of staff education. In our center, we place a large emphasis on ongoing and continual training, which we provide in various formats. Our belief is that it is easier to add new compo- nents to our core services if we pay W hile a practice can garner tremendous revenue from proactively identifying and treating dry eye disease, the financial aspects are secondary to the interest of provid- ing good medical care that patients deserve. There are myriad value-add services that an eyecare practice can offer to better serve patients, but in my mind, managing dry eye is a core capability that every eyecare prac- tice should have. In a lot of ways, ignoring the dry eye patient is akin to ignoring a patient with elevated intraocular pressure and signs of glaucomatous change. With the upcoming changes in reimbursement, we are all faced with being measured in ways we still don't understand. Taking care of patients is what we do and we should all do our best to meet patient needs. So when I hear people ask whether eyecare practices should add dry eye services, my response is, "Why haven't they already?" When it comes to dry eye, whether or not to treat dry eye is a binary calculus, whereas the real question is how ex- tensively they want to treat the prob- lem. Similar to glaucoma, there is no question whether patients with a history of or who are at risk for glau- comatous optic neuropathy should be evaluated; the more appropriate question with respect to practice philosophy is whether one wants to offer medical management, perform laser, or have the capacity to provide surgical intervention. One either has means to vertically elevate the care of glaucoma or else has a trigger for when to refer to an external specialist provider. The same scenario should be in place for individuals with dry eye disease. In our practice, an estimat- ed 80% of patients present with some signs or symptoms that can be indicative of dry eye disease. Some of these patients are asymptomatic just as the glaucoma patient can be continued on page 22

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