Article Date: 10/1/2010

Surface Appeal

Surface Appeal

Treatment of meibomian gland dysfunction, dry eye and other ocular surface problems is an easy, lucrative way to boost patient satisfaction.

By Douglas K. Devries, OD

Meibomian gland dysfunction (MGD) and associated ocular surface conditions such as dry eye are highly prevalent in our patient population. If you can tie a patient's symptoms to a treatable entity, you increase his comfort and satisfaction, increase your status as a practitioner, and gain the rewards of increased revenues and job satisfaction.

In my opinion, ocular surface disease is the easiest entry into developing a therapeutic subspecialty because there are no new equipment expenses such as those associated with treating glaucoma. And because there's an overlap between MGD, dry eye and allergies, development in one area increases visits in other areas. It all begins with your existing patients.

"We can fix this"

Patients are extremely happy when you take care of a condition that's been previously overlooked. If you can treat MGD and make reading and computer use more comfortable, then you're making big improvements in a patient's life. After all, people spend an extraordinary amount of time on these activities, and their number one complaint is uncomfortable or tired eyes. You can make both occupation and avocation better experiences. And by doing so, patients learn that you serve in a medical capacity.

Today, MGD diagnosis and treatment boils down to practitioner awareness. You might find that a patient has had this problem for years, but his previous eye care provider simply gave him artificial tears and a new pair of eyeglasses. This is far from ideal for increasing the medical side of your practice.

In your practice, you'll soon realize that the golden opportunity lies in ocular surface problems that many people view as normal, or just an accepted part of aging. You're the doctor. It is your responsibility to identify and treat the problem. By accepting this responsibility, you will improve your patients' perception of the optometric profession.

No small accomplishment

Don't underestimate the value of making patients more comfortable and improving their quality of life. When you can do it, they'll be your patients for life.

Through questionnaires and discussion, you could find that contact lens patients with MGD have reduced their wearing time or abandoned their lenses altogether. They could also have increased dry eye symptoms, which in turn could make them more susceptible to allergies. Your job is to discover all symptoms present in your patient regardless of whether or not he includes them in his complaint. It's an opportunity to increase his satisfaction and your bottom line — two things that go hand in hand.

When you're performing the medical evaluation or switching a comprehensive ophthalmic exam to a medical exam, it's not difficult to encourage patients to pursue treatment if they can experience a decrease in their symptoms and have greater comfort in their daily activities.

Of course, if you're making a surgical referral, it's imperative to ensure MGD and other ocular surface problems are under control first. Outcomes will be better and patients will have a front-row view of your role as a primary care optometrist.

More billed visits

Why isn't every optometrist actively treating ocular surface disease? Some say it's too time-consuming — and it can be if you don't appropriately reappoint patients for evaluation and treatment. Avoid the temptation to include the evaluation and treatment during the comprehensive examination because this will put you behind and you'll be spending more time with the patient for the same reimbursement.

If you reappoint, you'll be paid for every minute of your time. You won't just extend a comprehensive exam � you'll get paid for at least one additional visit. Economically and practically, it makes all the difference in the world because you can devote adequate time to your patient and you're compensated accordingly.

In addition to the comprehensive exam, a typical case of MGD and coexisting dry eye can require anywhere from three to six medical visits, depending on the severity, over the course of the year.

When you start treating MGD, you should be dealing with all aspects of ocular surface disease as well. You'll see these patients more frequently, and many of these problems involve similar types of treatment as well as similar types of evaluation and management coding (E/M) coding. The process will soon become second nature.

Educate staff; market to patients

The primary marketing tool for MGD treatment is patient awareness followed by enthusiasm when treated. When you provide relief from daily irritation — especially relief they failed to get elsewhere —they'll rave about you to their family and friends.

In addition, you can raise both your profile as a medical practice and your revenues by actively marketing ocular surface disease treatment to patients. In your recalls, discuss ocular discomfort and reference symptoms such as red eyes that feel irritated, itchy or sandy. Tell patients that if they call for an appointment, you can address this problem and help them increase their comfort in daily activities. The contact lens wearers in your practice represent a huge opportunity to share your expertise.

Although it's easy to market ocular surface disease treatment to patients, you must ensure that your staff is prepared before you get started. They should share your mindset and be prepared to emphasize that you're the primary eyecare provider responsible for overall ocular health.

Recall notices, on-hold messages and waiting room literature should help raise awareness that you provide medical eye services, but your staff has to reiterate these messages. They should be the biggest advocates for your practice's mission. After all, they talk to patients every day and can enhance your efforts.

Educate your staff about the medical practice model and utilize pharmaceutical reps for lunch-and-learn sessions. Your staff should understand what you'll be doing differently and know details about your therapeutic subspecialty and the medical eye problems you'll be treating. They should be able to tell patients about testing and available therapies.

On the paperwork side, you and your staff should be versed in E/M coding (99000 codes). Prepare staff in advance to ensure that once you start treating patients with MGD, you're ready to collect reimbursements without a hiccup. From start to finish � from marketing efforts, to exams, to reappointments � you'll be fully prepared to strengthen the medical side of your practice.


Dr. Devries lectures nationally and is co-founder of Eye Care Associates of Nevada, a statewide medical/surgical comanagement practice

Tips for Treating MGD, OSD and dry eye

I would like to see all optometrists treat ocular surface disease, because it's an enormous opportunity to build your practice and increase patient satisfaction with little initial outlay. These tips should help you get started:
Plan your actions. When you have an ocular surface disease suspect in the chair, what will you do? Check the literature. Arrive at a testing protocol and initial treatment protocol. Utilize treatment sheets to map therapy.
Prepare Q&A sheets. Your forms will need to capture ocular surface disease patients. Your medical history and symptom sheets must reflect issues associated with MGD and other ocular surface diseases.
Gather patient education materials. Patients don't know what MGD is or how to perform therapeutic treatments at home. Create instruction sheets for patients rather than spending time writing it out each time. Review the sheets in the office together. Patients can take them home to reference later. Gather pre-written patient education literature about MGD and dry eye. Your sales representatives may have educational materials available for you to use.
Coordinate a set of procedures. Establish an ocular surface disease coordinator, who will help educate patients and streamline the process by assisting you. Make sure that those who handle billing and reappointments know their roles. I also recommend grouping your ocular surface disease reappointments and follow-up visits to help you and your staff get into "ocular surface disease mode."


Optometric Management, Issue: October 2010