Optometry practice investments to elevate patient care and profitability
By Joseph M. Munsell OD, Diplomat, ABO
Oct. 30, 2024
Practice investments at their best elevate patient care and spur practice profitability.
Here are three technology additions to our practice that did just that.
Two Widefield Cameras
The Optos Silverstone combines widefield retinal imaging and fundus autofluorescence with a screening-swept-source OCT.
Editor’s note: There are other widefield imaging cameras to choose from including the Topcon RC-NW400 Non-Mydriatic Retinal Camera, ZEISS Clarus Ultra-Widefield Fundus Camera and NIDEK non-mydriatic auto fundus camera AFC-330, among other options.
It allows us to capture 200 degrees of the retina with one image, and with steering retinal photos, we can image beyond that.
The screening OCT can also be taken anywhere throughout the optomap imaging. We wanted to offer the best technology for patients while providing our doctors with great diagnostic information at our patients’ annual exams.
This technology cost $180,000 per device. We financed our addition of these instruments through a lease with the company itself at $7,000 per month.
Our pricing per patient varies from $39 to $55 per patient. We offer it to every full examination and we have a capture rate of around 65 percent.
We collect about $35,000 a month. To break even on our monthly lease payment we need to perform the imaging on 155 patients. So effectively, monthly, we are profiting $28,000.
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This investment has immense positive impacts on our patient care. The ability to have an image saved into our patients’ charts allows for the tracking of progression of many diseases over time. The ability to take a screening OCT on every comprehensive exam has totally changed our standard of care at our clinics.
We are catching much subtler conditions earlier, providing better treatments and outcomes for our patients. We are catching subtle disease and extremely early disease states in comprehensive exams, glasses checks, consults and red eye exams that are difficult to see when observing the fundus through imaging or through dilated exams.
Having an image to discuss with a patient during the exam increases patient understanding of ocular disease and makes their compliance much more likely. A picture truly is worth a thousand words with patient education.
This instrument is a cash-generating machine. The screening images come from cash payments at the time of comprehensive eye examinations, and if there is a medical condition, then the images can be billed as fundus photography to the patient’s medical insurance.
Results: The technology generates around $400,000 for our practice annually.
Electroretinogram
We wanted to have more diagnostic information for our clinicians when managing retinal diseases.
ERGs always had a significant case use in clinics, but the size and testing lengths put limitations on the ability to use in a private practice. When LKC came out with its handheld ERG device, RETeval, it was a game changer.
Editor’s note: There are other ERG devices to choose from such as those from Diagnosys LLC’s Espion E2 Electrophysiology System, MonPack One Electrophysiology System the RETI-port Electrophysiology System from Roland Consult, among other options.
This technology cost us around $21,000. We financed our purchase through the company. The financing runs for 48 months at $505 per month.
At our monthly payment amount, we need to perform about five ERGs per month to become profitable.
Our break-even point on this investment was four months. This is taking into consideration the purchase price as well as the cost of consumable parts.
We found it to be extremely helpful to add the ERG as a part of our special testing protocols. Whenever a patient gets an OCT, they also automatically get an ERG unless specified by the ordering provider.
It prevents confusion and having to reorder it later in the exam slot if our technicians know that they perform it in addition to every retinal OCT.
After our financing payments, and factoring in our consumables, our average reimbursement per ERG performed is $110. We are profitable from a monthly payment standpoint after the first three days of the month.
This technology allows us to monitor conditions closer. It detects changes in cell functioning, which often precedes cell death that is measured by other instruments. With the new information I can intervene sooner in a disease course before irreversible damage has occurred.
Results: The profit on this instrument comes from the reimbursement from medical insurances. We generate approximately $57,000 yearly.
YAG/SLT Dual Laser
Wyoming, where my practice is based, passed a scope of practice expansion law in 2021, allowing optometrists to perform YAG/SLT dual laser procedures. As a result of this new opportunity, we acquired the Nidek Ophthalmic YAG and SLT Laser System YC-200 plus.
Editor’s Note: There are other YAG/SLT laser systems to choose from including Lumenis Selecta II YAG/SLT Laser, Ultra Q Reflex Neo from Quantel Medical and LIGHTLas SLT Deux-V.
We wanted to add these services because there is a huge need in our state for these services. Most of our patients had to drive to a neighboring state to have these procedures performed.
So, adding this technology to our office allowed us to offer our patients more access to care and be able to stay local at a reduced charge.
Our patients have established relationships with us and a layer of built-up trust that leads them to prefer their primary eyecare provider to render the services.
This investment dramatically improved our ability to care for patients. We are able to perform the procedures in-house, so our patients do not have to travel anymore. It also allows them to stay in-house with a provider that they already know and trust. We are also able to get the patients in much quicker, so they don’t have to wait months for the treatments.
As with any new technology, implementation is key. These new procedures come with more risk, so you need to have informed consents and patient education tools all ready to go.
It’s important to determine how these procedures will work into your schedule. I now allow these appointments to be scheduled anywhere throughout my schedule, but at the beginning, it was helpful to schedule multiple appointments on a designated day in order to get into a surgical/procedural mindset. In addition, the repetition in short increments of time allows you to improve faster.
It’s also key to educate your staff on these procedures so that they can discuss them on a surface level when people call your office with questions.
This instrument cost us $48,000. We took out a financing loan with a partner that both we and our vendor worked with in the past. The loan was financed for $790 per month for 36 months.
Through all medical insurance companies and cash pay, our average reimbursement for a single YAG procedure is approximately $533 and a single SLT is approximately $510.
We average about 15 YAGs a month and four SLTs. Based on these numbers, we broke even on our investment after 5.5 months.
After six months of performing this procedure, it became a profit center for us. The profit comes from reimbursements from insurance companies and out-of-pocket payments after chair cost is factored in. Provider time is minimal on this procedure, so in theory, this should not take up more than one exam slot per procedure.
Results: This technology generates around $95,000 annually.
Joseph M. Munsell OD, Diplomat, ABO, is the owner of Cheyenne Vision Clinic in Cheyenne, Wyo. To contact him: jmunsell25@gmail.com