the Dry Eye Annuity
your patients aware of the problem and show them you have the solution. It will
benefit you both.
SCOT MORRIS, O.D., F.A.A.O.
rarely thumb through an optometric journal lately without coming across an article
about dry eye. While this topic received little attention a few years ago, now it's
one of the most talked-about in our profession. Let's review some of the reasons
for this new prominence:
►Declining vision exam reimbursements have forced optometry to look for alternative
►Optometrists perform more than 67% of all eye exams in the United States, according
to the American Optometric Association.
►The National Eye Institute tells us that 15% of our patients have dry eye symptoms.
This number will increase as Baby Boomers reach ages where dry eye is more prevalent.
►Optometry, in most states, has therapeutic privileges that allow treatment of ocular
Thus optometry finally has a profitable niche.
Simply stated, there are two ways to enhance practice revenue:
You can see more patients or increase the revenue you make on your existing patients.
Which is easiest? Which is most profitable?
A conservative estimate of the average annual collections
per dry eye patient is around $245.04. Annualized, that's about $105,855 per provider
(based on the proprietary fee calculator I've developed; see the box, "Fee Calculator
Assumptions," below). That would be a nice boost to your practice's bottom line.
Now that I have your attention, let's talk about how you create your dry eye annuity.
seen per day: 10
contact lens wearers
Average patients per day with
ocular surface disease 2.16
All collections based on Medicare
Developing a dry eye niche
Just like developing any niche in your practice, you have to concentrate
on a few key things. These will take a little planning and work on your part.
►Make them see the problem. The first step is to make patients realize that they
have a medical problem. Face facts: Most of our patients see our profession as the
place for glasses and contacts, not medical eye care. The first step is to focus
on their problem. Place an ocular surface disease questionnaire in your waiting
room instead of the standard out-of-date, tattered magazines. We recommend a check-box
style questionnaire on one side with a brief explanation of dry eye, its causes,
various treatment options and, most importantly, that your office treats this condition.
Not only does this achieve the goal of educating your patient
base, it also accomplishes one of the most basic sales goals: The questionnaire
is a non-confrontational way to help patients realize they need something, or in
this case, that they have a problem.
►Train your staff. The most important asset and investment in your practice is your
staff, so use them wisely. You will only succeed at developing your dry eye niche
practice if you actively involve and motivate them. Conduct a series of training
sessions on dry eye. Communicate your goals to expand the scope of the practice
by adding a dry eye niche and designate each of your staff members a responsibility
that will move the team towards the goals. Then give them the tools to achieve these
goals and an incentive program to realize them and get out of their way.
Seven Steps to Better Patient Education
Explain how you're treating (in plain English).
Explain why you are treating.
Give written instructions.
Have patient repeat instructions.
Have a family member present, if possible.
Make them commit.
Ask if they have questions.
►Patient education. The first step in patient education is to explain that dry eye
is a chronic problem and typically takes some time to get this far, so it will likely
take multiple visits to manage the condition. This subtly establishes the fact that
management may involve multiple medical visits over the patient's lifetime.
The second step is to be an optimistic realist. Dry eye is
a manageable condition and there is a protocol to effective diagnosis and management.
You have to believe that you can assist your patients. Furthermore, your staff has
to see it and your patients have to believe in you in order to succeed.
The third step is to follow the basic steps to enhance your patients'
compliance. (See "Seven Steps to Better Patient Education," above.)
Know your lines
Like everything else in your practice, you will need to develop
a "script" for both you and your staff. These scripts should include a description
of each dry eye test, a description of the different types of dry eye, as well as
how they interact with each other, potential treatment options, common drug side
effects and anticipated timeline for results.
Getting the word out
This is where the key rule in business comes in to play: Market,
market, market! Everything you do in practice is about how you market yourself.
So be proactive, market your niche aggressively and sleuth out dry eye disease in
every patient who has clinical signs or symptoms. Here are a few suggestions about
the marketing pieces you can employ.
►Annual newsletter: Add a section on your dry eye practice.
►Phone message: Instead of on-hold music, record a customized phone message that
explains your ability to diagnose and treat many eye health issues, including dry
►In-office brochures: Ideally, make your own or talk to your pharmaceutical
representative for corporate brochures.
►Motivate your current patients to provide referrals by developing a new patient
referral incentive program with movie tickets, etc., as rewards.
►Always write a follow-up education letter and/or thank you note to your patient.
Not only does this provide another contact to reinforce compliance issues, but it's
also a nice personal touch that shows you care.
Do You Bill This?
are some billing examples for new patient
What do you need?
►The exam. The first step in any medical visit is to establish medical necessity
by documenting a chief complaint. Then, as with any medical exam, you should document
a thorough history, examination, patient education and a complete diagnosis and
►Coding. All medical patients will fall into one of three categories based on patient
status in your practice and the level of history taking, exam components and medical
decision-making that you document.
New Patients 99201-99205
Established Patients 99211-99215
Confirmatory Consults 99271-99275. These
are second or third opinions when requested by the patient.
If you are not familiar with the criteria for each of the above
codes, you should become so before you initiate reimbursement submission. Also be
sure to use the correct procedure and supply codes when appropriate:
■Procedure codes: 68761 Punctal Closure by Implant
■"A" Supply codes. "A" codes for silicone plugs are no longer reimbursable by Medicare.
Many third party insurance carriers follow Medicare's change last year and deny
99070 (Miscellaneous supply code) at this point. However, it is still variable,
so I would suggest that you continue to bill the 99070 code. If the insurance carrier
denies the claim, you can either bill the patient, if you have him or her sign a
financial responsibility waiver, or write it off.
Converting into medical
Procedure Modifiers - 68761 +
Significant Separately Identifiable Evaluation or
Performed on the same day of the procedure
(Use with Exam, not procedure code)
Because most people are unaware that they have dry eyes, the first
step to conversion is helping the patient realize that he or she has a problem.
If a patient presents a chief complaint that's medically related to dry eye, then
you have the option of proceeding with the medical exam and putting the visual exam
off to another time.
A more prudent method for your mild patients is to complete the
vision exam and bring them back for a medical exam. The purpose is to create a second
visit (and more chair time) in which you can perform more extensive ocular surface
disease testing, including vital dye staining, Schirmer testing and possibly photography
It also allows more time for patient education on the etiology
and treatment strategies, as well as another opportunity to impress him or her with
your expertise. The hope is that this person will become a loyal patient who in
turn will help generate referrals to your practice.
Improve your bottom line
Provide a better standard of care for your patients. Provide your
patients with more than just solutions to their visual needs: Take an active role
in providing solutions to their eye health needs by addressing one of the most common
and symptomatic problems that our patients have dry eye. And start managing
the easiest dry-eye patient you have: The one in your chair!
only succeed at developing your dry eye niche practice if you actively involve and
motivate your staff. Conduct training sessions and provide incentives.
Dr. Morris is the director of Eye Consultants of Colorado, LLC, and Morris
Education & Consulting Associates. He is a member of the American Optometric
Association and is a Fellow of the American Academy of Optometry. Contact him at
Optometric Management, Issue: August 2006