Optometric Management Tip # 435 - Wednesday, June 16, 2010
Who should present optional screening tests?
This week's article asks a question that I don't really have the answer to, but I've been studying the matter closely and I can present some pros and cons for your consideration. And of course, I always like to hear from readers about their experience. I'll report back with a summary of your input in a future article.
Many eye care providers (ECPs) offer optional special screening tests to patients, not covered by medical insurance or vision plans, for an additional fee. Typically the fee is nominal and designed to encourage a large number of patients to opt in and agree to the test. This allows patients who have basic routine vision coverage to obtain the most advanced technology in eye care. Patients with medical insurance have access to screening tests that are never covered without a medical diagnosis. Many ECPs report patient acceptance rates of 75% or higher, which validates the concept of special screening tests. But acceptance rates can vary widely and I believe the manner in which the test is offered can have a huge effect. What's your experience?
Typical screening tests
Here are a few of the more commonly performed exam upgrade tests:
- Digital Retinal photography
- Macular pigment optical density test
- GDX or OCT screening
- Automated visual field screening
- Corneal topography
- Others – what optional test do you offer?
When, where and by whom the test option is offered to the patient is an important consideration. Here are some pros and cons for three possibilities.
Receptionist presents the option to the patient at check-in
- Typically, the receptionist will present a printed handout form that describes the test and the fee and asks the patient to check yes or no and initial or sign the form.
- The form prevents misunderstandings and provides proof that the patient authorized the test.
- The form presents a practice-approved message about the test and can also provide sample images.
- The patient has a chance to read about the test and think it over.
- The patient has a chance to confer with a spouse or other party.
- It offers the patient a graceful way to decline. While the goal of the practice may be to have more patients accept screening tests, think carefully about the patient experience and crossing the line to being pushy.
- Patients may tend to stand at the front desk to read the educational handout form, blocking access by other patients and creating an awkward situation.
- Patients may ask questions about the screening test to receptionists who are not as well trained in clinical eye care as technicians.
Technician presents the option during pretesting
- The technician has a better understanding about the nature of the test and what it does.
- The technician may have an incentive to discourage acceptance of the test because it is just more work for her. This may be especially true if the office is running behind schedule.
- Explaining the screening test in the pretest room takes more time and could cause a bottleneck to patient flow and block access to the room by others.
- The patient may feel put on the spot. There is little time to understand the test and the patient may feel forced to give a verbal answer quickly.
Doctor presents the option in the exam room
- May result in the highest patient acceptance rate because recommendations from the doctor carry more weight.
- The doctor can provide case-specific reasons why the test is advisable.
- Associate doctors may not have an interest in recommending some screening tests.
- The test results are not available before the doctor's portion of the exam. It is helpful to see most data before the exam and the doctor may have to see the patient twice if the test is to be reviewed and discussed.
- If the patient is dilated, some tests may have a better outcome after dilation, rather than in pretesting.
Regardless of how you offer screening tests now, it may be smart to experiment in your practice with the various options. It could reveal a method with better patient acceptance, improved efficiency or a less confrontational approach. Simply try different procedures and track the acceptance rate and revenue production for each over a period of a couple weeks. Advise staff members that you are testing different methods and ask for their feedback on each. Listen and observe patient reactions.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management