Charting the Right Course
How to expand your role as a primary care provider.
K. DEVRIES, O.D., Sparks, Nev.
Expanding your role
as a primary care provider begins with a comfort level regarding testing and treatment
of conditions beyond traditional vision care. A strong base in vision care typically
makes for a stronger primary care practice. This type of practice has already established
good communication with patients about the services they provide to improve patients'
are unlikely to utilize a new product or service unless you promote it somehow,
and the same holds true for primary care procedures. Unless you make patients aware
that you provide a particular service, they may seek out a practitioner they know
offers tests and/or treatments for that specific condition.
I recommend starting with procedures and testing that are not
technologically intensive. Dry eye disease and allergic eye disease are two processes
that are abundant in our patient population. It doesn't require large capital expenditures
to integrate testing and treatment of these diseases into your practice. These conditions
also have low morbidity rates and aggressive treatment results in high patient satisfaction
All too often, practitioners are convinced that they must purchase
new technology, which results in its over utilization if equipment does not meet
the expected return on investment. This can cause patient dissatisfaction if they
feel they are being tested unnecessarily. Conversely, if your practice begins to
integrate therapeutics and primary care by treating prevalent diseases, your patient
base will grow to include patients with other ocular diseases that require greater
technology. Once the patient base is there, utilization is no longer an issue.
Alternative revenue streams
By identifying additional treatments opportunities for your practice,
you can increase your revenue. This active integration can further be built into
practice subspecialties that will differentiate your practice from others in your
It's not as difficult as it may seem because you already treat
many of these conditions on a daily basis. Testing and treatment for conditions
such as dry eye, ocular allergy and glaucoma can be leveraged to build your practice.
Dry eye and ocular allergy are ideal examples given the crossover between conditions
(dry eye patients are more susceptible to ocular allergies and vice versa). By educating
your patients about these conditions, you position yourself as a valuable eye heath
expert now and in the future. Patients will see the benefits of your care
as their overall ocular heath improves.
Adopting the medical model
Adopting the medical model is important to help your patients
distinguish between vision care and primary care. This means reappointing patients
for additional visits to address conditions outside of the traditional vision care
appointment. As optometrists, we often attempt to do too much in one visit. Reappointing
allows enough time to address a specific condition such as dry eye or ocular allergy
and prevents bottlenecks that can occur when trying to accomplish too much. This
level of treatment detail and patient concern will also endear you to your patients,
increasing satisfaction and contributing to patient retention.
adopting this model, you will begin charging patients for the additional visits
as any professional would. I believe a practitioner simply can't spend the time
to test, educate and treat patients without being paid to do so. Emphasize to your
patients that their next appointment is particularly important, as the additional
information you will gain at that time will enable you to address their condition
specifically and prescribe an effective treatment regimen. Make sure they understand
the significance of the condition and the benefits they will receive from proper
treatment, including possible outcomes if the condition is not treated.
Everyone in the office is responsible for the success of the practice
and each employee can contribute to an increase in the bottom line. In every aspect
of patient care, members of your practice should look for opportunities to provide
additional products and/or services to benefit patients. Establish a baseline for
the percentage of patients who receive specialty products so you can keep track.
This will provide a number of different growth areas from new and existing patients
that will increase profitability.
Provide options based upon the needs of each individual patient.
For those patients who come in needing spectacles, members of your staff can offer
lenses with advanced features such as UV-protection and antireflective coatings.
For those patients wearing contact lenses, offer the option to purchase additional
All too often, optometric practices do not enter medical diagnosis
codes for routine exams such as allergic conjunctivitis, dry eye syndrome, blepharitis,
cataract, posterior vitreous detachment, meibomian gland dysfunction or myriad systemic
diseases. If you check for each of these conditions, it should be noted and coded
for each patient. For many eyecare professionals, Medicare and insurance reimbursement
coding may seem intimidating. However, once you have treated the first few patients
and completed the appropriate paperwork, you will find coding is much easier than
Once you have taken all the relevant patient information, build
a database of your patients' ocular health. You can start the process by entering
the information as each patient visits the practice. Or, if the information is available
on previous exam forms, have a staff member look retrospectively at past visits
to collect the data.
This is critical to your success as a primary
care practice because it will allow you to better manage and anticipate your patients'
needs. Further, it allows you to provide information to your patients on new treatments
as they become available.
Writing prescriptions for therapies, such as Restasis (cyclosporine,
Allergan) for chronic dry eye, is common practice for us all, but many do not take
the time or do not think to write a prescription for specific treatment
regimens for over-the-counter therapies. When treating dry eye, for example, don't
just tell patients they need an artificial tear or hand them a sample of whatever
you have available. Take the time to write down the specific brand name of the drops
you feel are the best treatment for that patient. This will help alleviate confusion
in the drug store and increases the likelihood that the patient will purchase the
drops and not just rely the sample you provided. It also enforces the importance
of the condition and your position as the eye health expert. This is also true with
lid hygiene techniques.
Educating your existing patients about all the services available
in your practice is crucial for expansion. If patients are unaware of the services
you provide, they will not think of your practice when they need treatment. A good
example is the patient with ocular allergies or a corneal or conjunctival foreign
body. Typically, you would only treat a patient if he or she happens to complain,
or show symptoms during a routine visit. However, if you educate patients on all
the aspects of your practice, they know to contact your office at any time when
they may have allergy symptoms, or if they get something in their eye.
This education process is as simple as it is important. You can
use many of the existing educational tools in your office to communicate these services
to patients in your practice. These may include on-hold messages, office newsletters,
patient recall notices, practice Web sites, yellow page ads and others.
You can also add other items throughout your office and in your
waiting room. These may include patient literature on primary care ocular conditions
personalized to refer patients back to your practice for treatment. Framed signs
at the reception desk that are easily visible will also reach patients while they
are completing paperwork and scheduling future appointments.
Your staff is an integral part of practice success everyday
they will be even more important as you work to grow your practice. To successfully
reach your patients consistently and meet all of their needs, you need to include
each member of your staff in this drive to build the practice. You can conduct this
practice-wide education in an open setting, such as a "lunch-&-learn" meeting,
to provide information, answer questions and discuss how staff should manage scenarios
they may encounter in the future. This time with your staff will help further communicate
your practice-building philosophy, while building a stronger bond by increasing
staff's role in the practice.
Create positions for key staff members who will carry certain
responsibilities within your practice. These should include coordinator positions
for refractive, dry eye and cataracts. These individuals will build confidence in
your patients and keep your office running smoothly by answering patient questions
about the condition before or after you meet with them. Further, they will reinforce
the importance of the patient's treatment at every step of the visit.
Getting yourself a refresher on primary care treatments is always
helpful as well. Continuing education courses are an excellent way to learn, or
to sharpen your skills. Understanding the latest treatment tools and techniques
available will help you integrate them into your practice. CE courses also help
build your practice in the future, keeping you up-to-date as the market changes.
Seek out continuing education courses that have a practice management curriculum
to help you keep current.
In addition to educating your patients, staff and self, take the
time to educate other physicians in the area about all the services available in
your practice. Family practice physicians and pediatricians are often the first
places patients think of when they have any health concern. These offices, however,
often don't have the training or equipment to properly diagnose and treat ocular
conditions. Building relationships with the health care providers in your area will
generate referrals without the fear of competition between practices.
Mailings that target practices and/or individual physicians in
your area can accomplish this. These mailings should educate other practices about
the services you provide and the benefit you can bring to their patients as a supplement
to their care. You can strengthen your position by including specific conditions
that may be of interest to their patient population. Some things to consider include:
diabetic and hypertensive exams, corneal or conjunctival foreign body removal, glaucoma
testing, chronic dry eye, ocular allergy screening and monitoring for visual side
effects associated with various conditions or medications. Be sure to include key
contact information as well, such as the location and hours of your practice, so
those receiving the mailing have all the information on one place.
Establishing your practice as the treatment center for all your
patients' primary care optometry needs will provide additional revenue and practice
growth. It will also further elevate you as your patients' authority on overall
eye health and increase patient satisfaction, which is really the key to building
your primary care practice. OM
DeVries is practice administrator
for Eye Care Associates of Nevada, a group practice in Reno and Las Vegas. He is
also past president of the Nevada Optometric Association. Send e-mail to
Optometric Management, Issue: December 2005