Time for a New Imaging System?

Remember the days in optometry school when you were the pre-testing technician, the doctor, and the optician—and sometimes also the person who made the glasses? In the real world of patient care, we need to be more efficient and use tools that help us see more than four patients per day, while also ensuring excellent patient care and running a financially successful business.

As primary eye care providers, we are at the forefront of diagnosing diseases and conditions. In our daily clinical routines, we use myriad technologies to accomplish this task while providing the best patient care and experiences possible as efficiently as possible.

The eye care profession arguably uses the most diagnostic instruments of all medical professions. Consider the fact that while an orthopedic specialist primarily uses x-rays, CT scans, and an MRI, an optometrist or ophthalmologist uses all of these on occasion, but on a daily basis uses an autorefractor, tonometer, slit lamp biomicroscope, binocular indirect ophthalmoscope, visual field analyzer, retinal imaging, scanning laser ophthalmoscopy with OCT, topographer, visual evoked potential test, electroretinogram, and more.

Making the decision to bring new technology or equipment into your practice should be analyzed from different perspectives to ensure that it can help you be a better clinician and still be a financially good investment.

IS A NEW PIECE OF EQUIPMENT THE RIGHT DECISION?

What’s best for you and your practice depends on the volume of patients your practice sees and your ability to self-manage your patients over time versus referring them to another practitioner for care. We all want to have every toy in the store, but if you’re a single OD in a new location with excessive overhead and you see only three patients per day because the community isn’t aware of you yet, you won’t be able to sustain the financial burden of making payments for a retinal camera, an OCT, a topographer, etc.

I am thankful to be practicing in a group setting that has all the equipment I desire. We have three external cameras (two mounted on slit lamps and one within our topographer), one topographer that can double as a meibographer and an external camera, a Zeiss Humphrey Visual Field Analyzer 3 (Ziess), visual evoked potential and electroretinogram devices, an OCT, and two retinal imaging systems. But the device that none of our doctors would want to practice without is a retina wide-field imaging system.

This article serves as a quick guide to the available options for bringing in a new piece of equipment, plus my opinion on which option is the best choice. This discussion can be applied to virtually any form of equipment.

BUY, LEASE, OR SUBSCRIBE?

Historically, many banks have offered low interest rates to purchase medical equipment and typically partnered with equipment vendors to assist in the transaction. Interest rates may be on the rise, but I was still able to secure a 0.99% interest rate on the purchase of a new lane of equipment (chair, stand, slit lamp, and electronic phoropter) in April. The goal is the same for any loan: Generate revenue quickly and pay the unit off so that it delivers added revenue to the practice as early as possible.

Our group could have fully paid off our last widefield imaging system in 7 months; however, we opted not to because we had a 0% interest loan over 5 years, so we used it as free money. The unit then generated positive cash flow for the remaining years of the loan.

Once you purchase equipment, even if there is a loan tied to it, it is the purchaser’s responsibility to maintain the equipment. Most vendors offer an annual service agreement and repair plan, which are not cheap and can run from $2,000 to $5,000 a year! But when you consider the cost of repair on a simple laser scanner (~$10,000 labor), it seems worthwhile.

Next, consider the lease option. The first thing to remember is that unless there is a buyout at the end of the term, you will never own the equipment. Therefore, the lessee will always be tied to the equipment with a debt. This can be a long-term financial burden on a practice. However, the benefit here is that the equipment is always under a service agreement, so the manufacturer covers any repairs or downtime. In this case, if you can cover the monthly payment with patient flow, then leasing would be a reasonable option. Another benefit here is that, as technology changes, you can update your devices easily, as long as you are past the initial term of the lease.

The last option to evaluate is the subscription, or as some call it, “pay-per-click” method. In this scenario, the volume of patient care is not a factor, as the device is generally only charged per patient encounter or use. This is a great option for new clinics or for testing a new device in a clinic. However, the cost to use this system is typically fairly high, leaving little profit to the practice after factoring in technician time and accounting (ie, billing and coding and applying payments). If you are trying to grow your practice financially, take the time to carefully analyze the metrics here.

your best bet in imaging

Financially speaking, the best bang for your buck in generating revenue for your practice is a retinal imaging system. Oftentimes, optometry offices will allow a patient to “opt-in” for a retinal screening for conditions such as glaucoma, diabetic retinopathy, hypertensive retinopathy, and malignant nevus for an out-of-pocket fee. However, in the realm of medical billing and coding, the retinal imaging system can provide a significant return on investment, as the practice can bill for many different retinal and vitreal findings, which is often reimbursed fairly well. By this token, the retinal imaging system can be used both by patient choice and as doctor ordered for monitoring. Not to mention, the device can pay for itself all at once in the absence of a finding.

Imagine the case of lawsuit for missing the diagnosis of a retinal hole or tear that led to a detachment. Having a widefield retinal imaging system would be your “eye witness” that you didn’t miss the diagnosis in many cases. (Note: widefield imaging does not replace the need for dilation and evaluation of the retina with a binocular indirect ophthalmoscope; however, it can be used adjunctly.)

If you don’t already have a widefield imaging system, I suggest getting one. If you already have one, you may wonder if it’s time for an upgrade to enhance your patient care. (With any technology, it’s important to stay up to date.) If this is the case, then refer back a few paragraphs to determine which option for bringing in that new piece of equipment suits your needs the best.

LOOK BEFORE YOU LEAP

As you venture to your next optometric trade show looking at the next piece of equipment you want to purchase, keep a few things in mind. Have you reviewed the metrics of your practice? Have you considered the reimbursement per patient and how many patients you will actually use this equipment with? Can you use it on every patient? Make sure you have reviewed your finances before taking the plunge.