Article Date: 2/1/2013

Medical Model Mistakes
practice mode

Medical Model Mistakes

How to avoid five common blunders when developing the medical model practice


Hindsight is 20/20 — no pun intended — after the pursuit of any endeavor. In developing the medical model in my practice and in discussing this undertaking with colleagues, I’ve arrived at the five common mistakes of doing so.

Here, I name these mistakes and how you can avoid them.

1 Failing to educate and engage staff

Your staff is a direct reflection of you. Therefore, if they can’t correctly communicate/answer patient questions regarding the services you provide, a patient’s diagnosis, treatment, how to instill medications, etc., that translates to a lack of confidence in your, the optometrist’s, ability to provide medical eye care. The outcome: The patient will very likely seek medical eye care elsewhere.

To prevent this from happening, make sure everyone in your practice understands the services you provide. The practical ways to help staff members better understand your services: Review cases of the diseases that you manage so that they can see success and also sequelae of untreated ocular disease, such as diabetic retinopathy. Any imaging software is remarkably helpful for staff education purposes. As the old adage goes, “seeing is believing.”

Also, constantly include your staff in optometric meetings for further training and education on these conditions. We all know the motivation we feel when we come back from a good meeting.

In addition, meet habitually as a team by scheduling office meetings regularly. I would suggest picking a specific day of the week and having the meeting every week or every other week, depending on your practice’s needs. This lends the opportunity for discussions and strategies that are being set forth by the practice and enables the discussion of new protocols or the reinforcement of current ones.

Educating and engaging staff ensures that every time a patient has a touch point with your practice, he/she knows that you provide excellent medical eye care.

2 Underutilizing standard technology

To differentiate your practice as one that provides medical eye care, you must be judicious in employing readily available tools that we, as optometrists, already have to help identify ocular disease.

One such example: the utilization of the vital dyes, such as fluorescein and lissamine green. You should ask yourself how often you utilize these dyes, and determine whether you may be overlooking underlying ocular surface disease.

I utilize fluorescein in every single exam, and assess the ocular surface using a cobalt blue light and a wratten filter.


Also, consider this: Recently, a low-cost point-of-care test became available that allows for the rapid identification of viral conjunctivitis.

These are just a few examples of technologies that can help you quickly develop the medical eye care segment of your practice.

Once you start using these technologies on a regular basis and, as a result, diagnose and treat more patients, you’ll begin to become interested in the related higher-investment technologies, such as an anterior segment camera.

Using patient records to determine whether the investment in new technology is worth it is a good idea, but my caveat to this: There hasn’t been one piece of technology that we have incorporated into our practice and have said, “Shucks, we shouldn’t have done that because we’re really not using it.” Every single thing we’ve brought into the practice makes us realize, “Wow, I can’t believe we didn’t use this earlier.”

The fact is it’s truly amazing what you don’t see and code for when you don’t have the needed technology.

3 Not providing patient education

The less patients understand their condition, the less likely they are to comply with your prescribed treatment and followup visits. This, in turn, obviously impedes the growth of the medical eye care portion of your practice. Thus, make sure to reserve a certain portion of the patient encounter on communicating their condition (educating/ engaging your staff will facilitate this) and “why,” specifically, it’s important he/she complies with your prescribed treatment and follow-up visits.

In my practice, I show patients a video of their slit lamp exam so they can see their condition and “what,” specifically, we’re treating. Additionally, I explain “why” the condition is causing their symptoms.

For example, this is what I say to my dry eye patients:

“Everyone has a thin layer of tears that is on the front of their eyes that prevents most of us from feeling our eyes when we blink. When I look at the tear layer on your eyes, it is very thin, and I actually see dry spots forming in it more quickly than I would expect. This is a condition called dry eye. The good news is that we can help you out with this condition. Here is what we are going to do…“

4 Failure to schedule patients for follow-up visits

Having a passive approach to managing medical eye conditions is a sure fire way to hamper the development of the medical eye care portion of your practice. To avert this mistake, make sure you follow current treatment protocols, and schedule all medical patients for follow-up appointments.

For instance, after giving a dry eye disease patient artificial tear samples, tell him/her:

“I’m going to schedule you for a follow-up appointment, at which time, I’ll determine your response to the artificial tear samples.”

This statement not only provides the patient with the personal benefits of returning, which instills compliance, but it also motivates the patient to seek your care for other ocular conditions and refer others for your care. The reason: Scheduling follow-up appointments shows you’re committed to providing the best medical care possible to the patient.

5 Using the wrong codes

Failure to properly translate the services you perform to the appropriate CPT codes can result in either “under” or “over” representation of the services delivered.

To avoid this mistake:

Have a good resource or reference tool for the “rules” of billing and coding (if you’re an AOA member, check out this no-cost resource:


JULY 2007
Move to the Medical Model • page 67

10 Steps to Building a Medical Model Practice • page 55

Introduce a streamlined process to easily identify the level of office visit that you performed. Attempt to avoid the, “This is what I did for another patient and I coded them a 992xx; I performed about the same amount of services on my current patient so I will bill them at the same level” tactic. This tactic, unfortunately, will tend to start skewing the levels that you are billing either toward higher or lower levels than the services you actually performed. So, you’ll either attract an audit, which could permanently damage the medical portion of your practice, or you’ll cheat yourself out of thousands of dollars. Either outcome will throw a wrench into the medical portion of your practice.

(Note: the systematic way to breakdown the level of office visit I use can be viewed at:

From failure to success

“We learn from failure, not from success,” novelist William Jordan once said. By learning about my medical eye care model mistakes and the mistakes of others and how to avoid them, you’re on your way to optimizing the medical eye care portion of your practice. OM

images Dr. Brujic is a partner of Premier Vision Group, a four-location optometric practice in Northwest Ohio. He has a special interest in glaucoma, contact lenses and ocular disease management of the anterior segment. E-mail him at, or send comments to

Optometric Management, Issue: February 2013, page(s): 29 - 31