By David I. Geffen, OD, FAAO
April 13, 2016
Maximize the use of each instrument to ensure the greatest benefit is provided to patients, and to practice profitability.
When you acquire a new instrument, you have an opportunity to enhance patient care and your practice brand. These opportunities increase significantly when you use the instrumentation for both primary, as well as secondary, uses. My shared OD-MD practice has found ways to maximize use of our instrumentation, both for the benefit of our patients, as well as to increase our profitability.
Identify Multiple Uses
Some of our more costly instruments have multiple uses. Our Optovue iWellness OCT is used for screening purposes, but if we find some type of irregularity, we can do a full scan, which would be considered medically necessary. This also applies to our retinal camera. We take screening pictures, but if we find an irregularity, we can use our camera in a different mode for documentation, and it may be a billable event if done on a different day.
We also have the ability to do anterior segment scans with our OCT. These scans help determine angle depth and in depth views of the cornea layers. Most important in my practice is the ability to measure semi-scleral and scleral lens clearance and edge touch. Utilizing this technology has revolutionized the way I fit these lenses. I can view the images and most of the time determine changes without even having to look at the lens in the eye.
I believe that using the iWellness this way gives the doctor very valuable information and helps give us the security that we are not missing any early pathology. We also offer the option of screening photos to every patient, and have about a 75 percent acceptance rate for these.
Other technologies, such as topography and pentacam, are determined by the doctor and used extensively in our contact lens practice.
Raise Level of Care
By utilizing advanced technology we are able to provide a higher level of medical care than many patients receive at an ophthalmology practice. We are looked at as a cutting-edge practice. My patients are excited to return for their annual exams to see what new “toy” I have added to the practice. Most important, it gives me the confidence we are doing everything possible to ensure we are finding any possible pathology at the earliest stages.
Build Your Practice Brand
Our practice has a reputation as being the most technologically advanced of any ECP in our area. These pieces of equipment go hand-in-hand with our philosophy of offering the best for our patients. We get many referrals from patients partly as a result of this. I have found that purchasing technology generally makes the practice more profitable, even if there is no direct billing for the technology.
A practice-building side benefit of advanced technologies is the patient reaction. In our practice we have our technician screen the patients and set up the exam room with our flat screens having the OCT scans loaded, as well as the patient’s retinal photos. During the exam I will show the patient the Optos photo explaining that we are seeing a wide angle view of the retina looking for any breaks or tears.
Then I show them the photo from our Annidis multi-spectrum imaging device, which I explain shows the macula and optic nerve in more detail, as well as going through the different layers of the retina. This shows early macula changes, along with cupping and nerve head changes. Then I show them the OCT and talk about how this scan will pick up things like glaucoma and macular changes we cannot see with normal viewing. If we see drop out of nerve fiber bundles, we talk to the patient about possible reasons for this and why we need to order more tests (full nerve head OCT), as well as more frequent follow-up. The old adage, “a picture is worth a thousand words,” doesn’t come close to the effect these technologies have on our patients.
Enjoy Greater Profitability
From a ROI point of view, having secondary billable uses helps directly pay for these technologies. The cost of an OCT can range from about $35,000-$70,000 depending on what functions you want. If you are finding two patients a week with billable pathologies, the payback is about three years. But even if you are finding no pathology, the contact lens function of the OCT will save so much in time, and in the reduced costs of lens changes, it will be worth it.
Set Billing Policy for Use of Instrumentation
I view the importance of our iWellness as so great that we have made it part of the normal exam with no additional charge. The amount of positive findings have given us the ability to order more routine OCTs to get more detail on possible pathology. The increase in these scans has more than paid for our equipment. Insurance will cover the OCT scans when the doctor orders the test due to possible abnormal findings during the routine exam or specific patient symptoms.
The billing codes are standard for the test. It is important that the doctor put in the exam results an order for the test related to specific findings and make sure there is a doctor interpretation of the scan in the file. For retinal photos, we offer our patients the option to have screening photos as part of their medical record. We explain how valuable these are to refer from year to year to any changes that may occur. We do charge a fee for this, but most of our patients accept this fee. When we find pathology, we will order photos to have a record of the disorder and be able to monitor it. These will be billable under medical insurance.