By Maria Sampalis, OD
Oct. 5, 2016
Your patient base ages as you age, and treatingage-related maladies, such as glaucoma, should be part of your practice growth plan.
PRACTICE FULL SCOPE. Review treatment parameters allowed by your state and prepare to practice fully.
INVEST IN INSTRUMENTATION OR CO-MANAGE. An OCT, visual fields and digital retinal imaging are key tools. Compute reimbursement, and compare purchase vs. leasing.
MARKET SERVICES. Educate your patient base and community, via Google Ads, Facebook, information on your web site and speaking engagements.
Our aging population means more people will come to your practice with glaucoma, as glaucoma is one of many chronicdiseases that we are at greater risk for as we age. More than 120,000 Americans are blind from glaucoma, accounting for 9-12 percent of all cases of blindness, according to the National Institutes of Health. This presentsa significant opportunity in expandingpatient service and practice growth.
In our practice, we established a “glaucoma center of excellence” to serve a growing need in our patient base. It has involved building a clinical skills set, investing in equipment and promoting this medical service.
My practice isan independently owned office located inside a Sears in Warwick, R.I. Weseeabout 300 glaucoma patients annually, including those who are glaucoma suspects. Each of these patients brings around $600 annually into the practice with two visits each per year for glaucoma suspects and more for those diagnosed with glaucoma, which involves testing to monitor the progression of the disease. In my practice, that comes to $180,000 a year annually in revenues from the monitoring and management of glaucoma. About 15 percent of my annual revenues stems from glaucoma management and treatment.
About 10 minutes of chair time with the doctor is required for each glaucoma patient. The technician does the majority of testing, while the doctor interprets the results and educates the patient about the condition and the further treatment that will be needed.
Check on Scope of Practice for Glaucoma
Your state laws will determine how, and what kind, of care you can provide to glaucoma patients. Before creating a plan on services to provide to glaucoma patients, it is best to check with your state optometric board. In my state ofRhode Island, I am permitted to diagnose and treat glaucoma patients on my own, without sending the patient to an ophthalmologist for a consult.
However, I am careful to send the patient to an OMD glaucoma specialist if I am not able to effectively control a patient’s glaucoma on my own. If the patient continues to have high intra-ocular pressure even on oral medication, or has experienced vision loss, I send them to an OMD.
In my state, I am permitted to prescribe glaucoma medications, but just those that are taken orally, no injections. I most often prescribe Lumigan. —Maria Sampalis, OD
Respond Effectively to Common Questions
The most common questions from patients are: “Will I go blind? What will happen to my children (if I go blind)? What will my insurance cover? How expensive are the medicated drops?”
I reassure the patient that though glaucoma is a serious, sight-threatening disease, there is still hope to limit, or avert, the damage, and preserve their sight, if they carefully follow the treatment plan I have prescribed. I explain to them that glaucoma is a slow-progressing disease, but that at least two visits per year, at six-month intervals, or even more frequent visits, are needed to treat and maintain low intra-ocular pressure, and stop the progression of the disease. I also note that, fortunately, my practice has the proper technology to monitor glaucoma, and that I have been trained as a doctor to do so.
Invest in Needed Instrumentation
A few pieces of instrumentation are necessary to diagnose and manage patients with glaucoma. I acquired these instruments in a lease-to-own program, have paid off all of these leases, and now own each of these pieces of equipment. In the case of the OCT–a vital tool in the management of glaucoma–I send out patients for these measurements, and then have the patient sent back to my practice.
Insurance: Reimburses around $80 per use
Digital Retinal Imaging
Insurance: Reimburses around $90 per use
In addition to leasing options, if a practice doesn’t have this instrument (as mine doesn’t), you can send the patient out for OCT measurements and have the patient sent back to you for evaluation.
Direct Patient to Lifestyle Help
In addition to the medical aid you provide in monitoring and helping to manage the disease, patients who have already experienced vision loss may have need of help to maintain their quality of life.
I do not currently sell specialized eyewear for glaucoma patients or low vision devices in my practice, so that requires me to send patients who need such tools to another eyecare practitioner’s office that does sell specialized eyewear and low vision aids.
Market Glaucoma Services
I do Google Ads, and the online marketing consultancy for optometrists that I use, EyeCarePro, has added information about the glaucoma diagnosis and management services my practice provides to my practice Facebook page and web site. Here is an example of a Facebook post that educates patients, while promoting our glaucoma services:
Educate Your Community
Along with online marketing, it is helpful to go in person into your community to educate. For example, I recently spoke to a local health center four miles away that doesn’t have an eye clinic to let them know we do glaucoma screenings for all patients over 40, and that African-Americas are at higher risk.