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We hear a lot of talk about the wow factor these days when we discuss clinical instrumentation,
and for good reason. If you’re trying to grow your practice in patient volume and revenue, and
most of us are, it’s important to set yourself apart from the other eye care options in your
marketplace. In business terms we call this a competitive advantage. Since we are in the
business of performing eye exams, we should look for ways to make our exam services stand out
from the norm. Nothing delivers the wow factor like digital retinal photographs that are
networked and displayed on computer monitors in the exam rooms.
The value of a wow factor in diagnostic instruments occasionally meets some criticism from
clinical purists, who feel there is no place for it. But if the instrument also provides
excellent clinical benefits, I think it’s great. Patients are actually pretty smart health
care consumers and my experience is that they enjoy the technology and the time the doctor
spends with them reviewing it. There is no question that it leads to more word-of-mouth
Utilizing retinal cameras
There are three major ways that retinal cameras are used in the eye care practice.
Medical use only
The instrument is used only to document medical conditions of the eye. The CPT code of 92250
is used to bill the procedure to health insurance plans if there is an acceptable diagnosis
code to go with it. Medicare typically sets this fee at around $70 as a bilateral procedure.
The problem with this approach is that the retinal camera would be used fairly infrequently in
most optometric practices. We see a lot of patients without retinal disease, and all of those
people would never be exposed to the amazing technology and the excellent patient education
benefits. There is very little wow factor. The procedure also may not earn much income when
used in this manner, even though the fee is respectable, because of the relatively low number
of procedures billed.
The retinal camera is used as an optional screening test which is offered to all patients who
are seen for complete eye exams. This is an exam upgrade if you will, which is not included in
the basic exam fee because vision plans don’t cover the test and medical plans only cover it if
a disease is diagnosed. 50 to 75% of patients will opt for the procedure if they are well
educated about it and if the fee is reasonable. Of course, the test can still be ordered for
patients when it’s medically indicated – even those who opted out on a routine basis will accept
it if the doctor says it’s needed, and the fee may be billed to health insurance in those cases.
This approach is mostly used in practices that have a high percentage of vision plan patients,
which holds the exam fee to a fixed minimum. The retinal photo procedure can provide additional
practice income in these cases while allowing those patients who want high tech services to
Just part of the exam
Retinal photos are included as part of every routine eye exam at no additional charge. The exam
fee is generally increased significantly when this procedure is added, but it is not broken out
as a separate charge. This is my preferred method of usage because every patient receives the
benefits of the technology and the practice benefits from the in-office efficiency and wow factor.
This approach also removes the unpleasant task of asking the patient if they want to upgrade their
eye exam – a question that may be hard for a lay person to decide on. Of course, retinal cameras,
computers and software are expensive, so the exam fee will have to be higher than average. But
that is actually a good thing if vision plans don’t dominate the practice, because there is a
segment of the market that will happily pay more for advanced services.
Instrument pays for itself
In practices with average or greater patient volume, the retinal camera is a device that pays for
itself at a minimum, and often generates a profit. This is especially true in the latter two
scenarios above. If you leased the instrument at a cost of $500 per month, but charged an
additional fee of $25 for the procedure, you would only need 20 patients per month to cover
the cost. If you had 40 patients opt for the test, you would pay for the camera and earn a $500
profit per month. Of course, it’s all profit after the lease is paid off.
Why do we need a photo?
Well, we don’t actually need a photo to document a normal eye; but it’s often very nice to have.
Retinal photos don’t take the place of examining the fundus directly, but it’s simply another very
good way to visualize the fundus. Your technician can obtain a beautiful, high-resolution image of
the macula, optic nerve head and surrounding fundus without dilation in most patients. Today’s
retinal imaging software provides some amazing computerized tools, such as zooming, cup/disc ratio
measurement on the image, stereoscopic viewing, and mosaic matching of the peripheral retina into
one panoramic view. It’s very helpful to compare changes in the retina over time when you have a
series of photos, and to verify the previous presence or absence of a questionable finding.
Reviewing the retinal images with the patient in the exam chair, even when they are healthy,
provides a vehicle for patient education that is unsurpassed. Patients are naturally fascinated
by seeing an important organ of their body, which they may have never seen before. When you show
and discuss the retinal anatomy, the things you look for and what is normal, the patient gains new
insight into what happens during an eye exam, and that’s worth a lot.
More nuances on integrating retinal photography into your practice routine next week.
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.