As we come to the end of the calendar year, it is a good time to consider your equipment wish list for your practice. The IRS section 179 income tax deduction is limited to $25,000 at the present time, although there is hope that it may be increased in the coming year. Regardless of that regulation, there are many great reasons to invest in instrumentation for your practice.
While not an exhaustive list by any means, I’ll share a few of my thoughts about equipment that can help your practice, clinically and financially.
Second exam lane. This could easily be overlooked when we compare it to high tech diagnostic tools, but if you don’t have two fully equipped exam rooms per working doctor in your office, it may be the most bang for your buck. For relatively low cost, a chair, stand, slit lamp, phoroptor and digital acuity chart can allow you to be much more efficient than working out of one room. A second or third lane will greatly impact your profitability. The life of this equipment is quite long, which makes used equipment a good value also.
Retinal camera or Optomap. These devices are now in most optometric offices, but they deserve to remain high on our list because of the clinical value, the wow factor and the profitability. Prices have come down for these and Optos now sells their imaging instruments outright, eliminating the leased only model that many doctors did not like. You can use cameras and Optomaps as a screening tool for an out-of-pocket fee and also bill it medically.
OCT. This instrument has quickly become the most coveted advanced instrument in optometry and for good reason: it helps doctors to diagnose conditions at an earlier stage and manage them better. Even with the drastic cut in Medicare fees for this procedure, most optometric practices have enough patients who need the test to make this instrument pay for itself.
Topography. No longer new, but I think this test should be run at every annual eye exam for contact lens wearers and you can increase the evaluation fee accordingly. Also, orthokeratology is growing in popularity and represents an exciting new service for many practices.
Tonometer for technicians. Various non-contact tonometers and the iCare tonometer are the leading candidates for accurate intra-ocular pressure measurement in pretesting. These are huge time savers for the doctor. They do not require an anesthetic and are easy for techs to master. I have both in my practice and we love them both.
Macular pigment density test. If you are not prescribing fairly large numbers of nutritional supplements for patients, this device can help your practice. Patients love the fact that you are doing something to help prevent age-related macular degeneration (AMD) and they opt in for this screening test at a nominal fee not covered by insurance. The test helps determine one important risk factor for developing AMD by giving you a score for pigment density.
Finishing lab (edger). Edging systems today allow your staff to finish all kinds of lenses in your office very easily with minimal training. You can greatly reduce your cost of goods by having an inventory of stock lenses and by cutting lenses that are surfaced at your wholesale optical lab. With VSP and EyeMed now paying independent offices to do the finishing work, you can increase your payments and profit from these plans.
The basics: autoperimeter, autolensmeter and autorefractor/keratometer. In case you somehow skipped ahead and never acquired these three instruments, you should go back and get them. They are so common in practice and have been around so long that we can’t really call them advanced, but there is a reason they have become standard. You really can’t be a good clinician without a good visual field device. Some autolensmeters are now extremely accurate (spend more to get an accurate one) and they are huge time savers for staff. Autorefractors help make the subjective refraction go much faster, which is reason enough to get one. Stop doing retinoscopy unless you are doing it on kids for accommodative dysfunction. Yes, I’ve heard from ODs who love their retinoscopes, but there are better ways to gather the information and I’d rather save the time by letting a technician run an autorefraction in pretesting.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.