Dr. Wolfe examines a patient in one of his exam rooms. Dr. Wolfe says there are specific metrics that will give you an accurate sense of the profitability of your medical eyecare services.
KPIs for managing chronic ocular diseases in optometry
By Christopher Wolfe, OD, FAAO, Dipl. ABO
Nov. 13, 2024
In optometric practice, we’re no strangers to tracking traditional key performance indicators (KPIs) like revenue per refraction, capture rate and annual contact lens supply sales.
These are all critical numbers, but they only tell one side of the story. They reflect a practice’s proficiency in routine eyecare and optical sales, yet fall short in evaluating something increasingly vital—our ability to manage chronic ocular diseases effectively.
Without KPIs that capture the impact of our medical services, there’s a risk that we’ll undervalue this aspect of care. Managing chronic ocular conditions like glaucoma, diabetic retinopathy and macular degeneration is not only essential to our patients’ well-being, but it also requires significant resources and expertise.
If we don’t measure these areas, they may start to feel like a financial drain instead of the valuable, necessary services they are.
To balance our focus between routine eyecare and medical management, it’s time to adopt a fresh set of additional KPIs—nine key metrics that give insights into our practice’s performance from a medical standpoint.
By monitoring these KPIs, you’ll gain a comprehensive view of both the business and medical sides of your practice, empowering you to grow in a way that prioritizes patient health and long-term practice success.
1. Revenue per OD Hour: Measuring Patient-Centered Productivity
Revenue per OD hour is like your practice’s heartbeat. It’s not just a reflection of the patients you see, but of how well your resources are being used to deliver quality care. Unlike revenue per exam, which can be skewed by the types of visits, revenue per OD hour provides a balanced view, capturing the value generated during patient-facing time.
2. Level 3 to Level 4 Code Ratio: Balancing Complexity in Care
Coding may seem like a routine task, but your Level 3 to Level 4 code ratio reveals a deeper story about the complexity of care you provide. If your ratio skews too heavily toward Level 3, you might be leaving revenue on the table by under-representing the full scope of your work.
We find that optometrists consistently under-code their care for both acute and chronic diseases. Simply learning and reviewing the guidelines on a regular basis can prevent this from occurring.
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3. Medical Visit to Refraction Ratio: Shifting from Exams to Management
Comprehensive eyecare is about more than one-off exams; it’s about managing ongoing health. Your medical visit to refraction ratio gives insight into how well you’ve incorporated chronic disease management into your practice. The higher this number, the more your practice moves from simple exams for acute care toward comprehensive care and chronic ocular disease management.
4. Anterior Segment Photography to Refraction Ratio: Enhancing Diagnostic Protocols
Anterior segment photography can provide a more in-depth view of conditions like dry eye or keratoconus. By monitoring how often you use it compared to refractions, this KPI helps you refine your approach and ensure you’re using diagnostic tools to their full potential.
5. Posterior Segment Photography Ratio: Keeping a Close Eye on Chronic Disease
Posterior segment photography is a powerful tool for managing diseases like glaucoma and macular degeneration. This KPI reflects how well you’ve integrated this technology into your regular care routines, particularly for patients requiring close monitoring for progression.
6. Macular OCT to Refraction Ratio: Sharpening Your Focus with OCT
OCT technology revolutionized the way optometrists manage conditions like macular degeneration and diabetic retinopathy. Your macular OCT to refraction ratio gauges how seamlessly OCT fits into your care protocols for these conditions.
7. Optic Nerve OCT to Refraction Ratio: Building Consistency in Glaucoma Management
Optic nerve OCT is a go-to for managing glaucoma patients. Tracking this ratio provides insight into how consistently you’re incorporating it into your care protocols. Each optic nerve scan enhances your understanding of a patient’s progression, ensuring that you stay ahead of any changes.
8. Gonioscopy to Refraction Ratio: A Standard for Glaucoma and Suspect Patients
Annual gonioscopy is recommended for all glaucoma patients and suspects, and this ratio shows how well you’re adhering to those guidelines. Ensuring regular gonioscopy evaluations is important because it is a clear recommendation from the AOA Clinical Practice Guidelines and the AAO Preferred Practice Patterns for our glaucoma patients and glaucoma suspects. Despite this, nearly 30 percent of glaucoma patients will not have gonioscopy documented at the time of diagnosis (Citation).
9. Visual Field to Refraction Ratio: The Value of Peripheral Insight
Visual fields reveal the unseen, offering crucial information on conditions ranging from glaucoma to neuro-ophthalmic disorders. Monitoring this ratio gives insight into how routinely you’re incorporating visual field testing for at-risk patients.
Putting KPIs to Work in Your Practice
Tracking these nine KPIs isn’t just about numbers; it’s about creating a roadmap that turns data into meaningful action, enhancing both your patient care and practice performance.
With regular review and refinement, these metrics become a tool for growth, giving you insight into how well your practice manages chronic ocular conditions and whether you’re meeting patient needs comprehensively.
Over the past year, with support from Vision Source, we at EyeCode Education have analyzed these KPIs across nearly 300 practices.
The data is compelling: when paired with prevalence data for common chronic ocular diseases, these metrics reveal where practices can focus to better identify and manage these conditions in their patient population. This powerful combination helps practices develop targeted processes that ensure no patient’s condition slips through the cracks.
In future articles, I’ll dive deeper into the prevalence data and specific numbers, exploring how practices can use these insights to further enhance patient care and elevate practice success.
In the meantime, embrace these KPIs as your guide to creating a thriving, comprehensive care-focused optometry practice.
Christopher Wolfe, OD, FAAO, Dipl. ABO, is the founder of EyeCode Education and the owner of Exclusively Eyecare, a Vision Source practice in Omaha, Neb. To contact him: drmoskweli@gmail.com
