Expand Your Opportunities for Profitability

Running a successful optometry practice goes beyond providing quality eye care services. In order to thrive in today’s competitive health care landscape, optometrists must adopt strategic approaches that maximize their profit streams. Optimizing profitability requires both the owner and staff to embrace cutting-edge technologies and expand the scope of services offered.

The good news is that optometry practices can increase revenue and achieve sustainable growth. This article explores how using advanced technology and treatment options can lead to improved business and patient outcomes. Note: specific technologies and treatment options are mentioned here because they are those with which I am most familiar. (See Additional Options for a rundown of other technologies and treatments that may boost your practice’s profitability.)

ELECTRODIAGNOSTICS

Visual electrodiagnostic tests, such as visual evoked potential, electro-oculogram, and electroretinography (ERG), offer valuable insights into the functioning of the visual system. ERG aids in the diagnosis and management of various ocular conditions, including retinal dystrophies and degenerations, optic nerve disorders, and visual pathway abnormalities. Incorporating electrodiagnostics into an optometry practice can provide more accurate diagnoses and disease evaluation, thus leading to more targeted treatment plans and improved patient outcomes.

The RETeval device (LKC Technologies) is, in my opinion, the electrodiagnostic equipment of choice for the modern day optometrist (Figure 1). It offers many benefits, including handheld portability, lightweight design, noninvasiveness (as it only requires skin sensor strips), ease of use, minimal testing time, and no dilation required. More than 120 peer-reviewed research papers demonstrate the importance of electrodiagnostic testing in eye care.^1-3

Most importantly, the RETeval device provides objective measurements that enhance clinical care. ERG data produce reliable guidance for detecting functional stress, often ahead of structural changes. Note: ERG testing can be repeated to assess for improvement in ocular conditions, especially for patients with diabetes. For example, a technician can perform a diabetic retinopathy (DR) assessment with the RETeval for a patient with DR. If blood glucose levels recover, the DR score can be expected to improve when repeated at the follow-up examination. The nationwide average in reimbursement for Current Procedural Terminology (CPT) code 92273 (Electroretinography with interpretation and report; full field) is above $120.

Pro Tip

Although RETeval has a variety of electrodiagnostic applications, the DR score is best determined with undilated pupils, so it’s best to run the DR assessment prior to dilation. Also, ensure proper strip placement to avoid testing errors.

COLOR VISION TESTING

All optometrists are familiar with color vision and the role it plays during the pre-testing stage of a comprehensive eye examination. What many ODs may not be aware of is how advanced color vision testing can be used to diagnose and manage a variety of ocular conditions. Integrating color vision testing into your practice enhances disease management and enables more personalized treatment plans. The Rabin Cone Contrast Test (Rabin CCT; Innova Systems) is portable (tablet-sized), simple for technicians to use, and easy for patients to understand (Figure 2).

Rabin CCT testing subjectively evaluates a patient’s response to color cues. Because color vision comes from cone photoreceptor operation, this test allows us to assess cone function. The software creates an analysis of color vision split into three easy-to-interpret categories: normal color vision, potential acquired deficiency, and acquired deficiency. Extended color vision testing aids in earlier detection of cone abnormalities, allowing timely intervention and treatment. An improvement in a patient’s disease state can be monitored via improved scores with repeated Rabin CCT testing. Better yet, ODs can use Rabin CCT testing for a variety of conditions in which cone function is altered, such as age-related macular degeneration, DR, and glaucoma.

The nationwide average in reimbursement for CPT code 92283 (Color vision examination, extended) is more than $50. As with most CPT codes, this reimbursement amount varies based on geographic region. The remuneration, simplicity, reliability, repeatability, and effect on clinical care makes the Rabin CCT device an attractive addition to any optometric practice.

Pro Tip

Consider adding testing with the Rabin CCT device to your standard testing protocol for patients with diabetes. It will allow you to gather baseline testing and cast a wider net to detect abnormal retinal function prior to visible DR.

AMNIOTIC MEMBRANES

Amniotic membranes have in recent years captured the attention of optometrists because of their unique biologic properties and remarkable healing potential. They come from placental tissue and possess a rich array of collagens, growth factors, cytokines, and other molecules that facilitate tissue regeneration and modulate inflammation.⁴ When applied to ocular surfaces, these membranes create a bioactive scaffold that promotes wound healing and reduces scarring, ultimately restoring visual function and improving overall eye health. In addition, amniotic allografts are avascular, which mitigates the risk for tissue rejection. These membranes can be applied in various ocular conditions, such as corneal ulcers, dry eye syndrome and dry eye disease, and recalcitrant corneal defects.

Amniotic membranes are available in a several forms: cryopreserved, lyophilized, and dehydrated. Each form carries its own distinct advantages and disadvantages, which are beyond the scope of this article.⁵ Costs per allograft vary substantially, ranging from $100 to more than $700, with dehydrated membranes leaning towards the less expensive side of the scale. Application of amniotic membranes, office flow, and follow-up protocols warrant additional articles and conversations (see More on Amniotic Membranes). Comparisons on clinical efficacy aside, dehydrated membranes are a wonderful tool, as they have great performance and are significantly less expensive than lyophilized or cryopreserved options.

More on Amniotic Membranes

Check out these videos for more in-depth information on amniotic membranes, including steps for placing and removing them, tips for making the fitting process easier, and billing and coding issues.

Amniotic Membranes: What They Are and How to Use Them

Wax On, Wax Off: Placing and Removing Amniotic Membranes

Meet Code 65778 and Hone Your Amniotic Fitting Process

CPT code 65778 (Placement of amniotic membrane on the ocular surface; without sutures) is one of the highest reimbursing ophthalmic codes available for optometrists. The amount varies, but often lies between $1,200 and $1,500. This should give us pause for concern. Due to the fantastic reimbursement, it’s not surprising that use of amniotic membranes has increased in recent years. Allografts may now be applied in cases that could likely be managed just as well with traditional therapies. It goes without saying, then, that clinical judgment and patient care should always be prioritized over revenue when determining the appropriate use of amniotic membrane application.

Pro Tip

The global period for 65778 is zero days. In other words, additional amniotic membranes may be employed and billed for in the same clinical case, if appropriate. Consideration should be given to prior authorization, patient insurance deductibles, and insurance reimbursement prior to use.

THREE AREAS OF OPPORTUNITY

In the ever-evolving field of optometry, clinicians continually seek innovative approaches to address complex ocular conditions and enhance patient outcomes. However, improving patient care while increasing revenue can be a source of headaches for practice owners everywhere. Amidst the pursuit of practice growth, electrodiagnostics, advanced color vision testing, and amniotic membranes have emerged as remarkable clinical tools, offering novel and versatile solutions for a wide range of ophthalmic purposes. Incorporate them into your office and watch your practice grow.