Issue link: http://optometricmanagementsupplements.epubxp.com/i/771138
JANUARY 2017 15 for patients diagnosed and treated for dry eye can be level II, III, or IV encounters, depending on the extent of the history, exam, and medical decision making. e dry eye treatment armamentarium is more extensive than it used to be. In addition to treatments that have been used for years, such as manual meibomian gland expression and punctal occlusion, we can also use newer in-office options that take into account the rela- tionship between dry eye and lid disease, MGD, and demodex. ese include BlephEx treatment (Rysurg), LipiFlow thermal pulsation treatment (TearScience), MiBoFlo ermoflo (MiBO Medical Group), and the Cliradex Complete eyelid- and eyelash-cleansing treat- ment (Bio-Tissue). For patients with advanced, chronic, or recurring ocular surface disease, the Prokera cryopre- served amniotic membrane (Bio-Tissue) can be used to reduce inflammation and promote healing. As mentioned previously, we also sell a variety of dry eye care products to help patients manage their signs and symptoms, such as eyelid cleansing pads, warm and cool compress gear, moisture chambers, artificial tears, and HydroEye 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 to our profit margin for dry eye care. LET'S OWN DRY EYE Making dry eye diagnosis and management a prior- ity in the practice is an excellent opportunity to do more for the patients who are already in the exam chairs by providing them with much-needed services. e patients are definitely there. We have become increasingly more aware that millions of people suffer from dry eye. Millions of baby boomers, a large percentage of whom are post-menopausal women, are now joining Medicare. Furthermore, the majority of eye exams are performed by optometrists. All of these factors leave no reason why ODs shouldn't own dry eye care for the benefit of their patients and practices. y I find that most of my dry eye patient visits at Eye Care Associates of Nevada qualify as level III encounters for insurance purposes. In my state, the payment for a level III visit ranges from $74 to $88. And, depending on where a patient is in his or her treatment and what we're doing at a given visit, I may be billing the insurance company or the patient for any of the following, in addition to the visit itself (ranges encompass both Medicare and private insurers): • punctal occlusion OU ($231-$264) • anterior segment photos ($17-$57) • amniotic membrane ($1,489-$2,532) • osmolarity testing ($12-$23) • InflammaDry ($10-$19) • LipiView ($65-$150) • LipiFlow OU ($950-$1,000) • manual meibomian gland expression ($125-$300) • BlephEx ($150-$250) • demodex treatment ($125-$200) • nutritional supplements ($395, or $161 net for a year's supply) • lid scrubs, artificial tears, eye masks, etc. ($196 per patient net in a year). These are a few examples from my practice of services a patient received and the net revenue the services generated: • 4 visits, artificial tears, eyelid scrubs, diagnostics ($577) • 4 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics ($768) • 4 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics, BlephEx ($948) • 6 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics, BlephEx, LipiView, LipiFlow ($1,556) • 6 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics, BlephEx, LipiView, LipiFlow, 1 Prokera amniotic membrane ($2,464) • 6 visits, punctal plugs, artificial tears, eyelid scrubs, diagnostics, BlephEx, LipiView, LipiFlow, 2 Prokera amniotic membranes ($3,272). FROM MY CASE FILES Dr. Devries is a co-founder of Eye Care Associates of Nevada. e majority of his clinical practice involves surgical comanagement and treatment of disease, particularly ocular surface disease.