Why the Medical Model Makes Good Financial Sense

With the current economic instability, all-time high levels of inflation, and accelerated rate of change in today’s world, we may wonder what the future holds for our beloved profession. The landscape of the ophthalmic world in the United States is like no other, in that vision care plans (VCPs) are the major force that directs the bulk of patient access. In fact, it is common knowledge that they are the main source of patient flow to many practices in the United States.

VCPs are not trending to increase reimbursements; therefore, practitioners must “make it up in volume” by seeing more patients. However, VCPs do bring patients to the practice, where providers have the opportunity to convert them to medical eye care. We need to work smarter, not harder. Medical optometry is the answer to growing our profession in the absence of increased reimbursement rates.

PRACTICE BUILDER

As the scope of our profession continues to grow, so too does our ability to step up and become our patients’ comprehensive eye care providers. Medical optometry provides a powerful opportunity to take an initial patient encounter and create multiple future encounters, thereby maximizing our patients’ lifetime engagement.

VCPs typically only cover one vision examination per year. If you are not practicing medical optometry, then the patient is essentially “one and done” after their annual or semi-annual office encounter. However, when you practice to the full extent of your license and you see a patient who presents with a medical condition or conditions, this initial encounter can be the springboard to several more annual visits.

Many medical eye conditions require chronic disease treatment. Some common examples of eye conditions we see in everyday practice include glaucoma, diabetes, retinal disease, dry eye, iritis, ocular allergies, and giant papillary conjunctivitis. These conditions may require complex medical management and involve multiple patient visits and regularly scheduled follow-up visits to receive diagnostic testing to track progression. For example, depending on severity, a glaucoma patient may need to be seen in the clinic one to eight (or even more) times in 1 year.

PROFITABILITY ANALYSIS

If a VCP examination generally pays X, the medical encounter billed to the patient’s insurance may reimburse at three to four times X, depending on the condition, coding, and payer. Additionally, recommended diagnostic testing or procedures (depending on the condition) could increase the total reimbursement for that particular patient to six times X or more.

For example, depending on your patient demographic, if 25% of the patients already in your chair on day 1 need additional medical eye care, yielding three to six times greater additional revenue, you can multiply this figure by your total patient care days to discover your revenue opportunities associated with practicing medical optometry.

As another example, once a patient with dry eye is identified, their quality of life can be enhanced by appropriate medical treatment, which may include return visits for dry eye testing and follow-up visits, punctal plugs, and potentially noncovered treatments for meibomian gland dysfunction, such as thermal pulsation and corneal bandages, among others.

A caveat to keep in mind: Medical optometry will increase practice overhead in terms of equipment, staff, training materials, office space, and expertise. However, if your practice already has stable patient flow, these investments will more than pay for themselves many times over. Or, to help offset costs, you may be able to take advantage of a program that offers rebates on equipment purchases made through a group or organization.

get FUTURE PROOfed

We already have patients walking through our doors and sitting in our chairs. By offering (or expanding) medical optometry services, our clinics can become a one-stop-shop for our patients, reducing unnecessary time, inconvenience, and cost burden of having to refer patients out to another provider to re-establish care. We are competently trained and equipped to handle their aliments in our offices. Simply put, we owe it to our patients to offer them this care and convenience.

Much of the eye wear and contact lens market is rapidly becoming commoditized. The growth of e-commerce is undeniable. In the future, disruptive technologies such as remote refractions will work consistently. We need to lay the groundwork today to ensure that we continue to play a pivotal role in eye care and fill our offices and examination chairs. As our patients’ doctor, we should never become a commodity.

In advocating for the medical model, I am not saying we should relinquish the core values of optometry to provide vision care; however, I am advocating that we expand our capabilities and services and embrace a future where ophthalmologists can focus on surgical eye care, leaving optometrists to fill the medical eye care void. Be the doctor you were trained to be, and practice to the fullest extent of your licensure—it’s best for your patients, your practice, and your profitability.