By Jason Miller, OD 
There are practice growth opportunities in helping diabetic patients to improve their vision.
Diabetic Patients
Making management of diabetic patients a priority in your practice is the right thing to do for your patients’ eye health, and it also brings financial rewards to your practice.
Diabetic Patients Per Day
3 to 4
75 percent of the time visit is for diabetic eye health check.
Among Added
Services Required
Visual field testing
Retinal imaging
Glaucoma evaluation
Reimbursement
You can bill for diabetic patients as medical care rather than visual care, resulting in nearly double the reimbursement.
Diabetic patients are potentially the most loyal of your patients. They are preconditioned by messaging from their family doctor and specialists, such as endocrinologists, about the importance of caring for their eyes. Most know that diabetes makes them more vulnerable to glaucoma, and that fluctuating blood sugar levels can affect their vision.
In addition to the annual exam, patients with diabetes often need follow-up appointments for specialized
You cannot bill a third party more than what you would normally charge a self-pay patient.
“Double the reimbursement” is the difference between what vision plans pay for a comprehensive exam and what medical third parties pay for a comprehensive exam.
–ROB Editors
screening such as visual field testing, retinal imaging tests and glaucoma evaluations. The fee for an annual exam for a diabetic patient is typically the same as it would be for a patient without diabetes, but the difference, due to their condition, is that the doctor may be able to bill the visit and services as medical care instead of vision care. This results in nearly double the reimbursement from insurance companies. When the patient presents with medically oriented chief complaints, or if they are following up for previously diagnosed medical conditions, this visit is appropriately allocated to their medical carrier. This typically results in improved reimbursement.
Stable Blood Sugar, Stable Eyeglasses/Contact Lenses Prescription
If a diabetic patient’s blood sugar is fluctuating significantly, you will not be able to provide them with a reliable long-term eyeglasses or contact lenses prescription. If you have an electronic health record system, you are at an advantage in managing diabetic patients. Not only is it easier to manage the billing process, in the future these systems will allow you to easily look up information provided on your patient’s centralized electronic health record by the patient’s other doctors. Before refracting a diabetic patient, it is best to understand the stability of your patient’s last few blood sugar tests. I often need to educate patients that their blood sugar must be stable before I can prescribe the best eyeglasses or contact lenses prescription for them.
If you don’t explain that fluctuating blood sugar can lead to fluctuating prescriptions, a diabetic patient with a prescription that no longer works because their blood sugar level is significantly off from when they had their refraction is liable to think you made a mistake. Along with educating the patient of the role blood sugar plays in their vision, I tell them not to hesitate to contact me if the prescription is no longer right for them. If a prescription changes, most ODs have some sort of warranty program, and VSP even provides a one-time Rx remake if it is within six months.
Co-Manage with MDs
Since the diabetic patient’s physical health plays such a significant role in their eye health, you should establish a relationship with their primary care doctor, and any MD specialists they see. The American Optometric Association provides a diabetic eye exam form, which gives you a template to use when providing eye health results to the patient’s MDs.
The patient’s MD’s, in turn, could develop a referral network with you concerning their eye care. This communication is usually an equal exchange, with primary care doctors frequently inquiring, for example, whether the patient needs any extra intervention such as laser treatment for proliferative retinopathy. It often is the OD who alerts the patient’s MD of the possibility of diabetes in the first place. Many of us have referred patients to their primary care doctor after noticing retinal hemorrhaging, a classic sign of diabetes.
Educate Patient Base About Diabetic Services
To ensure my patients know that our practice offers medical eyecare services, an educational video plays in a loop in our waiting area, providing information about the impact of diabetes on eye health, among other medical topics. To make sure diabetic patients understand the potential effect of diabetes on eye health, we have photos of normal retinas alongside photos of retinas belonging to diabetic patients whose disease is out of control.
I explain to patients–diabetic or not–what I am looking for when I look at the back of their eye, including that I am checking for conditions like glaucoma and indications of diseases like diabetes.
By educating patients about your practice’s ability to serve diabetic patients, you can enhance the patient care you provide, and encourage a loyal subset of patients to consider you the go-to eye health specialist.
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Jason R. Miller, OD, is in a partnership private practice with Tamara M. Kuhlmann, OD, MS, at EyeCare Professionals of Powell, Ohio. Contact: jasonrmiller@columbus.rr.com.
