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10 JANUARY 2017 Treat or Refer? There's more than one way to ensure your patients get the dry eye care they need T he founder of our practice, Frank Bowden III, MD, FACS, long ago recognized the importance of treating ocular surface disease. erefore, in addition to the comprehensive surgical and optometric care the practice provides, we also have a dry eye treatment model in place. e model addresses all of the etiologic factors that contribute to dry eye and it's driven by diagnostic tests and the metrics they provide. As we all know, dry eye is not a simple disease, so a great deal goes into our comprehensive dry eye exam (Table 1). e good news is that today's diagnostic tests help us to identify what's happening in each case, guide treatment, and monitor progress. We are obtaining true medical data to help us provide the best possible care. We think about dry eye the same way we think about, for example, glaucoma. ere's a standard of care to fol- low for glaucoma in that certain testing needs to be per- formed: visual fields, OCT scans, gonioscopy, pachymetry, and tonometry. If we're not performing those tests, we're not providing today's standard of care and, as a result, we are putting our patients at risk. erefore, practices that don't provide the latest tests and treatments for dry eye need to find a way for their patients to have access to them. THREE OPTIONS FOR PROVIDING STANDARD OF CARE Practices have three options to choose from when it comes to ensuring their patients receive proper care for dry eye disease. ey can choose to be a 1) referral-only practice, 2) shared-care practice, or 3) specialty practice. A referral-only practice recognizes when patients could benefit from dry eye care and refers them to a specialty practice to receive that care. In this scenario, it's important to research which nearby practice is offer- ing top-notch, comprehensive care. Consider, too, that a referral-only practice could play an important role in educating patients. A shared-care practice is one that has acquired some but not all of the necessary dry eye diagnostic tests and treatments and, as such, refers patients out to receive whatever aspects of care it doesn't yet offer. is practice may, for example, perform meibomain gland evaluation, By Jerry Robben, OD THE FIVE Ps OF RAMPING UP A DRY EYE PRACTICE To add a comprehensive dry eye segment to the services your practice offers, follow what we at Bowden Eye & Associates refer to as the Five Ps. 1. People. Practice leaders develop clinical protocols, i.e., a standard of care. All staff members are trained and engaged in that standard of care. 2. and 3. Products and Procedures . Adopt a portfolio of tools, not just one, to accurately diagnose dry eye and treat it in all its forms. 4. Process. Decide how patients who need care will be identified and what will happen next. At Bowden Eye & Associates, the SPEED questionnaire drives our dry eye standard of care. The technicians complete the form with the patient. From there, they can decide what to do next. For example, does the patient need an allergy test? Does the patient need meibography? 5. Payment. Some dry eye services and products are patient-pay and others are covered by insurance. A practice that's serious about dry eye care need not worry about that. Based on our experience, the economics will fall into place if you follow these simple steps: establish a standard of care and fee structure; identify what can and can't be filed with third- party payers, then file accordingly; educate patients about the importance of any test or therapy; use advance beneficiary notices when appropriate; and collect fees as needed.