Article Date: 10/1/2009

Equipment Deductions Peak in 2009
Practice pulse TIPS, TRENDS & NEWS YOU CAN USE

Equipment Deductions Peak in 2009

INVESTIGATE PUSHING UP BIG-TICKET PURCHASES

■ If you're already planning to buy or lease a significant amount of business-related equipment, you may want to consider the idea of obtaining and installing the equipment before the end of 2009.

The reason for pushing up these purchases, which cover a broad range of business-related equipment, is that the Section 179 federal tax deduction was increased to $250,000 (on total lease or purchase of business equipment up to $800,000) by the Economic Stimulus Act of 2008 and later extended until the end of this year. The Section 179 deduction will revert back to a maximum of $125,000 in 2010.

Further, Section 179 offers a 50% bonus deduction good until December 31, 2009, that you can take on the remainder of the value of the equipment after you calculate the initial Section 179 deduction. Thus, if the total value of the equipment you purchase and install in 2009 is $800,000, the initial Section 179 deduction is $250,000, and you can use the 50% bonus deduction on the remaining $550,000.

“Basically, if a practice is planning to obtain major big-ticket equipment, it may be wise to investigate the possibility of doing it this year,” says Mark Kropiewnicki, Esq., LLM, of The Healthcare Group in Plymouth Meeting, Pa. “To qualify for the deduction, the equipment must be in service by December 31. The Section 179 deduction will still be in effect in 2010, just at a reduced level.”

Be aware, however, that just signing a contract in 2009 for installation of an EMR system, for example, does not qualify for the deduction. The system must be up and running by year's-end to qualify for the deduction.

Gordon Siteman, of Lombart Instruments, suggests you consider taking advantage of the additional tax break available until the end of the year.

“It is wise to invest in your practice, and let Uncle Sam help you pay for your equipment rather than pay 35% federal tax on the income you earn,” he asserts.

If you're interested in obtaining complete information about Section 179 deductions, visit www.section179.org, or contact your accountant for further information on the tax deduction.

Studies Reveal Vision Screening Failures

STATISTICS SHOW PUBLIC LACK OF KNOWLEDGE REGARDING VISION CARE

Lou Mancinelli, contributing editor

■ Individual studies conducted by the National Commission on Vision and Health (NCVH) and the American Optometric Association (AOA) expose the inadequacies of vision screenings and lack of public knowledge regarding the importance of comprehensive exams.

“The majority of vision screenings fail to adequately screen millions of children who have undiagnosed and untreated vision problems,” says Dr. Michael Duenas, O.D., and associate director of Health Sciences and Policy for the AOA. “That can lead to vision impairment and may severely affect a child's educational and social development.”

The NCVH report: “Building A Comprehensive Child Vision Care System,” revealed a quarter of children have an undetected vision problem. Likewise, one in four school-age children suffer from problems, such as amblyopia, color blindness or strabismus, that could have been addressed or eliminated with an appropriate exam and follow-up treatment, according to the report. Furthermore, eye screenings miss a problem in one third of children, while a comprehensive eye exam can detect a variety of health issues, such as diabetes or glaucoma, which are less common in children, or retinoblastoma, which is rare but can be detected in children younger than age six. A comprehensive exam can offer follow-up treatment and a rehabilitative plan to combat these problems, says the NCVH's report.

Meanwhile, the AOA's American Eye-Q survey found three out of every five older Americans (aged 55 and older) are unaware comprehensive exams can detect diabetes. Also, 71% didn't know the exam can detect high blood pressure. In addition, a majority of the respondents were unaware a comprehensive eye exam could detect brain tumors (75%), cancer (78%), cardiovascular disease (80%) and multiple sclerosis (90%). This despite the fact that the top concern of these respondents was losing the ability to live independently (48%), drive (23%) and read (21%).

So, what can you do to ensure both parents of young children and older adults seek a comprehensive exam as opposed to a vision screening?

“Perform vision exams at gratis for [your local] Lion's Club or for the Special Olympics,” says Andrew Gurwood, professor at the Pennsylvania College of Optometry, Salus University, who also practices at the Albert Einstein Medical Center in Philadelphia. He says that each time you give a free exam and a patient realizes something is abnormal with their eyes and that it requires follow-up treatment, you can generate business.

He also suggests you look into attending your local community day or school day or book fair to educate patients about the importance of comprehensive exams vs. vision screenings.

Older Patients At Lowest Risk For Laser Vision-Correction Surgery Side Effects

SURVEY REVEALS HALF OF 55+ PATIENTS REPORTED NO SIDE EFFECTS POST-OP

■ Patients age 55 and older were the least likely to report laser vision-correction surgery side effects, slightly beating out patients age 40 and younger, according to a recent Consumer Reports survey of 793 adults who underwent one of these procedures in the past eight years. Further, the survey showed patients age 40 to 54 were at the greatest risk of postoperative side effects. These findings were a major deviation from all other survey data, which revealed — not surprisingly — the younger the patient, the greater the likelihood of positive outcomes.

In fact, laser vision-correction surgery patients younger than age 40 were the most likely to report improvements in their effectiveness at work as well as in sports and leisure activities. Further, this age group overwhelmingly outnumbered the age 40 to 54 and 55+ age groups with reports of no spectacle wear post-op.

So, why were the 55+ patients — the oldest patient population — the least likely to report postoperative side effects? Consumer Reports editors theorize surgeons may be doing a better job of eliminating inappropriate candidates in this age range and/or these patients may be less likely to report/remember postoperative side effects than the other age groups.

Given the magazine garnered these results through a period of eight years, do they accurately reflect a refractive surgery procedure today?

Yes and no, says Uday Devgan, M.D., F.A.C.S., of Los Angeles.

“The survey accurately shows that while LASIK is able to accurately treat myopia, hyperopia and astigmatism, it is not as adept as addressing presbyopia. The older the patient, the more presbyopia and need for reading glasses,” he says. “It emphasizes what we tell our patients: “LASIK is a superb procedure, but it's not perfect, and it can't give a 55 year-old the vision of a 25 year-old. Well, at least not yet.”

In addition, forme-fruste keratoconus (FFKC) remains difficult to detect in the early stages, causing some younger patients to develop ectasia post-LASIK, Dr. Devgan explains. This isn't the case for older patients, which may account for their fewer side effects in the survey.

Further, an aggressive healing reaction can still lead to post-refractive surgery issues, such as scarring, which may induce haze and a subsequent compromise of vision. This is particularly true with photorefractive keratectomy, Dr. Devgan says. Because patients older than age 55 exhibit less of a tendency toward scarring, this may also account for few side effects in this age group.

Dr. Devgan adds, however, that the LASIK procedure of 2009 is significantly better than in years prior — in terms of outcomes — as the result of two main reasons: First, most surgeons are now performing bladeless surgery. Second, the ablations of the excimer lasers of today, unlike the older versions, are designed to treat, correct and preclude the post-op glare and halos associated with LASIK via wave-front technology.

Optometrist Marc Bloomenstein, who comanages refractive surgery patients at the Schwartz Laser Eye Center, in Scottsdale, Ariz. agrees:

“This survey demonstrates that patients gain the most improvement in distance-related activities, regardless of age,” he says. “However, in the last eight years, patients and doctors have really adopted the custom treatment, and I believe a study now would show an even higher percentage of effectiveness.”

Dr. Bloomenstein adds that he wouldn't read too much into the postoperative side effects, as corneal refractive surgery really has very few if any side effects — aside from the pain associated with surface ablation — and younger patients tend to be discriminating and less tolerant of side effects compared with the aging population.

The # 1 Practice Builder

SUCCESS FILE

Bob Levoy O.D., Roslyn, N.Y.

■ What single factor contributes most to the success of your practice? In my judgment, nothing comes close to the importance of having a great reputation. The following reputation management strategies may help achieve that goal:

1. It starts at the top. No matter what the core values of your practice — a commitment to excellence, kindness, courtesy, ethics, friendliness, confidentiality, punctuality or something else — you must live those values, and set an example.

“You must decide what you stand for and then you must align every one of your systems to reinforce it,” says John Young, recently retired human resources executive of the fabled Four Seasons hotel chain. “You recruit for it, you select for it, you orient for it, you train for it, you reward it, you promote for it, and you terminate those who don't have it.”

2. Hire the best people and keep them happy. When a practice becomes known as the best, the best people want to work there. What's more, they want to stay on the job.

3. Remember that appearances count. However firmly you believe, “You can't judge a book by its cover,” patients and referring physicians do. If they see out-of-date equipment, for instance, they may question your competence and commitment to excellence.

3. Exceed patients' expectations on every visit. Patients whose expectations for quality care and personal service have been exceeded, talk in glowing terms about the practice and the people in it. Needless to say, this requires a team effort and total commitment.

As investor/philanthropist Warren Buffet has said:

“It takes 20 years to build a reputation, and five minutes to ruin it. If you think about that, you'll do things differently.”

American Board of Optometry Taking Shape

OPTOMETRIC ORGANIZATIONS APPOINT ABO REPRESENTATIVES

■ The American Academy of Optometry (AAO), American Optometric Association (AOA), American Optometric Student Association (AOSA) and the Association of Schools and Colleges of Optometry (ASCO) have entered into a Joint Memorandum of Understanding (MOU) regarding the formation and organization of the American Board of Optometry (ABO).

“The AOA is pleased that the formation of the ABO is proceeding on schedule and is appreciative of everyone who participated in developing the model for optometric board certification over the last two years…” says Randy Brooks, O.D. and AOA president. “It is my hope that, as future standard bearer for national certification, the ABO will continue drawing upon the collective expertise of our profession's most respected organizations as well as practicing optometrists throughout the country.”

As part of the MOU, the aforementioned organizations have appointed representatives for the ABO board of directors. Specifically, the AAO appointed Tom Lewis, O.D., Ph. D., current president of Salus University (formerly the Pennsylvania College of Optometry) in Philadelphia, Pa. The AOA appointed optometrists David Cockrell, of Still-water, Okla., and Paul Ajamian, of Atlanta, Ga; the AOSA appointed Mary Phillips, O.D., of Canadian Lakes, Mich.; and ASCO appointed David A. Heath, O.D., president of the State University of New York State College of Optometry, in New York City. Also, these appointees appointed Mary Jo Stiegemeier, O.D., of Beachwood, Ohio, as an at-large member.

The six appointees are currently considering the ABO Bylaws and Articles of Incorporation and working on the creation and qualification of the ABO as a tax-exempt entity and the implementation of the certification process.

BOOK HAS BUSINESS AND PERSONAL IMPACT
OM Columnist Pens Book
In his new book, “When Your Success is on The Line: Fundamental Lessons for Reaching Your Personal and Business Potential” Dr. Walter West, the chief optometric editor of Optometric Management, shares lessons that not only impact your business, but you personally.
Whether you have patients, clients or customers, Dr. West writes his down-to-earth lessons on personal and business success, communication skills and customer service to enhance your relationships with your friends, family, patients and employees while improving your own self-satisfaction.
The book is a motivational collection of stories told by Dr. West delivering the messages he's presented to audiences across the United States and in 16 countries on five continents. You can obtain the book from www.walterwest.com.

Elmer H. Eger

IN REMEMBRANCE

■ Elmer H. Eger, O.D., F.A.A.O., who operated a private optometric practice for more than 40 years and was known for his work in the field of low vision, died on June 26, 2009.

Born in 1919, Dr. Eger graduated from the then Pennsylvania College of Optometry (PCO) in 1941. After service in the U.S. Army, he established his practice in Corapolis, Pa. He retired in 1983 and spent the next 12 years in practice with his son, Mark W. Eger, O.D., the current president of the American Academy of Optometry (AAO).

Dr. Eger invented the LogMar Comparison Pocket Screener and in 1998, he patented the Egerstressometer — a hand-held instrument used for the early detection of macular problems — while working at the University of Rochester and PCO. Dr. Eger held a faculty position at the College of Optometry at Nova Southeastern University. He also served on the Optometric Management editorial board.

The Eger Fellowship

The Eger family plans to establish The Elmer Eger Student Travel Fellowship, which will sponsor the attendance of one optometry student each year to the annual AAO meeting. Donations to the fellowship can be made by mailing a check to the American Optometric Foundation, 6110 Executive Blvd., Suite 506, Rockville, Md. 20852.

Americans Cutting Back on Doctor Visits

FOURTH ANNUAL EYE-Q SURVEY

■ A total of 52% of Americans say they're limiting their eye doctor visits due to the economy, says a recent American Optometric Association (AOA) survey. This statistic compares with 63% of Americans who say they're limiting dental visits, followed by 59% who say they're curbing visits to their primary-care physician. The bottom line: Only 8% say they are sticking with their regular schedule of doctor visits.

Hispanics are affected the most by the economy with 63% limiting dentist visits, and 53% cutting back on eye doctor appointments, according to the AOA's American Eye-Q survey. Almost half say they are limiting primary-care doctors visits, compared with African Americans (36%) and Caucasians (33%). In terms of gender 38% of women say they're curbing doctor visits and 53% say they're limiting eye doctor visits. A total of 51% of men say they're limiting eye doctor visits, and 32% say they're limiting primary-care doctor visits.

The survey was based on online interviews conducted in May 2009 of 1 000 Americans age 18 years and older.

HEALTH Notes

• A three-month study presented at ASCRS of patients who used one of three prostaglandin analogues (PGAs), each with varying amounts of benzalkonium chloride (BAK), reported no statistically significant differences among the therapies in terms of hyperemia, corneal staining or tear break-up time. The study included 109 patients at nine sites. Its researchers concluded that longer follow-up time is needed to further evaluate the effects of ocular surface tolerability of PGAs.

• Bepotastine besilate ophthalmic solution 1.5% (Bepreve, Ista Pharmaceuticals, Inc.) has received FDA approval as a prescription treatment for allergic conjunctivitis-caused ocular itching in patients age two and older. These patients, or their care-givers, should instill one drop of the non-sedating, antagonist of the histamine (H1) receptor into the affected eye(s) b.i.d.

Systemic fluoroquinolones may induce diplopia, according to a database study in September's Ophthalmology. The median patient age was 51.6, drug doses were within recommended levels, and the interval from drug start date to diplopia onset was an average of 9.6 days. Because tendon dysfunction is a systemic fluoroquinolone side effect, the study's researchers say possible tendinitis of the extraocular muscles may be causing the condition. The good news: Diplopia resolved in all cases of 53 patients who ceased medication use.

• Researchers from the United States, China and the Barbados Family Study Group have identified gene variants for glaucoma on chromosome 2 in the black population, according to an online Proceedings of the National Academy of Science (PNAS) study. The researchers found the gene variants in glaucoma patients in the Barbados population, in whom the incidence of the disease is nearly 10% of all Island residents. The hope now is to use the information to enable early diagnosis and new treatments, such as gene- or stem cell-based therapies.

Antihypertensive drugs may slow diabetic retinopathy progression, says a study in the July 2 issue of the New England Journal of Medicine. Specifically, at five-year follow up, the odds of retinopathy progression by two steps or more was decreased by 70% with 100mg daily of losartan (Cozaar, Du Pont De Nemours and Company) and 65% with 20mg daily of enalapril (Vasotec, Biovail Pharmaceuticals Inc.), when compared with placebo and independent of blood pressure changes.

O.D. NOTEBOOK
Bausch & Lomb enhanced its eCommerce Web site with features that include a new, interactive order summary dashboard, simplified ordering of contact lenses, one-click access to track shipments and improved order history and search capabilities. Visit www.bauschon line.com for information.

Topcon Medical Systems and Tracey Technologies announced an exclusive distributorship agreement for iTrace, the ray tracing aberrometer/topographer. Under the terms Topcon will be the sole U.S. distributor for the iTrace Combo and iTrace Solo.

Compulink, developers of Compulink Advantage EMR and Practice Management solutions, has completed the Marco EMR Certification Program and is now a Marco EMR Certified Partner. The certification ensures that Compulink systems will integrate with Marco products.

Reichert has named Jerry C. Cirino chief executive officer. Mr. Cirino, who also serves as chairman of the board, assumes the role as the company prepares for growth in global ophthalmology and optometric markets. He also serves on a number of private and public healthcare company boards.

Vistakon named Colleen Riley, O.D., M.S., F.A.A.O., Dipl. C.L., as vice president, Professional Development. In this role, Dr. Riley will lead the company's continuing efforts to develop and implement strategies and programs that focus on professional and practice development for eyecare professionals. She also will oversee all activities for The Vision Care Institute.

I-Therapeutix, Inc. announced that it has changed its corporate name to Ocular Therapeutix, Inc.

The AMD Alliance invites you to create and submit videos that creatively communicate the impact of AMD. The winning entry will receive $10,000. For more information, visit www.AMDAlliance.org.

Correction:
The August “Health Notes” (OM) incorrectly identified the manufacturer name of the fixed combination drug brimonidine tartrate 0.2%/timolol maleate 0.5%. The correct name of the drug is Combigan (Allergan).


Optometric Management, Issue: October 2009