CLINICAL

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How to Build a Medical Practice

Follow these 10 steps to achieve success

JOSH JOHNSTON, O.D., F.A.A.O., ATLANTA

Optometrists must fully embrace the practice of medical eye care to continue to be successful for five reasons: (1) the Affordable Care Act has increased the amount of patients who require medical eye care; (2) the baby boomer population, now dealing with age-related eye disease, is overwhelming; (3) reimbursement rates on services that traditionally fall under optometry are continuing to erode; (4) there is the potential for technological advances and legislative rulings to allow for online refractions and online eye exams; and (5) there is a decline in optical revenue due to online contact lens and spectacle retailers.

Whether you are a recent graduate or a seasoned clinician, you can make the shift to practice full-scope medical eye care by following these 10 steps.

1 Learn medical coding and billing

Ask yourself, “What do I not know about coding?” And go find the answers. To accomplish this, read eyecare journals, conduct research, take courses at an optometric meeting and work with a consultant to stay abreast of how to properly code medical eyecare patients.

2 Hire a credentialing consultant

A lot of paperwork and due diligence is involved in becoming credentialed on medical plans. To expedite the process, hire an outside party that has a great deal of experience with it. Several consultants are efficient and knowledgeable at enrolling doctors in a diverse range of commercial medical plans, as well as Medicare.

While you are waiting to get credentialed, have a patient out-of-pocket payment option.

3 Find a mentor

Begin networking at your state/local optometric associations to meet someone who has the kind of medical model practice you want. Shake hands, get phone numbers and e-mail addresses, and ask a doctor whether you can take him/her to a meal to glean insight into his or her success and what pitfalls to avoid. You will learn so much, and you will achieve personal success much faster when considering his or her background and recommendations.

4 Assume every patient is medical until proven otherwise

Do you use vision insurance or your patients’ medical insurance? When you see a medical condition, such as glaucoma, that requires treatment, bill the medical carrier that day, or have the patient return for a follow-up medical evaluation, and bill to his or her medical insurance at that time.

5 Actively identify and treat ocular surface disease

Ocular surface disease (OSD) is the most common medical eye condition, yet it is too often underdiagnosed and ignored.

You already have the needed equipment to identify OSD, so start actively looking for patients who suffer from this disease, make a medical diagnosis, prescribe a therapeutic treatment plan, and appoint these patients for a follow-up exam. Doing so will enable you to develop a medical model practice fast because these patients will realize your abilities go beyond refraction, and, thus, they’ll present for other medical eye problems, such as AMD.

Show patients you have prescription rights by prescribing therapeutics.

6 Prescribe therapeutics

You potentially do a disservice to patients and yourself when you simply recommend an OTC product for a condition when more efficacious prescriptions for the condition are available. For the patient’s part, he/she may not achieve relief as fast. For your part, patients may wrongly assume you don’t have prescription rights and may, therefore, go elsewhere for medical eye care.

Something else to keep in mind: Prescribing a therapeutic usually requires a follow-up appointment, enabling you to scrutinize patient improvement, enhancing their satisfaction with your services, while growing your practice revenue.

7 Train staff

If your staff doesn’t know about the medical services you offer, your patients will question your abilities. Therefore, you must train your staff by providing education on these conditions, as well as on their responsibilities in the medical eyecare services you provide from check-in to checkout.

In addition, staff training ensures efficiency, so you won’t have to worry about new medical eyecare services needlessly sucking practice time. I suggest you have a five-minute office meeting before clinic every day to ensure your staff is on the same page as you with regard to their responsibilities, your expectations of them and any new service you’ll be providing.

8 Develop protocols

Adhering to protocols for the various medical conditions you diagnose and treat will allow you to achieve success fast through constant repetition, while ensuring you and your staff become efficient.

For example, I give a SPEED questionnaire to all new patients and at annual exams. If a patient scores high enough, our tech follows a dry eye protocol starting with a case history focused on dry eye disease (DED), performs osmolarity testing and the latest point-of-care tests and discusses the disease and treatment options.

For my part, I perform additional diagnostic tests, such as fluorescein and lissamine green staining, tear break-up time, etc.

9 Market your services

Use the Internet, local advertising, e-mail blasts, free educational seminars, etc., to make sure your practice community knows your services. Talk to every patient about your complete service portfolio. Speak to your middle-aged patients about their parents’ eye care, and briefly educate them on AMD, cataracts and glaucoma. Also, consider writing letters about your services to other healthcare professionals in your community, so you can collaborate in their patients’ care.

For my DED patients, I send a detailed letter to their PCP, rheumatologist and OB/GYN, when applicable. As a result of these marketing efforts, I have gained new patients.

10 Analyze your business

Refer to industry benchmarks to determine where your practice is with regard to the full-scope medical eyecare practice. Use your EHR to measure and track your analytics.

Get moving

Fully embrace medical eye care to ensure future success. Our skills surpass refraction. By failing to practice to our full extent, we do a disservice to our patents and to ourselves. OM

Dr. Johnston practices at Georgia Eye Partners. He focuses on ocular surface disease and has extensive experience in comanaging cataract and refractive surgery patients. E-mail him at drj@gaeyepartners.com, or send comments to optometricmanagement@gmail.com.