Article Date: 12/1/2005

Layout 1

Charting the Right Course
How to expand your role as a primary care provider.
DOUGLAS 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' lifestyle.

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.

Getting started

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 rates.

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 area.

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.

By 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 boxes.

Diagnostic coding

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 it looks.

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. 

Write prescriptions

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.

Patient education

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.

Staff education

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.

Professional education

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

Dr. 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