Article Date: 6/1/2009

Riding the Tide of New Technology

Riding the Tide of New Technology

Learn how to buy the right equipment for your practice and provide the best patient experience.

By John Warren, OD, Racine, Wis.

WHEN IT COMES TO optometric practice, the technology a practice uses and has access to is critical for delivering the highest quality patient care and patient experience. The public has few options to assess the quality of its eye exams. As long as people can see comfortably with their eyeglasses and contact lenses, they have no way of knowing how thoroughly their doctors examined their eyes.

A practice can choose to implement many different types of technology. But choosing the right blend of technology is crucial. To this end, it will be important for you to develop a good technological integration plan. This plan should include a list of the technologies you'd like to incorporate in your practice, an explanation of how they'll work together and a timeframe for when you'll add them to the practice. The plan also should include a budget for how much you'll spend on each piece of equipment. It's best to implement this plan as early as possible in the life of your practice — ideally before you finalize your business plan and submit it to lenders. This will ensure you receive sufficient financing for the technology that will serve your practice for many years to come.

In this article, I'll discuss the types of equipment that may be best for your practice, the benefits of digital imaging, ways to buy equipment and how to determine if the technology is right for you.

Beginning Steps

Because every practice and situation is unique, it's impossible to give specific recommendations about what technology to buy. But I can make some general suggestions.

Before purchasing technology, it's always best to implement a solid practice management strategy, such as incorporating electronic medical records if you're building a new practice. If you're beginning a new practice, there's no advantage to starting with paper charts and moving to electronic medical records later. A practice management solution is a program, such as OfficeMate, RevolutionEHR or MaximEyes.

After you've taken this step, you should consider purchasing good scheduling software, such as Practice Management Solution, for front desk staff. Part of creating a good experience for patients is having a software system in place to schedule appointments quickly. You don't want patients waiting any longer than 30 seconds for an employee to open the software, go to the scheduling page and locate the next available appointment that meets their needs. The software should operate quickly and efficiently.

Technology Essentials

Refractive technology often is very desirable to improve patient flow and enhance the patient experience. Even in a newer practice that doesn't have a heavy patient flow, suggesting the need I for greater efficiency, you may want to think about where you want your practice to be 10 years from now, not just 10 months from now. So make sure you consider buying a refracting system that integrates autorefraction, a phoropter and an electronic, or computerized, eye chart. Every patient should come into contact with this technology in the exam lane. You also should consider future equipment additions when choosing your lensometer, autorefractor/keratometer and eye chart technology. Several manufacturers can sell you al a carte devices you can link together with other equipment in the future. You don't want to invest several thousand dollars in different pieces of equipment that won't work in tandem.

Keep in mind that an autorefractor/keratometer isn't required to administer quality patient care, but it speeds up refractions, potentially enabling you to see more patients per time block. And from the patient's perspective, it speeds up the time it takes to perform a refraction. You may not choose to purchase one of the integrated devices that provide much more information than autorefraction and keratometry alone, but you'll need to be able to give your patients a great refraction experience they might have had in the past.

Corneal Topography

Once thought of as advanced diagnostic equipment, corneal topography now has many clinical applications. From explaining unexpected reductions in best-corrected visual acuity to allowing for truly custom contact lens design for just about any type of refractive error, topography is powerful technology that gives you a wealth of information. Some of the combination autorefractor/keratometer units also perform topography, reducing not only equipment expenses but the office space needed to add topography to your practice.

Digital Imaging

As more and more practices embrace (structural imaging in both their well-vision and ocular pathology visits, you'll want to incorporate this technology as well. Digital images and structural data about the posterior pole aren't just powerful clinical findings, they're unparalleled when it comes to educating patients about posterior segment pathology. And since there's a specific and frequently used CPT code for reimbursement for fundus imaging and posterior pole structural analysis, you may want to consider adding this technology to your practice first. Not only will you be able to provide superior patient care, you'll be adding a great internal and external marketing tool to your practice. Just be sure to calculate the return on investment based on known or estimated patient flow and mix.

Patient Education

After choosing which technologies you'd like to bring into your practice, you should develop a plan to ensure your patients know how the technology will benefit them, especially if you'll have specific charges associated with it, such as basic screening or baseline fundus photography. You can write about the new technology on your Web site, in newsletters or in other materials you distribute to patients

The best way to ensure every patient is exposed to the technology in your office is for you and your staff to learn how to use it. This involves training employees so they know how to operate the equipment and explain its clinical applications to patients. Of course, you shouldn't ask your staff to make judgments about clinical findings, but employees should be able to tell patients in general terms how the device works, what it measures and explain some of the clinical applications. Not only will this make your employees your best advertisements for the new technology, but it will boost morale because of their personal contribution to the practice.

Financial Considerations and Planning

Once you've decided which equipment to purchase, you'll need to determine whether to pay for it in cash, take out a loan or sign a lease-to-pay agreement. All three methods of payment have benefits, but only your accountant or financial advisor can tell you which option is best for you.

It's important to look at the cost of new technology as a cost of doing business, not as a fixed dollar investment. In reality, the impact the expense will have on your practice most likely will be on a monthly basis. You should be able to estimate not only the monthly expense but also your expected monthly income, which will allow you to calculate the true impact of the technology on your cash flow and profit and loss. For example, let's say your new fundus imaging device costs $44,000, and the monthly payment is $1,125. If you expect the average reimbursement for using the new technology to be $85 per patient encounter, you'll need to examine 14 patients per month to avoid a negative net impact on your cash flow. Seeing more than 14 patients is considered net profit, after taking into account the cost to use the device, which may or may not be minimal.

If you want to charge patients more for the type of technology you're using, make sure you adhere to the requirements of third-party payers. You can raise the cost of the exam and include it in the exam fee, but this won't generate any additional revenue. Instead, you may want to add a separate fee for the exam, so you can apply the charges only to patients who will benefit from the technology.

Exciting Time

Choosing new technology for your practice should be a fun and exciting experience. With all of the new equipment being introduced, you're in the best position to provide superior patient care and boost income and cash flow for your practice — that is, if you plan carefully for the future and make wise purchasing decisions. nOD

Dr. Warren is the owner of a group practice that includes several optometrists and an ophthalmologist in Racine, Wis. This practice setting provides a varied patient base that offers many clinical challenges on a daily basis. You can reach him at

Optometric Management, Issue: June 2009