Diagnostic Instrumentation

Invest in Instrumentation to Grow Your Practice

By Ann Rea Miller, OD

April 29, 2015

SYNOPSIS

Purchasing new instrumentation is a cornerstone of practice growth. Research well and evaluate usage before making a costly acquisition.

ACTION POINTS

PLAN & RESEARCH. Determine what new information the instrument will give you, and whether you need the most advanced model.

PURCHASE WITH GROWTH IN MIND. Buy instrumentation to serve growing patient populations, including those with diabetes and conditions like AMD and glaucoma.

BROWSE & MEET VENDORS AT SHOWS. Use trade shows, like VEE and VEW, to meet vendors and have instrument demonstrated.

Choosing and purchasing instrumentation for your patients is one of the most important decisions you make as a practice owner. Here is what I’ve learned is the best way to research, and then make the best purchases for patients and practice profitability.

Map Out Research & Selection Process

Once I decide on an instrument I would like to purchase, I research different brands that offer the instrument, including pricing, show special pricing and vendors who sell the instruments and may offer different service plans.

Decide Whether to Lease or Buy

I usually purchase new instrumentation outright. If I have enough money in savings, it makes sense to me to avoid taking a loan, which I will then have to pay interest on. Conversely, if money is tight, it may be more wise to keep your cash and get a loan to lower the amount you are paying on a monthly basis.

Purchase with Growth in Mind

I bought a new fundus camera three months after opening my practice because I knew I wanted the ability to document and follow eye diseases such as diabetes and glaucoma, and other conditions that many of my patients have. Plus, I knew I could get a return on the investment by billing medically necessary photos to medical insurance and wellness photos to patients.

Update Aging Instrumentation & Shop Expos

I had a very old Synemed visual field machine that I was using when I opened the practice. I questioned its reliability, so I purchased a used Humphrey visual field from another optometrist who had upgraded. I was able to use it for a few months, but the screen stopped working. I went to Vision Expo East this year to look for equipment and frames, and purchased the Oculus EasyField visual field machine. I chose the Oculus because it was the most cost-effective, and it was recommended to me by a colleague who thought it worked well. I also liked that it ran a threshold visual field in much quicker time than the Humphrey or Synemed I had been using.

Knowing that the majority of visual fields are run on the older population, I wanted something that would be reliable, yet fast, because many patients have told me in the past that the long duration of visual field testing wears them out.

At VEE, I also purchased the iCare tonometer. I had purchased a used NCT when I first opened my practice, and was using the NCT for screening IOPs. If high readings were measured on NCT, or if a patient had glaucoma or was a suspect, I used a Goldmann tonometer. I talked with other practitioners and saw studies that showed the iCare tonometer gave readings as accurately as Goldmann, so I thought it would be a good addition to my instrumentation. This allows a technician to perform the test versus me, thus allowing me to be more efficient with my time.

I am in the process of purchasing digital eye charts. Many patients say they have the projector chart memorized, so it sometimes becomes difficult to know if patients are seeing better, or if they are just remembering the letters. I also examine many kids, so I wanted digital charts that would allow for videos to play during retinoscopy and include symbols for children who don’t know their letters yet.

Plan Research at Trade Shows

Going to VEE this year was the first time I’ve experienced a large vision show. In the past, when I was an employee, the only meeting I attended was the East/West eye conference in Cleveland. My eyes were widely opened by the vast amount of vendors at VEE. I was unable to see all that the show had to offer, so I focused on finding the vendors that I wanted to see. Prior to the show, I knew I wanted to look for a visual field machine. I talked with other optometrists about what they were using and what recommendations they had about field instruments. I talked with one vendor ahead of time and had a demo webinar, so I was informed about the machine before the show. I did not set up meetings at the show. Instead, I visited vendor booths and asked them questions since I did not know ahead of time what my schedule for each day would be, having never been to the show before.

Balance Need with Bells & Whistles

At VEE, I was very intrigued about the idea of purchasing auto-phoropters.

A new program was available that I had not seen before in which you use an iPad that looks like a real phoropter to perform refractions. The phoropter and projector system was around $10,000. It looked amazing, and I was very tempted to buy, but when I thought about it, I could not justify paying $10,000 for an instrument that will bring me no more money on each exam I perform. Yes, there is potential to possibly decrease my refraction time, but I’d have to significantly save time to make a return on investment on this $10,000 system.

What Will the New Instrument Give You?

One of my first steps is asking myself whether the new instrument will give me more information than I currently have, or increase the level of care I am able to provide.

Secondly, I need to see if the instrument is cost-effective, meaning can I get reimbursed medically, or offer the test to patients at an additional cost outside of a comprehensive or medical exam?

Adding a fundus camera was a perfect example of an instrument that would increase the level of care I was able to provide by tracking different conditions, and also offer a fairly quick return on investment by billing medically and offering wellness photos.

Don’t Overlook Basics of Up-to-Date EHR & PMS

Not having a practice management software when I first opened my practice earlier this year was a big mistake. The practice owners I purchased from had been using paper ledgers. I opened the practice in a three-week time period from when I stopped employment at my previous job.

Because the timeline was so tight, I did not have time to implement computers and an EHR right away. It was very difficult to track inventory, details of options that patients chose for their glasses, how much money was being written off for different insurance companies, etc.

Seven months after opening, we tackled the challenge of adding computers and implementing RevolutionEHR. My staff did not have much experience using computers, so I was also challenged with teaching basic computer skills, in addition to learning a software program, with a staff that believed “everything was easier on paper.”

Lesson: When opening or purchasing a practice, make sure you have an EHR and practice management system ready to go right from the start. That should be the first instrumentation you line up.

Find Out Whether Training is Included

Purchasing from vendors that offer complimentary training is very important to me. I know that once my staff and I feel comfortable running an instrument, we are going to use it more frequently because we aren’t intimidated by it.

On the other hand, ongoing maintenance guarantees are nice, but I feel a new instrument should not have problems in the first one to two years that the guarantees typically cover.

Ann Rea Miller, OD, is the owner of Visual Eyes in Lima, Ohio. To contact her: drmiller@wcoil.com

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