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Some readers will think this is a radical idea; others will say I've been doing it for years. I was speaking to a colleague/client recently and she described how her usual office routine for contact lens follow-up visits is to have her clinical technicians see the patient. All those office visits are scheduled with a technician on the appointment schedule, freeing the doctor to do more revenue producing exams.
As one who believes strongly in the practice building power of delegation, I think the idea has merit. I'm always looking at new ways to delegate without reducing the quality of care. Can that be done with contact lens care?
As I see other health professions moving more and more to delegation, with respiratory therapists prescribing drug regimens, nurse practitioners doing physical exams and pharmacists giving injections, I realize that we must continually challenge our old ways of thinking. We also must look for ways to make health care more efficient and more cost effective.
Keep an open mind
I think we all know that ophthalmic technicians can be trained to perform slit lamp exams and over-refractions. We know of some practices that use techs in this way, yet most optometrists have not seriously thought about adopting the process in their own offices. Many would say they want and need to know the ultimate success of each case. It helps refine the doctor's knowledge of various lenses when they are seen on follow-up. Good points, but I'm not sure you would lose that if you delegated contact lens follow-ups, providing that you had the right office protocol and kept some data.
Consider this procedure:
The contact lens technicians have been specifically trained to evaluate contact lenses and have passed a clinical proficiency exam.
All patients with new fittings or re-fittings are scheduled for a follow-up office visit with a contact lens technician.
The technicians have an appointment schedule of their own – these patients are not on the doctor's schedule. The doctor is present in the office, however.
There could be a special exam room equipped for technician contact lens exams. The room may be smaller than a typical exam room, but it would still have a slit lamp, phoroptor™, and visual acuity display. Or the tech could just use an available exam room.
The technician does everything that the doctor would do on a progress exam: case history, review of lens handling and hygiene, visual acuity, over-refraction, slit lamp exam for lens fit and eye health, case assessment and plan, including recall date.
The doctor is called in to examine the patient if anything is abnormal. A specific criteria would be established for this such as 1) any complaint in the history, 2) contact lens acuity less than 20/20 in either eye (or at the BVA level for an eye that does not see 20/20), 3) any over refraction greater than .25 diopter and 4) any abnormality observed on slit lamp.
If everything is normal, the patient does not see the doctor.
In this scenario, the doctor would still see all the complications and problems associated with contact lens fittings. Data could be kept that provides a success rate for each brand of contact lens so the doctor retains an overall sense for what lenses are working best and the percentage of cases having problems.
Since most follow-up visits are completely normal and without complication, this approach should save a significant amount of doctor time and allow everyone in the practice to work at his or her highest level. The doctor would have to be flexible enough to work in an occasional contact lens problem on top of his schedule, but the examination and disposition of those cases should not be too time-consuming given the high level of technician assistance.
Always follow your state law when determining what you delegate in your office.
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.