screenings

Should You Add “Wellness” to Your Practice?

Top-rated medical centers have offered executive health screenings for decades. Is it time for optometry to follow suit?

April Jasper, O.D., West Palm Beach , Fla.

Should you incorporate “wellness” screenings into your practice? To answer this question, consider that, as a rule, successful businesses are those that provide a service to customers that customers find valuable and that is not easily obtainable elsewhere, regardless of price. As I read through publications such as Fortune, Inc. and CEO, rarely do I find that the price of a product or service is the reason for a company's success.

Adopting the “executive health” model

For example, for more than 30 years, top-rated medical centers around the country have offered “Executive Health Physicals” for an out-of-pocket, noninsurance covered fee, ranging in price from $2,500 to $7,500. Taking anywhere between one-to-four days to complete, these screenings were originally developed in response to requests from business executives and corporations that, according to the Mayo Clinic Executive Health Program brochure, “ … recognized the importance of maintaining the good health of their leaders.”

It is interesting to note that these programs are no longer exclusively marketed to — and used by — top executives alone. But all who utilize such services appreciate the efficient, personal, comprehensive and proactive health evaluation that integrates the latest technology available.

Worth magazine publishes an annual “top 10” of executive health programs, and with the advent of new technologies in healthcare, the “Executive Physical” continues to be recreated and improved. The medical centers that offer these programs more often now label them a “Wellness Program,” and most of the centers offer this program to anyone age 12 and older.

Components of a comprehensive program

Fortune listed Scripps Center for Executive Health, in San Diego, Calif., in their top 10 of executive programs. On its website, Scripps includes in their program description that “you will get details about your health that no routine physical checkup is designed to discover.” Scripps goes on to say, “our exam is based on the thorough, comprehensive testing and the health maintenance strategies so needed for the early detection and prevention of problems that could affect the quality of your life.”

These comprehensive wellness exams offered by many centers around the country typically include screenings, such as:

► Hearing
► Mammography (women)
► Blood
► Pulmonary function
► A resting electrocardiogram
► Stress treadmill testing
► A dermatologist total body skin evaluation
► A body fat determination
► A full-body CT scan
► A colonoscopy
► Vision
► A multi-detector computed tomography
► A review of medications by a Doctor of Pharmacy

In most cases, the medical centers have the healthcare provider present the patient with a written and electronic summary of all their test results.

Many critics of these wellness exams say that they incorporate unnecessary testing and do not necessarily prolong one's life. However, in a 2004 article in The Wall Street Journal, Kenneth Cooper, founder of the Cooper Aerobics Center in Dallas, Texas said, “There's hardly any excuse for missing a major problem, but major problems are missed all the time in most exams because they are so superficial.” A oneday “Wellness Physical” at the Cooper center begins at $2,500.

Wellness and optometry: questions answered

When discussing wellness programs with regard to the optometric practice, the following questions arise.

• How does this “executive physical” or “wellness program” relate to optometry?

Optometry has had the great fortune of extensive developments in technology through the past 15 years. With the advent of this technology, those who are interested in being at the cutting edge of our profession have been given an opportunity to develop an “Eye Wellness Program” as a separate program from the routine eye exam. In addition, EHR has given us a way to provide a written summary of our findings to patients even now with our routine evaluations.

• How do you create an “Eye Wellness Program?” Without reinventing the wheel, one way you could accomplish this would be to follow the same pattern that the top medical centers have followed when developing their wellness programs: Create ageappropriate screening programs that could be offered to patients on a yearly basis, and then customize the screening program for year two and beyond based on family history, prescription(s) and the results of the initial screenings.

• What would this “Eye Wellness Program” look like?

There is no one program that fits all practices. I recommend you incorporate those technologies that you feel are appropriate based on the needs of your patient population and the equipment available to your practice. For some practices, the “Eye Wellness Program” may include cholesterol and diabetes screenings; for others it could even include a noninvasive scan that measures overall carotenoid antioxidant activity.

Other tests/devices to consider including in an “Eye Wellness Program:”

► Optical coherence tomography (OCT) technology. Many cases exist in the medical literature of patients who have learned of a previously undiagnosed condition through the use of OCT. Every OCT on the market now has a screening program that you can quickly and easily run on every patient and provides a very descriptive report of the findings, which can be helpful not just with glaucoma screenings and diabetic screenings, but also with screenings for retinal side effects of systemic medications.
► Ultra-wide field scanning laser ophthalmoscopy. Consider the studies that demonstrate this technology's value as a screening tool as well as the documented cases of difficult-to-see retinal lesions that practitioners have discovered by using this technology.
► Specular microscopy. We, as optometrists, have the ability to quickly and easily screen patients for severe endothelial corneal disease with in-office specular microscopy. Using these results, we are then able to prescribe more appropriate contact lens materials for these patients or, in rare cases, advise the discontinuation of contact lens wear entirely for a period of time.
► Frequency Doubling Technology (FDT). Studies have revealed that FDT can help the practitioner detect glaucoma early in some patients and, if used as a screening tool, may aid the practitioner in discovering other types of disease, such as space-occupying lesions that could be missed otherwise.
► High-definition, machine vision pupillograph. One of the newest screening tools available as of January 2012, this technology measures pupil function and has been found to help the practitioner detect very minute differences in pupil function.

Providing access to tests

Many of us already use several of these technologies in our practices, and many currently provide one or two of these tests as an optional screening program to patients as well. Unfortunately, as is the case in primary care medicine, patients do not have access to the majority of these tests until or unless we find a problem.

In addition to including only those technologies available within your office for your “Eye Wellness Program,” consider developing the exam from the patient's perspective. For example, ask yourself how many patients would want you to identify their risk of macular degeneration (through genetic testing and macular pigment optical density measurements) and then recommend nutraceuticals to possibly prevent sight-threatening progression?

One of the most effective ways to answer such questions is to survey your patients. The answers to this survey will help you determine the menu of services you'll offer for your “Eye Wellness Program.” A caveat: Make certain to annually review and update your Eye Wellness Program, so that you're offering your patients the latest in healthcare.

Marketing wellness in your practice

To market your “Eye Wellness Program,” present to your patients a personally created e-brochure that describes the patient benefits of your services simply and in a menu format, which includes pricing. Or, present the patient with a paper brochure at the time of examination. Regardless of which method of delivery you choose, provide the patient with the opportunity to opt in or out of the screening.

While you may find it challenging initially to create an “Eye Wellness Program,” — one that includes a plan for testing, pricing, marketing and integration into a busy practice — rest assured that many patients will gladly pay for the ability to have these tests done as a screening for disease, just as they pay for the “executive physicals.” While some may express skepticism of such a program, consider that in most of the screening programs already being implemented in optometric practices, the opt-in rate averages 70%, according to an informal survey of doctors currently using this model.

The practice benefits of an executive program

By incorporating such an “Eye Wellness Program” into your practice, you'll provide a service that your patients will not only find valuable, but one that is not easily obtainable elsewhere, thus setting your practice apart from the competition and boosting your practice revenue. You establish your practice as a leader in eye health and vision care services, a reputation that provides substantial benefits for your patients and your practice. OM

Dr. Jasper practices in West Palm Beach, Fla. She is a graduate of Nova Southeastern University and completed a residency in ocular disease at the Brockton/West Roxbury VA Medical Center. She is an American Academy of Optometry fellow and has recently begun a wellness program. E-mail her at drjas per@aeswpb.com, or send comments to optometricmanagement@gmail.com.