Let’s Get Medical: Part 1

medical model

Let’s Get Medical: Part 1

Why and how to develop a medical niche


It’s in our chairs every day, and yet many of us do not give it the focus or place the proper amount of value on it, in terms of services rendered, that it deserves. I’m talking about medical eye conditions. The following four points illustrate why it’s time we start:

1. Dwindling numbers of ophthalmologists. The demand for ophthalmological services will have grown 18.1% between 2008 and 2015, says a Market Scope research study. It was anticipated the number of ophthalmologists finishing residency would grow approximately 2% during this same period. That has not happened. The number of ophthalmologists finishing residency programs each year and entering into practice is barely keeping up with the amount of ophthalmologists retiring each year. You, as an optometrist, have the needed background to pick up the slack, and make a profound difference in patients’ lives.

2. Maturation of baby boomers. In 2011 alone, between 8,000 and 12,500 people a day turned 65, based on U.S. Census information. By 2025, this population will grow to almost 72 million in the United States. Keep in mind that age-related eye diseases, such as AMD and cataracts, significantly increase after age 65, says the National Eye Institute.

3. The Affordable Care Act will create a slew of new patients. The creation of state-based health insurance exchanges that must provide coverage to the uninsured, along with a pediatric benefit package that requires vision coverage and finally, provider non-discrimination means an influx of patients who have medical eyecare needs to our practices.

4. Increased income. The development of retail opticals, as well as other competitors that offer online spectacle/contact lens sales, may impact your dispnesary’s revenues. In addition, medical eye care expands the care you offer patients and is lucrative. It enables you to stay profitable regardless of difficult economic times.

Here, I provide a three-part series on how to build a medical niche in your practice. In part one, below, I give you the first three steps to transition your practice.

1. Change the practice’s mindset.

Inform your staff of the change. Specifically, say you want them to start to categorize each patient under refractive vision care or medical eye care. Next, tell them you’ll be providing education regarding the testing and treatment of medical eyecare conditions, such as glaucoma. (This education will be covered at length in part two of this series.) The successful expansion of medical eyecare services hinges on your staff’s comfort level.

For your part, begin reappointing non-emergency medical eyecare patients, such as AMD patients, for a follow-up visit, at which you exclusively focus on the condition. (See “Establish the Dry Eye Disease Visit,”

We, as optometrists, often attempt to cover too much during one visit. This results in schedule bottlenecks and patient education overload (the latter of which can lead to non-compliance to our instructions, and thus, the worsening of their conditions). Reappointing medical eyecare patients improves practice efficiency and allows enough time to address the specific malady. This, in turn, facilitates patient retention of the information and instructions regarding their condition. This level of service endears you to your patients, thereby increasing their satisfaction with your practice and contributing to patient referrals.

2. Identify your niche.

The initial determination of your niche should be based on your comfort level in managing a specific disease entity. Once you have identified this condition, check your patient and area demographics to make sure they support the niche.

Examine your patient demographics by pulling a simple report from your EHR or, if you’re old school, by designating a staff person to go through your patient files to obtain this information. In addition, determine the overall demographics in your local area. I use to acquire this information.

The data from your patient files and local area determine your medical niche. So, if most of your practice is comprised of patients age 40 and older who have dry eye disease, and your local area demographics reveal most of the population is between the ages of 40 to 49, you’re likely to be most successful in focusing on dry eye disease with an eye toward additional medical eyecare, as it presents itself.

This exercise may help other areas of your practice, such as your optical dispensary, but it is crucial to deciding what kind of medical niche at which you will be most successful.

3. Assess the niche’s value.

Once you’ve identified your medical niche, determine how many of these patients you currently see and how many you actually bill medically.

So, if your niche is dry eye, identify how many patients you currently see and bill their visits — as dry eye visits — to the patient’s major medical plan.

In using the dry eye disease example above, track every patient you see through the next week who you think has some form of dry eye disease and whether you decided to treat it.

Each day next week, write the total number of patients you treat for dry eye and the amount you bill major medical insurance.

At the week’s end, total the numbers, and enter them in the “Medical Niche Profitability Chart” below.

Medical Niche Profitability Chart
    M T W TH F Total
1. Current OSD patients (Pts) seen            
2. Pts billed same week last month            
3. Collected value of these patients            
4. Value per patient (#3/#2)            
5. Minimum potential value (#1×#4)            

Next, determine how many dry eye patients you saw in the prior month through the same time period.

Now, you’re aware of any collections problems that currently exist and what you were doing before becoming “aware” of the possibilities. The total amount billed for dry eye patients in a week last month gives you a collected value for these patients. That is, if you billed a total of $1,000 for 10 patients, your value per patient would be $100, or $1,000 divided by 10. If major medical paid $800 for these dry eye visits total, you have a collections problem, since you should have received $1,000.

This exercise provides you with the minimum value of what your new niche can bring you, in terms of additional patient flow (#1) and potential revenue (#5).

By the time this three-part series is completed, you will know how to at least double the final column in row #5. So, for now, take the final column in row #5, and multiply it by 50 (50 weeks a year after vacation and holidays). __________(#5) × 50 = $ __________ OM

In part two of “Let’s Get Medical,” I explain how to develop the knowledge, skills, tools and staff to achieve success.

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