Article Date: 5/1/2013

Let’s Get Medical: Part 2
medical model

Let’s Get Medical: Part 2

The preparatory steps required for success.

DOUGLAS K. DEVRIES, O.D., SPARKS, NEV.

You hit home runs not by chance but by preparation,” Major League Baseball player Roger Maris once said. To hit a home run with the medical eyecare niche you’ve chosen, preparation is also required. Therefore, here, in part two of this three-part series, I discuss the three preparatory steps you must take to give your chosen medical eyecare niche an excellent chance at success.

1. Refresh your skills and knowledge.

Seek both regional and national optometric meetings at which CE on your niche is offered. To find out whether such CE is available, ask the common organizations responsible for the well-known meetings whether they can send you a program booklet prior to the meeting. If this isn’t possible, ask to speak with the meeting’s CE coordinator.

In addition, subscribe to the latest related journals, consider membership in associated organization(s) (conduct an Internet search to find such groups), and maintain contact with colleagues who specialize in the same area. You can accomplish the latter by networking at the aforementioned meetings and making connections through online social media outlets.

Once you understand the latest advancements in your niche’s diagnosis, treatment and associated tools (see “Point-of-Care Testing,” below) and practice management issues, such as coding, you can correctly integrate them into your practice.

Point-of-Care Testing

This type of ocular testing has seen a recent boom with the availability of tests that now detect the adenovirus in the red eye patient and determine tear osmolarity of the tear film in dry eye disease patients. In addition, point-of-care tests are currently being developed to detect inflammation in the ocular tissue by measuring matrix metaloproteinase-9 (MMP-9), allergic components and virus vs. bacteria, to name just a few.

Point-of-care tests not only assist you in making an accurate diagnosis, they also enable you to attract and retain several medical eyecare patients, as patients appreciate technology that facilitates diagnosis and, therefore, expedites treatment. In addition, they can increase your practice revenue, if, that is, your state allows you to become a lab director.

These tests require a Clinical Laboratory Improvement Amendment (CLIA) waiver, as they are lab tests. Therefore, review the CLIA waiver laws within the state you practice to determine whether you’re able to provide this testing in your practice. Once you become a lab director, you can provide and bill for the lab testing within your practice.

2. Apply to medical insurance panels.

Open your door to as many patients who fall under your chosen niche as you can by applying to the medical insurance panels that meet your required reimbursement level. Remember: You have the education and skills to provide care to these patients, so why not get reimbursed for it? (If a third party payer questions your scope of practice, refer the payer to your state optometric association for clarification.)

To determine your required reimbursement level, review your Medicare fees for both new and established patients for the Evaluation and Management codes (E&M) on at least a yearly basis. These are the 99XXX codes. Compare those allowable fees with the third party payer reimbursements. Those reimbursements should at least be equal to or, better yet, higher than the allowable amounts for Medicare to make the plan worth your while.

To streamline the application process, consider becoming part of the Council for Affordable Quality Healthcare (CAQH) (www.caqh.org). This organization collects a database of credentialing information. More than 400 participating organizations across the country will have access to your practice information to expedite the credentialing process when you apply to insurance panels. You will need a DEA number, an NPI number, liability insurance and, of course, a state license. Most provider network applications can now be filed online.

3. Provide staff education.

To instill optimal comfort in your staff regarding your chosen medical eyecare niche, you must provide this education:

► A niche overview. Give staff a synopsis of your selected niche. This synopsis should include related testing (why and how to use devices), diagnosis, treatment and common patient questions. To accomplish this, schedule a series of “lunch & learns” where you also discuss patient scenarios staff is likely to encounter and how staff should handle these scenarios. This time with your staff helps clearly communicate your practice philosophy. Also, supply staff with a “cheat sheet” of sorts that contains the synopsis information, and consider scheduling intermittent quizzes on it. In addition, contemplate sending staff to regional and/or national optometric meetings at which staff training in your chosen niche is available.

Armed with this education, staff is then able to take on key responsibilities, such as diagnostic and follow-up testing and patient education with conviction, allowing you to see more patients who fall under your chosen niche and grow your practice.

► Schedule modification. Instruct staff to schedule medical evaluation and medical follow-up patients in the most appropriate time slots, so you maximize the amount of patients you see. For instance, staff should not schedule dry eye disease evaluation appointments in a full exam slot because in many instances, it is not that long of an appointment. To avoid this, instruct them to group some of the similar evaluations and follow-up appointments, such as dry eye disease or perhaps post-operative exams, together during the same time block.

Putting it all together

By refreshing your skills and knowledge on your chosen medical eyecare niche, applying to medical insurance panels and providing staff education on the aforementioned areas, you’re now prepared to hit a home run with your niche. And as you develop and increase your medical niche practice and participation in various medical plans, you can expand your practice to provide additional medical eyecare services. OM

Next month, in Part 3 of “Let’s Get Medical,” the final installment in this series, I discuss the marketing strategies necessary to attract patients who fall under your chosen niche.

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Dr. Devries has a degree in financial management from the University of Nevada School of Business and is co-founder of Eye Care Associates of Nevada, a medical/surgical co-management referral practice. E-mail him at drdevries@ nveyelaser.com, or send comments to optometricmanagement@gmail.com.



Optometric Management, Volume: 48 , Issue: May 2013, page(s): 30 31