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Editor: Neil B. Gailmard, OD, MBA, FAAO
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Retinal Image Screenings: What Are Your Options?
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February 10, 2016
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Offering patients the option of having digital retinal photos or ultra-widefield laser retinal images as an optional screening test is a great way to enhance a routine eye exam. This procedure has been used for decades, but has grown in popularity and acceptance. Patients understand that their vision plan only covers a very basic vision exam, but many want the benefits of more advanced technology and are willing to pay out-of-pocket for it.
Chances are very good that you already offer some kind of retinal screening test, but you may wonder if you are doing it the best way. Or, perhaps you are new to retinal imaging and you are wondering how to position it in your practice. I have provided retinal screenings in my practice for a long time and I’ve tried many different methods. Here is a quick rundown of your options.
Always read the provider manual of any vision plan you work with and stay within the contractual guidelines you agreed to.
Which instrument and multiple tests?
The first step is to determine what type of screening to offer. Most optometrists offer retinal photos of some kind and for good reason; they provide useful clinical documentation for comparison with future exams and they offer a very high degree of the wow factor. Patients never get tired of having their doctor show them an image of the inside of their own eye and explain what the structures are and if it is healthy. Which retinal image device to buy depends on your budget and your preferences, so all I can say is shop around.
Many ODs are also offering other screening services in addition to or instead of retinal photos. There are wellness screenings available in OCT instruments and macular pigment optical density (MPOD) testing is also quite popular. These choices are up to you, but keep in mind as you bundle more tests, the cost is generally higher to the patient and the time it takes the technician to run the tests will increase. Keep an eye on the total patient experience and don’t let a very good wow factor turn into a drain on the patient’s energy and time.
I was always concerned that offering two optional screening tests would be too much, but we have had a very positive reaction from patients when we offer the Optomap and MPOD test as a bundled package.
Include in exam fee or charge additional?
Many doctors adding advanced technology to their exam tell me they just want to include it in the exam fee and have the test on all patients. I get that, but we have to look at the economics of the situation as well. The decision may come down to how prevalent vision plans are in your practice. You can’t raise your exam fee within vision plans and since the technology is quite expensive, collecting an out-of-pocket fee is an excellent way to generate a lot of revenue.
High fee or low fee?
Consider the tipping point of fees: at what price will many more people say yes? As an example, you could charge a fee of $40 and you might find 50% of patients opt in, but if you charge $20, you could find almost 100% say yes. The revenue you collect would be the same in both cases, but the time needed by your staff would increase greatly with the lower fee. You would also gain the exam efficiency and more people would have the wow factor with the lower fee. Your call.
Leverage dilation?
Another big factor for your opt-in success rate is if you can make the claim that patients who have the screening test will not need to be dilated as often. Optometrists vary widely with their opinions on this matter. It really only applies to ultra-widefield laser imaging, because standard retinal photos do not provide a very wide view of the posterior pole. All I would say is represent your clinical philosophy honestly. We dilate almost every patient in my practice, so we don’t make any claims about reducing the frequency of dilation.
Written handout or verbal?
Some doctors like the technician to discuss the screening option during pretesting, some doctors prefer to recommend it personally, and others have a staff member at the front desk hand the patient an educational paper form at check-in (and the patient checks a yes or no box and initials it). You can try all those methods and choose which way works best in your practice.
Surprisingly, I found a higher opt-in rate when our receptionists gave the patient a handout at check-in compared to having our techs explain the test and offer it during pretesting. I’m not sure why that was, but I suspect the technicians often feel rushed and they did not want to take the time to do the extra test. We went back to having the receptionist hand out the form. Some offices pay a bonus to staff members if they reach a certain goal on the opt-in percentage or for each screening test performed.
I prefer a low-key approach to offering the screening test. I don’t want the patient to feel pressured into having the test and I want to let them opt-out gracefully if they so choose. The patient experience is more important than the extra fee in the long run.
Maximize the wow factor
If you are going to offer retinal screening tests, I think it is important to obtain the full wow factor. The instrument should be in a pretest or special diagnostic room and it should be on the office computer network system. The screening test is performed by a technician and the images are brought up on a monitor in the exam room for the doctor to review and discuss with the patient. You may want the images from the previous exam also brought up for comparison.
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