Medical Model

3 Instruments to Better Serve Senior Patients–and Profitability

By David Geffen

Oct. 4, 2017

As our senior population swells with the maturing the Baby Boomer generation, there are growing needs to be served in the diagnosis and management of diseases like macular degeneration, glaucoma and cataracts. We have a shared OD-MD practice, and we find that three instruments, in particular, are essential to serving older patients, and growing our practice and profitability in the process.

The OCT is an invaluable resource, says Dr. Geffen, in diagnosing and monitoring conditions like glaucoma and macular degeneration.

OCT
Our senior patients have three major concerns. Number one is cataracts. We know everyone gets cataracts sooner or later, but there is still a lot of fear with this. Second is macular degeneration. Most of my senior patients have a friend who suffers from this debilitating disease. The third is glaucoma, which is not well understood by seniors, but it is feared the most.

In our practice, we use the OCT as a screening device. We do a screening nerve head and macular evaluation. This screening helps me catch macular degeneration and glaucoma early in the disease process. Showing my patients the scans gives them confidence in my exam. I can show, and reassure, them that they have healthy eyes. If not, we are able to begin treatment early to prevent loss of vision.

This instrument is vital to doing a good job in managing glaucoma and macular degeneration.

Cost
OCTs range from $40,000-$70,000 depending on how sophisticated a device you purchase. The OCT is rapidly becoming a standard of care, and I could not function without one.

Leasing versus purchase options should be discussed with a financial advisor. We purchased our OCT with an equipment loan with a low interest rate, which made our payments easy to absorb.

Break-Even & ROI
In our practice, the OCT broke even in two years, and we are profiting from the device with the medical billing we do. Along with our use of the anterior seg piece with our contact lens practice, this device is more than paying for itself in the time it saves.

Reimbursement
With a medical diagnosis, you can run full macular or nerve scans to monitor glaucoma and macular degeneration, and this is a reimbursed procedure when there is a diagnosed medical condition that the patient must return for additional monitoring, or treatment, to address.

Impact on Patient Experience & Efficiency
In our pre-testing routine, the OCT screening takes about three minutes, but saves time in the exam room as it gives me a quick assessment of vital components of the eye. With the anterior segment piece, it saves me a great deal of time in fitting scleral lenses, which is a big part of my practice

Patient Education
We talk to the patient when going through the pre-testing regimen, and describe the tests and what they are for. In the exam room, the tech has everything ready to be viewed on a flat display screen, so I can show the patient their results and tell them why it is important, and go over the importance of routine care.

Doctor & Staff Education
It is straightforward to teach the techs in the office how to use the equipment. After 30 minutes of training, they start taking the scans, and within a couple of days, they become proficient.

Dr. Geffen says the iCare Tonometer, a hand-held device, is especially useful in examining the eyes of elderly patients with mobility challenges.

iCare Tonometer
This device measures intraocular pressure, which is essential for diagnosing and managing glaucoma patients, and, in fact, can be used to measure the IOP of all patients during routine annual comprehensive exams. This instrument allows you to measure IOP with minimal movement on the part of the patient.

Cost
The device costs approximately $4,000. We purchased this device outright, as the low cost was a no-brainer to just pay for it.

There is no direct cost to profit from on this device, but IOP is a mandatory measurement on every patient, and this device is efficient and effective.

Reimbursement
IOP measurements are part of every regular exam, so there is no specific reimbursement for this test separately.

Impact on Patient Experience & Efficiency
Many senior patients have problems with movement and bending. This instrument allows IOP to be measured without having to move the patient into hard-to-get-into positions. My patients love this as they hated the NCT (or as patients know it, the “puff test”) with the large air blast, and were not that comfortable with Goldman due to the strange posture they needed to maintain. The eye pressure test using the iCare tonometer is quick and easy to perform by a tech or doctor. I believe this saves me 2-3 minutes per exam, and makes for happier patients.

Patient Education
Almost every senior knows they are going to get a glaucoma test, and are not looking forward to it. I tell them we have new technology to measure the pressure and perform the test. The reactions are mostly relief.

Doctor & Staff Education
It take about 10 minutes to train most people to use this device. It is straightforward and easy to use.

An exam chair that accommodates patients with mobility challenges is essential in serving the elderly population, says Dr. Geffen.

Exam Chair that Accommodates Patients With Limited Mobility
Many of our senior patients have trouble walking, and may be using walkers or wheelchairs. Having an exam chair, which can be swive-led with moveable armrests and footrest, allows nearly any patient to get into the exam chair. It is difficult to perform a thorough exam if the patient cannot get into the exam chair.

We have a devoted room for people with disabilities to make their experience as stress-free as possible. This results in much happier patients who refer their family and friends to us. It shows that we care about them, and have thought about their needs. They greatly appreciate this.

Cost
Chairs vary greatly in cost, and range from $400-$10,000.

We purchased our chair as a set with stands and other equipment, so we purchased it with an equipment loan. This allowed us to receive a tax break immediately, but with moderate payments over time.

There is no direct cost to profit from on this piece of equipment, but you need to have some type of exam chair, and having one that can serve the senior population is important if you want to treat many of these patients.

Impact on Patient Experience & Efficiency
This type of chair saves us a great deal of time as it is much easier to get the patient settled in the exam room to proceed with the testing. I see many offices where they have seniors who are slow, and have trouble with mobility, and it may take them an extra 10 minutes just to get situated in the exam room. The doctor ends up running behind in their schedule, and it can snowball, making them late for all their appointments that day.

Doctor & Staff Education
Just a demonstration to doctors and staff on how to operate the chair to accommodate all the patient mobility challenges that may be encountered.

 


David I. Geffen, OD, FAAO,
is a partner in Gordon Schanzlin New vision-TLC in La Jolla, Calif. Contact: dig2020@aol.com

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