By Paul Karpecki, OD, FAAO
Dry eye is an under-diagnosed and under-treated eye condition. Creating a dry eye clinic serves your patients’ needs—and provides you with a revenue stream.
Over 40 percent of my patients mention dry eye as a primary or secondary complaint. You may not have looked into it yet, but there is a good chance, with the aging population of Baby Boomers and the growing number of people on prescription medications that create dry eye, that this percentage is similar for your practice. What’s more, most patients with dry eye complaints are unsatisfied with the treatment they have so far received.
According to Gallup, over 70 percent of people with dry eye complaints have seen at least three doctors and are still searching for a remedy. In addition, the majority of that 70 percent still searching for a successful treatment have tried at least three different artificial tear products that have not provided relief. With numbers like these, I decided to launch a dry eye clinic, devoting one to two days per week to seeing nothing but patients with dry eye complaints.
High Per-Patient Revenue
Patients who have already tried multiple treatments unsuccessfully are willing to do what it takes to find relief. That attitude is borne out by the per-patient-revenue of dry eye patients. In my practice, that figure comes to between $300 and $800 per dry eye patient, depending on the severity of the dry eye. The chair time is not excessive to treat these patients. Dry eye patients typically spend about an hour in my office, but I only see them in the exam room for about seven to ten minutes. I see about 30 to 40 patients per day on the days devoted strictly to dry eye. I estimate a yearly growth of 20 percent in dry eye patient volume per year and growth of about 14 percent in dry eye clinic profitability each year. The instrumentation costs for launchingan extensive dry eye clinic are $150,000 or less, which I was able to break even on within one year.
Delegate Dry Eye Pre-Testing
The key to making dry eye clinics profitable is to streamline the process so you can see as many patients as possible on the days you devote solely to dry eye. For example, my staff will conduct osmolarity (Tear Lab) testing, a five-second test that measures the salt to solution level in the eyes (any reading over 308 is considered an indicator of dry eye). My staff will also perform testing with our iCaretonometer which does not require a puff of air or administering drops that could affect the surface of the eye and interfere with the rest of the dry eye examination. Patients are then placed in the exam lane and given a more specific dry eye questionnaire to fill out to assess how the condition is affecting their eye comfort and vision.
After the patient has filled out the questionnaire in the exam lane, they watch EyeMaginations educational videos with animated graphics that illustrate the condition and pose trivia questions. These videos also are playing in the reception area. Between the questionnaire and the educational videos in the reception area and exam lane, patients are primed to speak to me when I arrive. They have the state of their condition in mind from the questionnaire and have the beginnings of an education on the topic from the animated videos.
Streamlined Doctor-Patient Time
By the time I get to the exam room, my tasks are limited. After reading the osmolarity measurement, I then do an assessment of the eyes, expressing the meibomian glands in the lower central and nasal eye lid and then using the slit lamp for an assessment based on my observation. The technician instills a drop of fluoresceine and then lissamine green dye and using a Raton filter I can assess the degree of staining, the tear meniscus height and tear film break-up time. I then do a fundus examination to rule out eye diseases that can lead to dry eye such as diabetic retinopathy because diabetics have a high prevalence of dry eye disease. I project the images of the patient’s eyelid glands from the slit lamp onto a flat screen monitor via the TelScreen EyeRes system to show patients a picture of their condition and bring to life what I am explaining to them. I also run through the EyeMaginations animations related to their specific condition while in the lane.
Code and Bill for Dry Eye
When patients visit your office with medical conditions that they already know cause dry eye–often on referral from their primary care doctor–you are able to bill medical insurance for the visit and services, but when patients present with symptoms such as dry eye-related blurry vision, you would bill vision insurance. The extensive testing using instrumentation also offers an opportunity for billing. For example, in addition to offering patients a literal picture of their condition, the pictures I project onto the slit screen enable me to bill for anterior segment photography when appropriate. With dry eye a condition frequently related to medical conditions a patient may not yet know they have, such as diabetes, it is not uncommon for a vision insurance patient to eventually become a patient whose treatment is billable to medical insurance. I am also able to bill for the TearLab osmolarity test which reimburses approximately $46 for two eyes of testing (The AMA CPT recommends reporting 83861 twice, using the “-59” modifier for the second eye tested to indicate that it is a “Distinct Procedural Service”). Editors note: Click HERE for a detailed article on coding and billing for dry eye.
A Long-Term Treatment
There is no cure for dry eye and it frequently worsens with age, additional medical conditions and the addition of new prescription medications. Your patients will be served by your long-term care, thereby creating a loyal patient base likely to refer you to friends and family as the doctor who finally provided them with relief.
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Paul Karpecki, OD, FAAO, is an ocular surface specialist and co-founder of Eyecare Educators, a provider of continuing education services to optometrists. In addition, he serves on TearLab’s Independent Board of Directors and consults for EyeMaginations. Dr. Karpecki practices at Koffler Vision Group in Lexington, KY. To contact him: firstname.lastname@example.org.