Looking to Give Your Practice a Boost?

If you’re looking to expand your practice, there are many areas of opportunity from which to choose. Some optometrists may opt to treat more ocular diseases, such as glaucoma. Doing so can instantly transform your practice into more of a medical model, increasing medical billing opportunities for exams and productivity with the addition of necessary diagnostics (eg, visual fields, OCT, other imaging), and increasing assessments that can be billed for (eg, gonioscopy, extended ophthalmoscopy).

Another option is to add more cash-based services, such as specialty contact lens fits, myopia control, or vision therapy. Some optometrists expand their optical selection and provide more of a high-end boutique feel to drive upgraded purchasing; others add more retail items for sale to promote a one-stop-shop feel. One of my classmates has a practice in Miami Lakes, Florida, where she provides high-end eye examinations and sells high-end confections.

Maybe you have already added a service and are looking for the next best offering. Or maybe you want to add something with growth potential that can outperform these more traditional methods. If this is the case, then I invite you to consider implementing dry eye disease (DED) management into your practice, as it can offer the best of these above-mentioned options. Recognizing and treating dry eye is good for business, but equally important, it is good for those whom we serve. It is time to stop ignoring our patients and get on board with this ongoing dry eye revolution. Adding dry eye treatments will pay you back greatly, if done right. I’ll explain in the paragraphs below.

SERVE A LARGER PATIENT POPULATION

There are 16 million Americans with diagnosed DED,¹ and an estimated 30 million Americans report symptoms of dry eye when asked.² I routinely see patients in my practice with dry eye findings and/or positive diagnostics who do not report symptoms, even when given a dry eye questionnaire. It is therefore impossible to know the number of asymptomatic patients with DED.

This could mean that DED by far represents the largest population of chronic disease patients in all of medicine. Understanding that asymptomatic patients need to be identified and treated appropriately, just as symptomatic patients do, can help us achieve better refractions, better fitting contact lenses, better overall ocular health for our patients, and leads to better future outcomes.

If you invest in dry eye, you will have, at the very least, a 10 times larger patient pool to treat, profit from, and help when compared to treating patients with glaucoma—and that is if you are look only for symptomatic patients. Or, if you are already treating glaucoma successfully, why wouldn’t you then add dry eye to your practice? Especially when there is at least a 10 times greater chance of having a patient with dry eye in your chair versus a patient with glaucoma. Also, keep in mind that more than half of all patients with glaucoma also have DED.³

DIAGNOSTIC OPPORTUNITIES

When you treat DED, you can bill medically and build in diagnostics that add to your revenue per patient encounter. You can also employ diagnostics to help diagnose and manage dry eye. Diagnostics covered by insurance, such as tear osmolarity and matrix metalloproteinase-9 testing, have specific use guidelines that must be adhered to in order for insurance to cover them, just as with OCT and visual fields in glaucoma. If insurance doesn’t cover the test, an advance beneficiary notice can be obtained to ensure the patient will pay for the testing.

Other diagnostics used for dry eye, such as meibography, lipid layer thickness, and noninvasive tear breakup time, are not always covered by insurance, although this is evolving. These diagnostics, and others like them, provide valuable information in the understanding of patients with dry eye, and obtaining them creates a cash-based revenue stream for your practice.

Just as in the treatment of glaucoma, the treatment of DED requires a robust standard of care to ensure that you are maximizing the use of your diagnostics to drive the need for treatments that you can offer in order to maximize the value of each patient with dry eye. This ultimately maximizes the patient’s experience and care outcomes.

IN-OFFICE TREATMENTS

Dry eye offers a larger array of in-office treatments that we can provide compared with glaucoma. Although our ophthalmology colleagues can perform traditional surgical interventions, the new microinvasive glaucoma surgery procedures, and even newer injectables for glaucoma, we as ODs should be mastering dry eye treatments, such as thermal pulsation, microblepharoexfoliation, intense pulsed light, and low level light therapy. If positioned and priced accordingly, an optometrist can command a fee for providing some of these dry eye services at a higher rate than a surgeon can bill for standard cataract surgery, which is a one-time event. Dry eye, on the other hand, is a chronic disease, and will likely need ongoing treatment. In other words, every patient with dry eye whom you take excellent care of becomes an annuity for your practice. Each patient remains productive with opportunities to treat and re-treat over the long term, and every new patient builds on what you have already grown.

OTHER REVENUE STREAMS

Treating dry eye allows other revenue streams beyond medical billing, increased chair time, and added diagnostics and treatments. With dry eye, you can also offer recommended products for patients to purchase in your office. There is a growing number of warm compresses, lid scrubs, nutraceuticals, lubricants, and other specialized products you can provide through your practice at a reasonable markup. This ensures that the patient is conveniently able to get the exact products that you are recommending. Of course, capital will be tied up in inventory for these products. You need the space and a process in place to minimize shrinkage, but it is a model that many dry eye practices take advantage of. It adds that retail aspect to gain another revenue stream, all from simply adding dry eye to your practice.

The diagnostic tools available for dry eye continue to grow. Some, such as tear osmolarity and matrix metalloproteinase-9 testing, have little upfront investment, but do have ongoing material costs. Others, such as some imaging technologies, can have an upfront investment but then no ongoing cost. Once you consider that, think about the actual numbers again. There simply are more dry eye patients walking in your doors than there are glaucoma patients. Both groups deserve treatment equally, but it seems that only glaucoma patients get the help that they deserve consistently. Glaucoma is something that none of us will ignore; even if we are not equipped to treat it, we don’t ignore it. If we are not in a setting able to correctly treat glaucoma, we will always refer it to someone who can. Dry eye should be no different.

DETERMINE YOUR LEVEL OF INVOLVEMENT

Once you decide to incorporate dry eye treatment in your practice, you need to decide how in-depth you want to get. Do you want a full-scope dry eye practice with all the diagnostics and available treatments? Do you want to be middle of the road and treat dry eye, but refer patients for the higher-order diagnostics and treatments in a shared care model? Or do you simply want to recognize patients who have dry eye and refer them to a full-scope practice and handle only their annual eye care yourself?

No optometrist should ignore dry eye, regardless of practice setting. It is too widespread and affects our patients’ everyday lives.^4-7 Dry eye is a chronic and progressive disease and its prevalence will continue to rise.⁸ It pays off in many ways to get on board with its diagnosis and treatment. It can be a powerful practice builder and even a practice-saver.