Medical Model

AMD: Treat Well, Grow & Profit

By Brooke S. Kaplan, OD

August 26, 2015

SYNOPSIS

Macular degeneration is the number one cause of vision loss for people over 60.Being prepared to serve patients with AMDis a key to practice growth.

ACTION POINTS

ADVERTISE SERVICES. Devote page on your web site to macula health, providing information about macular degeneration and the related services you provide.

UPGRADE INSTRUMENTATION. A fundus camera, visual field and OCT are crucial, and a PHP and Optomap also greatly help in diagnosing and treating AMD.

KNOW WHEN TO REFER. Build relationship with local retinal specialists that provide treatments that are outside your scope of practice.

Macular degeneration is an increasingly common diagnosis in the U.S. In fact, it is the number one cause of vision loss for people over 60. Medical eyecare that addresses age-related macular degeneration will be in ever greater demand, statistics cited by the National Eye Institute suggest: “By 2050, the estimated number of people with AMD is expected to more than double from 2.07 million to 5.44 million. White Americans will continue to account for the majority of cases. However, Hispanics will see the greatest rate of increase, with a nearly six-fold rise in the number of expected cases from 2010 to 2050.”

Practices that can serve this surge in AMB cases will grow faster and more profitably than those that cannot.

In 2014, my 15-locationpractice saw approximately 1,000 patients practice-wide with a diagnosis of either macular degeneration or drusen. These patients average 2-4 visits during the year with medical testing at each visit. The revenue generated is not just from the office visits, but also in materials (EYEglasses or contacts) purchased. Some 60-70 percent of the patients seen with macular degeneration purchased materials from our practice, and I attribute that to the fact that they trust us with the entire well being of their ocular health. The other revenue generated by these patients are family referrals. A vast majority of our AMD patients have at least one family member or caregiver who is also a patient in our practice.

We see a lot of cases and treat them (instead of referring out automatically) because we have put in place a system to diagnose and treat AMD. This has been successful because we have trained our staff, geared up with instrumentation, and promote the fact that we offer services to AMD patients.

The OD monitors the patient until they convert from dry AMD to wet AMD. At that point, the OD should refer to the OMD for treatment with a series of anti-VEGF injections. If there is ever a question of conversion, it is always a good idea to have the OMD take a look, but the only reason to refer is if the OMD will choose to treat with something different than we can. The average AMD patient is in the OD’s office 2-4 times per year.

The page on Dr. Kaplan’s practice web site devoted to macular degeneration. Dr. Kaplan said it is important to let patients know that this is a condition an OD can monitor and co-manage with a retinal specialist.

Show Patients You Care About AMD

We have an area of our web site devoted to macula health education. We call it our “Center for Macula Health.” And it is not just a name given to the web site; it is an ideal we strive for with patient care at all of our offices. Schaeffer Eye Center is first and foremost a primary care optometric practice. We see any and all diagnoses during any business hours. We do not set aside different days or hours based on the type of patient.

Invest in Needed Instrumentation

A fundus camera, visual field and OCT are essential. We also have a preferential hyperacuity perimetry (PHP) at our largest location, an Optomap at all locations, and offer genetic testing through Macula Risk/Arctic Labs. VitaRisk, part of the Macula Risk test, tailors which vitamin Arctic Labs recommends based on specific genetic markers.

Editor’s Note: The Age-Related Eye Disease Study(AREDS) study created the supplements+antioxidants+zink formulation that is given to AMD patients. Subsequent studies have shown that the AREDS forumula is beneficial for some people, but is detrimental for others. The Macula Risk test is one of two that drills down and gives a clearer picture based on your genetic profile of what is helpful to you and what is harmful to you.

This test has become somewhat controversial as new studies come out showing weaknesses in the original findings. However, I still educate the patient that the test is available, and if the patient is interested, perform the cheek swabs at a follow-up visit. I see it more as a piece of the puzzle toward monitoring progression, and I strive to obtain as much information as I can about every patients’ eyes in order to help ensure long-term ocular health.

An OCT costs around $45,000. If the OD opts for five-year financing using Medicare fee schedules as an average, it would take 22-23 patients a month to break even. If this does not seem feasible, find another doctor in the area and purchase one together. Optovue has a wonderful OCT that travels well called the iVue.All of our locations either have a permanent OCT, or share time with the traveling OCT.

Provide Neutraceutical Guidance

There are many companies out there with good vitamins, but it is up to us as eyecare professionals to prescribe the type of vitamin our patients take. If you walk into a pharmacy and look at all of the available eye health vitamins, it is extremely overwhelming. That is why we need to steer our patients in the right direction. Do your due diligence and research the product. Find one that you are comfortable with and prescribe it. We recommend Science Based Health Macular Protect (and Hydroeye for our dry eye patients). We have found this company to have quality vitamins at a competitive price, and they are very easy for patients to order either by phone or online.

Schaeffer Eye Center

Practice History: Started by Jack Schaeffer, OD, Dr. Kaplan’s father, with one location in Hoover, Ala., in 1978

Locations: now 17

Doctors: 21

Staff: Approx. 130

Comprehensive Exams: Approx. 4,000/month

AMD Often Comes With Other Conditions

Many of our AMD patients also suffer from dry eye. These are both chronic conditions needing multiple visits per year, andpractices should create treatment protocols for each.

Know When to Refer

When the ophthalmologist is going to do something different than the OD, that is when it is time to refer. When the patient converts from dry to wet and anti-vegf injections are needed, it is time to refer.We are extremely fortunate in Birmingham, Ala., where my practice is based, to have multiple vitreo-retinal practices that we refer to on a regular basis. Each of our doctors has a relationship with these practices, and the most important part of this symbiotic relationship is that the OMD refers back to the OD when the condition is stabilized. Retinal practices are overwhelmed with patients, and they appreciate having a medically oriented optometric practice with which they can co-manage patients.

Build Relationship, Establish Trust With Patients

Monitoring AMD is more about the relationship between a doctor and patient. It is a disease we still do not know a lot about, so the main treatment is assurance to the patient that you are going to do everything in your power to help them maintain day-to-day living. I also tell patients that I am constantly keeping up with research, and as soon as I see any changes, they will be the first to know.

Brooke S. Kaplan, OD, is a staff optometrist at Schaeffer Eye Center, a 15-location multi-disciplinary practice in Alabama founded by her father, Jack Schaeffer, OD. She earned a B.S. in genetics from the University of Georgia and is a graduate of the School of Optometry at the University of Alabama-Birmingham. To contact her: drkaplan@schaeffereyecenter.com

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