Contact Lenses

How to Create a High-Tech, High-Value CL Exam

By David I. Geffen, OD, FAAO

Jan. 13, 2016

Building a distinctive contact lens service within your practice can pay off in increasing value to your patients, and it can be a prime revenue generator, as well. Succeeding in that regard requires that your instrumentation be cutting edge so that you offer your patients a high-value, high-tech comprehensive contact lens exam with premium fees to match. Done right, this is a powerful practice differentiator.

The contact lens services you offer, from prescribing to fitting and selling, should be one of your practice’s most profitable areas. In my shared OD-MD practice, we’ve found that investing in technology can make the contact lens area of the practice serve patients better while generating greater revenues.

We have committed to purchasing a new piece of equipment every year. Our patients have come to expect it, and ask what new instrument I’ve bought this year. We have purchased all of our equipment new. For smaller purchases, we just paid outright, and for larger purchases, we purchased on a lease-to-own basis.

Investing regularly in new technology shows patients that we remain a cutting-edge practice, and that we are willing to invest in providing the best care possible for them. It also helps justify the higher fees we charge.

The LipiView from TearScience, which Dr. Geffens uses on contact lens patients to evaluate the meibomium glands and tear quality. Dr. Geffen says the use of high-level instrumentation not only serves patients better; it also sends a practice-differentiating message that your practice is on the cutting-edge.

Identify & Invest in Key Instruments

We have five key instruments that, among other uses, we use to better serve our contact lens patients. On an individual basis, these instruments might not increase profitability for your contact lens services, but put together, they create a high-value, high-tech contact lens exam that allows you to better fit, and keep, patients in contact lenses.

Slit Lamp: (Cost: $8,000) Used to view the anterior eye and contact lens relationship on the patient’s cornea. No direct profit related to the instrument, but a necessary piece for every practice. There is no charge for use of this instrument because it is part of every office visit.

Corneal Topographer : About $15,000. Used to view the shape of the cornea to help determine the correct fit for the contact lens. It also assists in multifocal lenses to see if the corneal apex lines up with the visual axis, which helps determine why a lens might not work. This equipment does not generate much direct income if it is included in the CL exam versus charged as an add-on fee, but again, is a vital part of a specialty contact lens practice. Specialty lenses generate much more income to the practice and much more patient loyalty. We bill for use of this instrument only for cases involving irregular corneas. Otherwise it is built into the contact lens fees.

Abberrometry: About $20,000. Used to determine higher order abberations of the visual system. Useful for irregular corneas and multifocal fits. Helps determine why a lens may not provide adequate vision. No direct profit if it is included in the CL exam versus charged as an add-on fee, but a nice benefit for specialty contact lens practices. There is no additional fee for use of this instrument. It is built into regular contact lens fees.

OCT: Can cost up to $65,000. Anterior segment OCT greatly assists in evaluating the fitting relationship of a RGP on the cornea. It is very useful in scleral designs. No direct ROI for contacts if it is included in the CL exam versus charged as an add-on fee, but in general practice the unit will usually pay for itself in two years through its use with all patients. We can bill if the symptoms warrant the test, but mainly for posterior segment and glaucoma.

Meimography: About $20,000. Used to evaluate the state of meibomium glands. This is useful to help with one of the most common reasons for contact lens drop out. Minimal income generated from the equipment alone if it is included in the CL exam versus charged as an add-on fee, but it also gives you the ability to bill for dry eye therapy and much better evaluate for treatment effectiveness. Possibly generates income for treatments like LipiFlow from TearScience.

Pentacam: Costs about $40,000. Used to determine the anterior and posterior shape of the cornea, and very good for irregular corneas. No direct billing for this procedure. This built into our regular contact lens fees.

Sometimes Bill Extra for Use of Technology

Most of these instruments are billed as part of my contact lens evaluation fee. We adjust our fees to reflect the complexity of the case. Generally, the more complex the case the more technologies we need to use. For certain cases, such as abnormal corneas, you can bill third parties for topography. Our contact lens evaluation fees range from $59 to $300. The range depends on the complexity of the case. A multifocal toric fit will be at the high end and spherical soft at the low. Some of our fees are higher than this including for keratoconus and orthok.

Train Staff to Use Instruments in Pre-Testing of CL Patients

My technicians are trained to perform many of these tests for the pre-testing part of the exam. If they know the patient has keratoconus, they know I will need topography and a pentacam. Sometimes I need to order the test after the exam. OCT is done at follow-up visits once we have a lens on the eye.

Keep in mind that testing can add 10-20 minutes to the technicians’ time with the patient, but is well worth the time in the greater care it allows you to provide.

Present Findings of Tests to Patients in Exam Room

The doctor will go over the findings with the patient in the exam room. A good example is the patient we cannot refract to 20/20, for whom I may order a topography and pentacam to be performed. This may show that the patient has early keratoconus and that I need to have a thorough discussion about this with the patient. I will tell them that their reduced vision is due to the irregular shape of their cornea, and show them “the map” image from the topographer to give them a visual of what is going on. This enables the patient to understand much easier what is going on.

Market New Technology Additions

Let patients know about your purchases of new instrumentation, and how it will improve the services you provide, including how it will benefit contact lens patients. We send e-blasts to our patient base announcing our new technology, and our staff also educates patients about the instrumentation that will be used to examine their eyes while they are in our office.

David I. Geffen, OD, FAAO, is a partner in Gordon-Weiss-Schanzlin Vision Institute in La Jolla, Calif. To contact: dig2020@aol.com

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