Issue link: https://optometricmanagementsupplements.epubxp.com/i/635658
Gland Evaluator (TearScience) enables standardized, repeatable evaluation of meibomian gland function at the slit lamp. All of the tests related to dry eye and meibomian gland disease (MGD) are revenue-generators for a practice, some more so than others. They fuel the dry eye segment of your practice by allowing you to uncover more ocular surface disease, schedule more patient visits, and provide more treatments. Re-Appointment and Treatment S c h e d u l i n g d r y e y e t r e a t m e n t s separate f rom routine exams and dr y eye testing — for example, re- appointing patients for subsequent visits — is key to ensuring you're being paid appropriately for your services. R e - app oi nt me nt s are a st apl e i n most medical care models, in which patients are rarely, if ever, diagnosed and treated on the same day. The subsequent appointments for patients you're diagnosing and treating for dry eye can be level II, III or IV encounters, depending on the extent of the history, exam, and medical decision-making. The dr y eye treatment armam- entarium has been expanding. In addit ion to t re at ments t hat have been used for years, such as manual meib omian g land expression and punctal occlusion, we can also make use of newer in-office options that take into account the connections between dry eye and lid disease, MGD, and demo dex. Thes e include t he microblepharoexfoliation BlephEx t re at ment (Rysurg), t he L ipiFlow t h e r m a l p u l s a t i o n t r e a t m e n t ( Te a r S c i e n c e ) , a n d t h e C l i r a d e x Complete eyelid- and eyelash-cleansing treatment (Bio-Tissue). For patients with advanced, chronic, or recurring ocular surface disease, the Prokera b i o l o g i c c o r n e a l b a n d a g e ( B i o - Tissue), a self-retained, cryopreserved amniotic tissue, can be used to reduce inf ammation and promote healing. In our practice, we also sell a variety of ancillary products to help patients manage their signs and symptoms, such as eyelid cleansing pads, Cliradex m oi st towe l e tte s w ar m an d c o ol compress gear, moisture chambers, a r t i f i c i a l t e a r s , a n d H y d r o E y e nutritional supplements (ScienceBased Health). Although our original intent was to bolster patient compliance by making carefully chosen products easily available, we learned that the merchandising adds signifcantly to our proft margin for dry eye-related care. Real-world Numbers I fnd that most of my dry eye patient visits qualify as level III encounters for insurance purposes. In my state of Nevada, the payment for a level III visit ranges from $74.09-$88.63. And, depending on where a patient is in his treatment plan and what we're doing at a given visit, I may be billing the third- party carrier or the patient for any of the following in addition to the visit itself (ranges encompass Medicare and private insurers): • Punctal occlusion OU ($231.24-$264.21) • Anterior segment photos ($17.35-$57.78) • Prokera ($1,489.02-$2,532.51) • Osmolarity testing ($12.57-$23.47) • InfammaDry ($10.57-$19.42) • LipiView ($65-$150) • LipiFlow OU ($950-$2,000) NOTE: TearScience recently reduced the price of its single-use activators, and I recently lowered my charge to patients given that I perform a high volume of treatments.) • Manual meibomian gland expression ($125-$300) • BlephEx ($150-$250) • C l i r a d e x C o mp l e t e D e m o d e x treatment ($125-$200) • Nutritional supplements ($395.40, or $161 net for a year's supply) • Lid scrubs, artificial tears, eye masks, and so on. ($196 per patient net in a year) These are a few actual examples from my practice, which illustrate the ser vices a patient received and the revenue they generated: ■ 4 visits, artifcial tears, eyelid scrubs, di agnostics (net $577) ■ 4 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics (net $768) ■ 4 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics, BlephEx (net $948) ■ 6 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics, B l e p h E x , L i p i Vi e w, L i p i F l o w (net $1,556) ■ 6 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics, B l e p h E x , L i p i Vi e w, L i p i F l ow, 1 Prokera (net $2,464) ■ 6 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics, B l e p h E x , L i p i Vi e w, L i p i F l ow, 2 Prokera (net $3,272) Creating Value As you can see, the value we can provide to our patients by utilizing the latest dry eye tests and treatments to di agnose and manage them is matched by its significant contribution to the practice bottom line. • Dr. Devries is a co-founder of Eye Care Associates of Nevada, a statewide medical/ surgical practice, where he is the clinical director and director of the Optometric Residency Program. "You really only have two choices for protecting your revenue stream. You can either see more patients or you can do more for the patients you already have. Dry eye is a great opportunity to do more — to provide much- needed services for your existing patients." FEBRUARY 2016 | 13