Medical Model

Key Steps to Thrive with a Medical Eyecare Specialty

By Peter J. Cass, OD

March 22, 2017

A strong optical, coupled with a strong medical eyecare specialty, is a recipe for success. Here is how I made the medical eyecare I provide a practice-builder.

Pre-testing equipment in Dr. Cass’s office. The practice educates patients of the importance of annual comprehensive exams, including the many preliminary tests that give the doctor valuable information.

Opportunity to Differentiate Yourself
Far too many ODs are still ignoring the medical aspects of eyecare. According to Alcon and Allergan prescribing data, some 5,000 ODs are writing 80 percent of the all the prescriptions for medications, and 12,000 ODs write the remaining 20 percent. Approximately 23,000 ODs are essentially not writing prescriptions.

Non-ODs write more glaucoma scripts than ODs. A full two-thirds of ODs will likely not even qualify for MIPS in 2017 because they bill Medicare less than $30,000 per year, according to an AOA estimate based on Medicare data. Some doctors emphasize optical and downplay medical, while others emphasize medical and downplay optical. The smarter move is to emphasize both medical and optical. In this article we are going to show you how to emphasize medical.

I practice 3.5 days per week, and have a part-time associate and a support staff of nine. I see 40-50 patients per day personally. I collected more than $280,000 in medical eyecare alone last year. This does not count exams that had both a medical and a refractive component, which would push that number closer to $449,000 (representing about a quarter of the practice income).

Over the past five years my practice has grown 64 percent, with medical eyecare a big driver of that growth, and accounting for 25-30 percent of our collections.

My practice is based in a young and affluent area of Beaumont, Texas. ODs must look for opportunities available to them. Regardless of the part of the country and city you practice in, there are opportunities to diagnose and manage glaucoma, diabetic retinopathy, macular degeneration, injuries, infections and foreign bodies, among other conditions.

Management & Business Academy statistics find that medical eyecare visits account for a median of 17 percent of total office visits in independent optometric practices, but the range of engagement in medical eyecare is wide, and can be less than 10 percent in many practices. Practices can begin to provide medical eyecare with little start-up costs. As medical eyecare grows, practices can invest in technology to continue to drive that growth.

One area offering tremendous opportunity is dry eye, which has seen huge growth in my own practice. There are an estimated 30 million dry eye sufferers in the U.S., which means that nearly one out of every 10 patients walking through my door could benefit from dry eye treatment.

Practices with many Medicare patients often have a good foundation for emphasizing medical eyecare. Over 50 percent of the population of the U.S. will enter the ranks of Medicare within the next 20 years, and 28 percent in the next 10 years. At the same time, there has been a tremendous increase in diabetes, so that our largest source of medical care over the next 10 years is likely to come from a younger population with just that one disease.

As my friend Craig Thomas, OD, a national lecturer, says: “Decide to be a modern eye doctor. A modern eye doctor treats allergies, abrasions, infections, ulcers, trauma, hordeola, glaucoma, retinal disorders, and any other condition that walks into their office. They perform minor surgery, and they take care of their patients after hours.”

Created Loyal Patients Who Refer Others
I recently used an amniotic membrane to treat a patient with a severe corneal ulcer that had been mismanaged by a local ophthalmologist. The patient was looking for a second opinion, and a co-worker told her about our office. Her co-worker had an eye infection treated at our office, and knew that we did more than just glasses and contacts. The patient with the corneal ulcer is doing much better, and is now a huge fan. She told me that she is telling everyone she knows about our office.

Map Out the Needed Investment
There are many medical eyecare tools ODs have, or could, acquire at little cost: sensorimotor evaluation, Gonioscopy, extended ophthalmoscopy, contact lenses, color vision assessment.

I have over $480,000 of equipment in my office, and about $270,000 of that only has a medical use, but over $200,000 of the equipment can be used in routine care or screenings, as well (the Optos camera being a prime example). While I have all the latest diagnostic equipment now I didn’t start that way. Fourteen years ago, I only had a very basic retinal camera, but I knew where I wanted to go, and worked toward the goal of expanded medical eyecare.

In general you should only consider purchasing equipment that you can generate 2x the note in billings. You don’t have to have that the first month, but you should be confident you can get there, and have a plan before making the purchase.

The instruments in Dr. Cass’s in pre-testing room. Dr. Cass says you can start small, and build up to instruments that can provide more advanced eyecare.

Performing Medical Eyecare: What Equipment is Needed
Here are key medical eyecare testing processes, including the equipment needed to perform the tests. “No cost” means the test does not require instrumentation beyond what every practicing OD should already have in his or her office.

Sensorimotor evaluation: No cost

Gonioscopy: $350 or less

Extended Ophthalmoscopy: No cost

Extended Color Vision Testing: $1,200

Visual Field: No cost

Then, as you progress, you can consider:

Scanning laser ophthalmoscopy: $50,000-$70,000

Florescein Angiography: $15,000-$100,000

Specular Microscope: $25,000

Visual Field Analyzer: $25,000-$50,000

Punctal Plugs: No cost

Fundus Photo: $10,000-$80,000

Anterior Photo: $8,000 or less

Corneal Topography: At least $15,000

Amniotic Membranes: $400-$800

Electrodiagnostic (VEP/ERG): $42,000-$62,000

Dr. Cass’s LipiFlow instrument and topographer. Dr. Cass says dry eye is one of the fastest growing segments of medical eyecare, so it’s important to have this kind of instrumentation, which makes it easier to diagnose and treat this condition.

Educate Yourself & Staff to Be a Full-Scope Clinician
ODs should constantly read the journals that are available to them, as well as seeking out conferences and meetings that offer lectures on medical eyecare. Finding a mentor who is willing to help can dramatically speed up the process, too.

Staff should be trained along with the doctor. Key staff should attend conferences with the doctor. Staff meetings should include time to discuss medical eyecare. The American Optometric Association training programs are great sources for certification.

Send a Medical Eyecare Message to Patients
Patients need to know that we are the primary eyecare provider. Optometrists see over 70 percent of eyecare patients, and are trained incredibly well. I always tell patients that they wouldn’t go to a cardiovascular surgeon for blood pressure medicine, instead they would go to their primary care doctor. We are the primary care doctor for the eyes.

Market Your Medical Eyecare
Here are the top ways we promote our medical eyecare services:

ONLINE. On our web site, our business cards and via video in our office.

ASK ABOUT INSURANCE. We ask patients for their medical insurance information when they call to make an appointment.

COMMUNICATE WITH OTHER DOCTORS. We immediately send reports to patients’ primary care doctors, rheumatologists, endocrinologists, and other doctors, when patients present with a medical issue.

MARKET TO OTHER DOCTORS. We have visited primary care and urgent care offices nearby and left brochures and business cards.

PATIENT EDUCATION. We always educate patients about the services we provide when they mention prior medical eyecare conducted by another specialty.

DEMONSTRATE INSTRUMENTATION. We often show, and even demonstrate, our diagnostic equipment to health care professionals (other doctors, medical office managers, nurses and others) who present for wellness eye exams.

Peter J. Cass, OD, is the owner of Beaumont Family Eye Care in Beaumont, Texas, and is a partner with Practice Compliance Solutions / Optometric Business Solutions. , and president of the Texas Optometric Association. To contact: pcassod@gmail.com

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