Diagnostic Instrumentation

Intelligent Investing: Crunch the Numbers–and Analyze Your Patient Base

By Scott A. Jens, OD, FAAO

Before purchasing new instrumentation, always crunch the numbers to calculate ROI. Equally important: Analyze your patient base to see how new instrumentation will enhance the level of care you provide and allow you to grow in new directions.

When acquiring costly new instrumentation, we run the numbers to calculate ROI from additional billing. An equally important calculation, however, is how much this new technology can enhance the comprehensive examination–and be a critical part of where your practice is headed. Most of the time, new equipment is used during other exams than the comprehensive eye exam that you provide–and patients are better served and more loyal over time, as a result. Before investing in instrumentation, I crunch the numbers to see how much it will cost my practice and when we will possibly break even on the investment. Cutting-edge instrumentation can provide new and improved testing opportunities, and corresponding revenue enhancements.

Think Big Picture

Most practices look at the diagnostic instruments as requiring a financial ROI to justify purchase. The impact on patient care is so significant that we decided that any billing ROI would be secondary. For example, the purchase of a high-quality corneal topographer and pachymeter allowed us to make justifiable assessments for patient candidacy determinations for LASIK, which has been a reasonably strong aspect of our practice through an excellent co-management experience in our community. Aside from that use, the topographer increases opportunities to fit custom-fit RGP contact lenses, while the pachymeter provides a ready opportunity to discuss glaucoma risk with ocular hypertensive patients. We have also been long-standing users of panoramic retinal imaging which has provided us with substantive data relative to at-risk patient management, successful referrals for advanced retinal care and a very positive high-tech positioning of our practice to our patients.

Think of Servicing Wide Swath of Patients

Optometry practices can specialize toward care of patients with advanced disease, but our practice simply has open doors to patients of any age. We decided that the expressed desire to manage patients from infants through seniors was marketable, and our patient base has expanded and thrived through successions of senior partners via integration of junior partners. Generally, a patient base mirrors the doctor within +/- 10 years of the doctor’s age, so it takes a special focus on maintaining a younger patient base as you advance in years in practice, while it similarly takes a focused plan for a new-in-practice doctor to achieve success in drawing in senior patients. Our technology integrations have been focused on widespread applicability. For example, our retinal imaging protocols are proven to work on infant patients. Obviously, new technologies that assess risk to macular degeneration will have a focus on the older patient, and we have been advancing our technologies to those patients as the US population ages.

Common Sense Indicator

The formula is not mathematical–it’s the common sense indicator. When we properly and judiciously determine a technology’s place in the practice, we make the acquisition based on the understanding that our patients expect to see us moving forward each time they visit the practice. Now, we certainly consider the financial impact of technology, but our long-standing plan has been to advance the practice’s technology incrementally, and we believe patient retention is one positive result of those investments, aside from the calculations of number of billings per month.

Consider Leasing Rather than Buying

Cash flow in an optometric practice is not always sufficient to service a high-expense piece of equipment, so there are instances where a loan or lease make sense. In some instances we have used lease programs for instrumentation that can then be properly maintained by the manufacturer and which we see as having a lifespan that may not be as long as the term of a loan.

Integration Between Instrumentation and EHR May Not Be Easy

Doctors often have the misperception that the industry is full of opportunities for interconnecting these instrumentation devices into one simple image management system or directly into an EHR. It’s not that simple. There are great interconnections between a manufacturer’s instrumentation and their proprietary image management system, but realize that you could have two to five of those image management systems running in your practice at a time. Ask your colleagues what they are doing for a reality check.

Before Making A Practice-Building Instrumentation Investment: Evaluate Your Patient Base

Assess your patient age distribution, and make the first purchase useful for the main demographic. For example, if it’s children, perhaps computerized exam room visual acuity screens will provide the most workflow advantage, even if they aren’t going to drive billable services.

Cover the basics. Visual field instruments may be the most utilized pieces of equipment in a practice, so plan accordingly by purchasing a solid technology and consider your practice’s plan for use. If you plan on using the instrument for screenings, it will need to be in a room that may be part of the normal entrance examination process and that could cause access conflicts when patients need longer, diagnostic visual field testing.

Primary care vs. specializing, make the choice. If you feel like you will be focusing your marketing efforts and your practice patterns on senior care, consider those technologies that are going to make the key diagnostic determinations for you such as OCT.

Related ROB Articles

Buying Instruments: New Toy or Valuable New Treatment Tool?

Carotid Artery Ultrasound Screening: Add Value to Comprehensive Examinations

Macular Degeneration Testing: Alert Patients to Value of Nutraceuticals

Scott A. Jens, OD, FAAO, is co-owner of Isthmus Eye Care, with offices in Middleton and Madison, Wis. In addition, Dr. Jens is the CEO of RevolutionEHR, a provider of online-based electronic health records. He can be reached at: sjens@revolutionehr.com.

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