The All-Medical Optometry Model: From Vision to Reality

It has been fascinating to observe the wide range of effects that COVID-19 has had on the optometric profession. One theme that was present even before the onset of the pandemic is the demand for medical eye care services.

There is an increasing need for optometry to embrace the medical model. We heard this theme early on in optometry school and, more recently, at lectures and conferences, as well as from our medical device and pharmaceutical industry partners. The reason is clear and well-documented: The aging baby boomer generation is stressing all facets of the health care system, including eye care.^1,2 There is a stagnant number of ophthalmologists who are largely focused on the surgical needs of their patients.³

Beyond the increased competition from online eyewear retailers, there are continued and evolving threats to optometry. Health systems use physician assistants to perform diabetic eye care and occupational and physical therapists to administer vision therapy to patients who have had concussions or strokes. As optometrists, we need to step up, practice to the full extent of our licensure, and take the lead on the medical eye care needs of the patient population while continuing to expand our scope. In this article I explain how I did just that.

GOING ALL IN

Practice ownership has long been a professional goal of mine, but finding the right platform on which to build a practice with a primary focus on medical eye care was the challenge. In late 2019, I engaged in a series of discussions with the team at Medical Optometry America (MOA), led by its CEO, Kenneth Krieg.

Ken and his team were observing the same trends I was. They were expanding the conversation to include leading medical economists and MDs and ODs in the eye care space to determine what the future of optometry would look like and how to forge a path ahead to it.

MOA sought to create an entirely new all-medical model of the optometry practice, with an advisory board comprised of leading academic and clinical thought leaders in both optometry and ophthalmology. They developed a comprehensive set of best practice guidelines to ensure the optimal management of patients by disease state.

I made the commitment to go all in and pursue what I had naturally gravitated toward my entire career. From residency to earning my fellow-ship in the American Academy of Optometry to pursuing research and collaborative opportunities with other medically minded optometrists, the MOA model seemed like the perfect fit.

Things progressed quickly from there; the buildout of the office space, hiring initial staff, purchasing equipment, and putting all the details in place to launch the practice. I was honored to open the first MOA location in the country on January 4, 2021, near my hometown in southern Pennsylvania.

REFLECTING ON THE FIRST YEAR

The first year of operation has been more challenging than I anticipated, but equally rewarding. This experience continues to push me to grow as a practice owner, optometrist, and hopefully as a leader for the future of our profession (Figure 1). Following are some of my biggest take-home points from the past year.

Office Layout

Opening after the onset of COVID-19 allowed for thoughtful changes to the office layout and protocols for patient safety, and also influenced the purchase of certain equipment to enhance the patient experience. To support the medical eye care platform, we needed to outfit the practice with a full complement of diagnostic and treatment equipment.

Staffing

Even more important than having the right equipment is having the right staff. The team I assembled made this journey during the first year successful and fun (Figure 2). Collectively, the five of us have more than 100 years of experience in eye care. Several of our team members left bustling ophthalmology practices to be part of making the MOA vision a reality. It took several months to find the right team members, and as patient numbers have gradually increased, we have expanded our team since the initial opening.

A complete focus on medical eye care requires a different staffing strategy to create an optimal doctor-to-staff ratio with cross-trained ophthalmic technicians and a medical scribe. The scribe saves a tremendous amount of time because he or she allows the doctor to fully focus on the patient during the examination. Having a scribe also helps ease the burden of prior authorizations for medications. Additionally, having an office administrator and in-house billing expert has been extremely helpful in promoting smooth operation and facilitating practice growth during this first year. Medical billing is difficult, and the traditional systems used in optometry generally don’t support the volume and complexity of medical billing.

EHR System

Taking time to research and determine the best EHR system for the practice is an important consideration. Optometry EHR platforms are not ideal for medically focused practices, and some systems cannot be placed in practices without an MD on staff. Investing in an EHR system that allows for high-volume medical billing is essential to the success of any medically focused practice.

OPENING A NEW PRACTICE MODEL

Although this is a new practice model, we are not immune to the traditional challenges associated with starting a practice cold. It can take years to ramp up from a cold start to break even and maintain profitability, even when buoyed by additional revenue from corrective lenses. The MOA team had faith in the model and the need for this type of care, and our patient and revenue numbers continue to increase each month, thanks to marketing efforts and referrals.

Marketing

Having the support of MOA made several key elements of the launch easier than had I done it on my own. A sophisticated marketing campaign was launched to drive patients through the door via targeted advertising, public relations, and raising awareness to build our network of referral sources. Building relationships within the local health care community was critical to driving home the access, quality, and value of care that MOA offers to its patients.

Referrals

Many of our referrals come from urgent care centers located within a 10 to 15-mile radius of the practice. Having on-call access to emergency eye care is a welcome resource for the physician assistants and staffers at these centers.

Dry eye disease, diabetic eye care, and glaucoma also drive a lot of our patient numbers (Figure 3), and it is immensely gratifying to earn referrals from MDs and ODs who understand and value the resource that a medical eye care practice offers (Figure 4).

A PREMIER PATIENT EXPERIENCE

We all know that the best way to grow a practice is by offering a premier patient experience. That has been a huge focus for MOA. Every aspect of the patient experience is intentional. The layout of the entranceway and lobby, patient flow throughout the practice, and even the sensory experience of what patients, see, hear, and smell were all thoughtfully planned.

In many ways, this first practice has been a testing ground for MOA to see what works and what doesn’t. Interest in the all-medical model continues to grow, and two more MOA practices are set to launch in the mid-Atlantic region in early 2022, with more to come later in the year. It has been an interesting journey thus far and I am excited to see what the future holds for MOA and our profession.