CLINICAL

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Add OSD to Your Business Plan

By diagnosing and treating patients who have ocular surface disease, your practice can reap big rewards

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

With decreased reimbursement on both services and products within vision plans and the upswing in the Internet dispensing of contact lenses and glasses, not to mention the changing landscape of health care (more patients), you should consider adding ocular surface disease (OSD) to your business plan, if you haven’t already.

Here, I explain why and how to accomplish this.

Why add OSD?

You should add OSD to your business plan for three reasons:

1. Dry eye disease (DED) and ocular allergy are the most prevalent conditions in patients. Up to 40% of the U.S. population has experienced ocular allergy symptoms at least once in their lifetime, with the peak in June and July, reports a recent study in the Journal of Allergy and Clinical Immunology. Meanwhile, an estimated 25 million people in the United States have DED, reveals a recent Market Scope report. With the continuing growth of computer device usage, it will likely increase.

2. It is an affordable sub-specialty to launch. O.D.s already have the tools needed, such as a slit lamp and vital dyes, to diagnose OSD. In addition, a variety of inexpensive point-of-care tests, such as tear osmolarity and MMP-9 level testing, are available to facilitate diagnosis and treatment. (A caveat: Review your state’s CLIA wavier laws to determine what is necessary to include point-of-care lab testing in your practice.) Yes, as you grow and expand your OSD sub-specialty you will need to invest more in technology, but patient numbers will justify that.

3. It goes hand-in-hand with contact lens wear. Contact lens exams account for 27% of the refractive exams performed by O.D.s, reveals the AOA’s “State of the Optometric Profession” study. To successfully fit patients and ensure they remain in contact lens wear, it’s essential you actively manage and treat OSD.

How to add OSD

To add OSD to your practice, you must establish the following protocols:

• Provide a quantified OSD questionnaire to all patients at every visit. Examples include the Ocular Surface Disease Index, The Dry Eye Questionnaire and the Contact Lens Dry Eye Questionnaire. The questionnaire enables you to immediately identify “low-hanging fruit,” or patients who have symptoms and complaints revolving around ocular allergy or DED.

A questionnaire that yields quantifiable answers can also be used to trigger the aforementioned point-of-care laboratory diagnostic tests. Those who make the effort to meet CLIA requirements to become a lab director can both provide and bill for the lab testing.

• Assess the patient’s medical history. Do this to determine possible links between OSD symptoms and systemic conditions, past surgeries, the environment and/or medications. Via a separate questionnaire, ask patients whether they have conditions associated with OSD, such as arthritis, have a history of refractive surgery, spend inordinate amounts of time near air and heating ducts, are avid computer users, smoke cigarettes and/or take anti-hypertensives, decongestants and any other drugs associated with inducing OSD symptoms.

• Employ diagnostic testing. Should the patient questionnaires reveal possible OSD, schedule the patient who has presented for a comprehensive exam for a separate visit, during which you use diagnostic tests to determine whether he or she has OSD. These tests include, but are not limited to, fluorescein staining of the conjunctiva and cornea, TBUT, partial blink, lissamine green staining, evaluation of the tear meniscus, conjunctival chalasis meibomian glands and the remainder of the lids and lashes. A portion of your patients will also benefit from additional laboratory testing for Sjögren’s syndrome.

As a related aside, I recommend your practice becomes aggressive in getting credentialed on the major medical plans. The most efficient way is to enlist the services of a company that specializes in those services specifically for optometry. These companies can assist you in billing for those services. The increase in medically coded visits will be the lion’s share of the revenue gained by the practice.

• Prescribe the appropriate treatment(s). Should the patient test positive for OSD, prescribe a treatment protocol based on the type of OSD. Many OSD conditions are co-morbid and exist together as the progressive cascade advances. Treatments include specific strategically implemented artificial tears, immunosuppressives, steroidal and non-steroidal anti-inflammatories, punctual plugs, specific lid hygiene products, compresses, nutritional supplements, inserts, antibiotics, meibomian gland expression, moisture exposure goggles/glasses, among others.

I’m an advocate of sourcing and supplying patients with the appropriate treatments. The ability to merchandise products to treat OSD is, in my experience, essential to help achieve compliance as well as improvement of the condition. With these patient benefits comes additional revenue from the products. However, this revenue will not be the driving factor; rather the patient compliance achieved.

• Appoint an OSD coordinator. This person keeps your office running smoothly by answering patient questions before or after examination.

End result

Treating or expanding OSD within your practice provides a valuable service to your patients, while enabling your practice to increase its revenue. Consider this: If your practice doesn’t provide those services, another practice will, threatening your patient population. OM

Dr. Devries is co-founder of the Eye Care Associates of Nevada, a medical/surgical co-management referral practice. Send comments to optometricmanagement@gmail.com.