I love technology and instrumentation in my practice. There are three good reasons why investing in clinical instrumentation provides a very good financial return:
It allows you to provide new services that are billable to insurance plans or patients or both.
It increases your efficiency and speed, often through delegation to technicians.
It creates a wow factor for patients, elevating your exam services and causing more word of mouth referrals.
As we end the 2013 and plan ahead for next year, think about your wish list and try to make at least one major purchase (or lease). Consider the tax benefits of buying equipment and speak to your accountant about the timing.
My list of must-haves and wish-I-hads
Here is a list of clinical instruments that I think you should already own or have in mind for the future. I'll start with the basics and move up to the advanced. It should be understood that new startup practices should not overextend the budget and can rightfully get by with less. Instrument decisions are relative to the size of the practice, but it is smart to push forward and reinvest as cash flow permits.
Autorefractor. Most optometrists have one, but surprisingly, quite a few do not. They are quite accurate and they make the subjective refraction much quicker. I know I'll hear from the purists, but for most patients we can just drop retinoscopy and let the technician do autorefraction. There are many wonderful combo instruments out there with autorefraction plus keratometry, topography, wave-front analysis and even non-contact tonometry! I love all that in one footprint!
Visual fields. Some form of perimeter is needed to practice. I like to have traditional fields for managing glaucoma plus a fast electronic field screener that is used in pretesting.
Autolensmeter. If you are willing to spend more money, you can find some that are extremely accurate and repeatable, even for progressive lenses. For the medium to large practice, autolensmeters are very helpful for clinical technicians.
Digital refracting systems. These have many applications for doctors or technicians and lots of wow factor for the patients. You can test for cylinder while presenting the choices side by side instead of flipping. You can also compare the habitual Rx to the new one with one click. And you can remain at your desk or console the whole time.
Non-contact tonometer. I love these instruments and the widely believed fear and hatred by patients is greatly exaggerated by colleagues who don't own one. A good alternative is the iCare tonometer. But the NCTs are simple for any technician to use and the measurements are very accurate when compared to Goldmann. It pays for itself by saving the doctor up to an hour per day (do the math)!
Retinal imaging/photography. This instrument is the best non-essential instrument in eye care. The decision may be about non-mydriatic retinal cameras or Optomap. Both are great and I have both in my practice. The former is more affordable but the latter allows an amazing view of the periphery. Choose based on your budget and your goals. I recommend using the device as both a screening tool for an additional fee not covered by insurance plans and also for management of eye disease.
Corneal topography. This instrument elevates your contact lens services and I believe you should require it as part of the yearly eye exam for all contact lens patients. Raise your evaluation fees accordingly.
OCT. Truly a break through instrument that allows us to provide a better level of eye care. Depending on your practice size and demographics, this instrument may be a no-brainer because you may be able to bill enough procedures to Medicare and private insurance to pay for the significant cost. Fees dropped a few years ago, but we can now bill for retina, optic nerve or anterior segment, plus the office visits in many cases.
Many other technologies are out there that could make your list, such as visual evoked potential, endothelial cell cameras, macular pigment optical density tests, and even digital devices for optical dispensing.
What's on your wish list?
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor,Optometric Management Tip of the Week