Article Date: 11/1/2010

10 Steps to Building a Medical Model Practice
medical model

10 Steps to Building a Medical Model Practice

Dramatically increase your practice revenue by creating a medical practice

Matt Dixon, O.D., Perry, Ga.

In the TV show Shark Tank, budding entrepreneurs with millionaire dreams present their ideas to a scowling panel of venture capitalists (i.e. the "sharks") in hopes of winning their investment dollars. Some business ideas aren't so good. Others, however, such as a healthy, yet tasty alternative to soda pop, have one or more of the sharks "ready to strike" — that is, to infuse the idea with capital in hopes of earning additional millions.

Although you aren't looking to convince venture capitalists to invest in your practice(s), to retire (and that day will arrive sooner than you think) you will have to convince potential buyers that your practice is a solid investment. As a result, it must achieve a high level of income production. One way to achieve high income is through building a medical model practice. (See "Example of Economic Impact of Medical Model, According to Medicare Guidelines," below.) This is defined as ethically emphasizing medical eye care with proficiency and skill that is significantly profitable to both the patient and you, the doctor.

Consider this:

► Having a diverse practice provides you with the ability to ride out market fluctuations (we're going through a big one right now).
► With the evolution of optical retailers and online contact lens/spectacle dispensing, you can no longer rely on your optical department alone to bring in the big bucks.
► By emphasizing both your optical and medical services to each and every patient, you'll increase your profits.

So, how can you build a medical model practice? The answer is by following these 10 tips.

1 Go public

Place medical eyecare-related pamphlets and posters in both your reception and exam rooms to show patients you possess the skills to diagnose and treat conditions, such as dry eye, age-related macular degeneration and glaucoma, among others. Patients often don't realize that an optometrist's abilities go beyond spectacle and contact lens prescriptions.

Also, reach out to the medical community. Many of us are the only eyecare provider in our area, so you must let other healthcare practitioners, such as primary care physicians, know that you have the professional skills to help their patients. For example, every diabetic patient requires an annual eye exam. One way to garner referrals: Write a letter that outlines your skills to local healthcare providers. A letter of thanks to the referring doctor goes a long way in maintaining these referrals and in acquiring additional ones in the future.

2 Prescribe

Prescribing medications is a privilege for which we fought long and hard. Prescribing indicates you've embraced the full scope of your training. Make a point to use your prescription pad (or EMR/ePrescribe) even if you're recommending the patient purchase a nutritional supplement or over-the-counter artificial tears. This shows patients you have prescription rights, and therefore, the ability to treat medical eye conditions, such as glaucoma. O.D.s in the 95th percentile of prescribers write four times as many prescriptions as compared with the entire group of surveyed respondents, says the American Optometric Association's (AOA) most recent scope of practice survey.

3 Join the "party"

Although some doctors can maintain financial success with "out-of-network" status, most doctors need to build their medical practices and must be credentialed through a vast array of health insurance carriers for payment. Research and determine which third-party plans would provide the most benefit based on your patient demographics and their employers.

Patients will often seek a provider who is on their plan, and they are willing to accept a treatment plan if out-of-pocket expenses are low. This is a great way to jump-start your medical model practice with new patients and billable medical procedures.

Credentialing does take a great deal of time and effort — it's an annual process — but it can be outsourced. My staff has learned how to do this, and a local provider association helps with this for a low monthly fee. Also, companies specific to optometry offer training, credentialing, as well as clearinghouse and adjudication assistance.

The AOA website has some great tips to get you started on determining which plan is best for you. (Visit www.aoa.org/x9617.xml.)

4 Buy the tools

Having an array of diagnostic devices in your practice not only increases the quality and array of care you provide, but also your profits. To determine which devices in which you should invest, analyze your patient records and area demographics. For instance, if you manage glaucoma patients, you should employ gonioscopy, pachymetry, threshold visual fields, fundus photography and spectral-domain ocular coherence tomography.

(Currently, Section 179 and the Americans with Disabilities Act tax credit make purchasing a smart choice to help reduce tax liability. Remember tax advantages are under threat of being reduced in the future.)

Two caveats: (1) Don't buy an instrument just because a current procedural terminology (CPT) code is reimbursable. If the device doesn't provide clinical value for your patients, you'll never use it, and therefore, never gain a return on your investment. (2) Use ethical judgment when ordering tests. In other words, always base your decision on medical necessity.

5 Know patients' plan(s)

Patients often aren't aware of the coverage their healthcare plan(s) provide in regards to routine and medical eye care. As a result, ask the patient what healthcare plan(s) he belongs to when he makes an appointment. Both vision and medical insurance can be verified online or via telephone by your staff. Having both available, your staff is better prepared to explore all patient options when examining benefits. Furthermore, patients sometimes are unaware of the benefits available through flexible spending accounts or their medical insurance carrier. Patients might be surprised if asked for medical plan coverage when making an appointment, but this provides the first opportunity for you to let them know you provide medical eye care.

Verifying benefits ahead of time not only reduces the burden on your office staff, but it also allows the patient to have an understanding of what to expect in regards to financial issues, such as co-pays and deductibles.

6 Be specific

The medical history portion of the exam is extremely important not only for proper diagnosis and management, but also for correct medical billing. As a result, it's imperative your staff clearly state the reason for the patient's visit. Technicians should state whether the patient is being seen for a diabetic exam, glaucoma check, etc. rather than a routine eye exam. The patient's reason for his visit and complaints of symptoms are the determining factor in how an office visit should be coded and billed.

It isn't possible to catch every medical need before the patient arrives, as often a patient will present for a "vision exam," and requires additional medical services. In these cases, consider bringing the patient back for further examination and medical treatment.

Also, take the time to add to elements of the patient's history, so you can be sure to address all his concerns. This adds revenue to your practice, and even asymptomatic patients will appreciate your attention to conditions that may worsen through time.

7 Commit to treatment protocols

A treatment protocol is a plan for each disease based on current standards of care and the latest research. Protocols guide a practice into consistency with treatment and coding. An example: When dealing with a Level 2 dry eye patient, the treatment protocol should outline, for instance, when to use punctal occlusion. In the case of a glaucoma or retinal disease patient, the treatment protocol should outline, for instance, how often ocular coherence tomography (OCT) should be performed.

Review prior patient visits, and determine whether your practice has been actively using a treatment protocol to provide the highest level of care for your patients. You may find you've been under utilizing medical testing. Using treatment protocols and the proper testing to provide for early detection of eye disease or medical problems allows for enhanced patient care and revenue production.

8 Make your staff a resource

Once the patient's benefit(s) are verified, the service has been provided and properly coded and the claim is sent to the health insurance's clearinghouse electronically, the reimbursement process isn't over. A host of things can and will go wrong with claim submission. Follow up for all claims is crucial, as some claims do get "lost" or go unprocessed. In addition, the rules for reimbursement are complex and can change from year to year. Therefore, utilizing a dedicated insurance and billing specialist amongst your staff allows for enhanced control of the claims process and allows for auditing of patient files and accounts receivable.

One process for following up on claims: Have your insurance or billing specialist review past patient sign-in forms every 30 days and analyze insurance balances due from that date of service. These routine reviews provide an easy snap shot of cash flow from a medical billing perspective and enable you to quickly identify problems with claims and fix them fast. Your entire staff should embrace the medical model to streamline the process.

9 Be the doctor not the coder

Andy Stanley made a wise statement in his book, Next Generation Leader: 5 Essentials for Those Who Will Shape the Future (Multnomah Books, 2006): "Only do what only you can do." Only you, the doctor, can diagnose and treat. Are tasks available that you feel comfortable delegating to allow you more time to diagnose and treat? My technicians are trained to perform the history and pretesting duties before I see the patient. In addition, they help explain treatment protocols and how to use medications to patients. (This is most valuable for complex conditions, such as meibomian gland dysfunction.) In the time it takes to educate patients on these matters, I'm able to see another patient. You may also want to look into having refracting technicians and scribes, as these jobs too can enable you to capitalize on the medical model.

10 Don't stop learning

Make use of every resource you have. Take continuing education courses offered on the array of ocular conditions and diseases at the various trade shows, and ask the lecturer to outline the proper coding that accompanies the specific condition or disease. In addition, read the related medical journals and trade magazines to stay abreast of the latest techniques and technologies.

Finally, seek an e-mail group that shares information about medical optometry and coding. The Georgia Optometric Association, for instance, offers an online community and a coding consultant. By constantly fine-tuning your medical eyecare skills, you'll create patient satisfaction, which will create patient loyalty and several referrals.

All of our practices are filled with hidden opportunities and potential profits. Don't allow your practice to be mediocre due to the obstacles accompanying insurance claims, billing and credentialing.

When you're ready to retire, you'll be in the optometric Shark Tank, attempting to persuade buyers that your practice is a solid investment. If you focus on both your optical dispensary and on providing medical eye care, you'll have several "sharks" swarming your practice. OM

Dr. Dixon practices in Perry Ga., where he sees an array of medical patients. E-mail him at drmattdixon@gmail.com, or e-mail comments to optometricmanagement@gmail.com.


Optometric Management, Issue: November 2010