MEDICAL SERVICES

LEARN FROM MY MISTAKES

AVOID THESE FIVE FAUX PAS WHEN INTEGRATING MEDICAL SERVICES INTO THE PRACTICE

Josh Johnston, O.D., F.A.A.O., Atlanta

MY FIRST job as an optometrist was in an M.D./O.D. group practice. Due to the state’s excellent scope-of-practice laws and ophthalmologists who recognized the astute skill set of optometrists, I was able to practice all I learned in optometry school. As a result, I spent the majority of my day practicing medical optometry.

When my wife and I relocated to a new state, I accepted a job at a practice where there was less of an ability to practice medical optometry than at my first job. The result? I missed being able to use all the skills I acquired to improve patients’ lives.

Fast-forward and today, I practice at an M.D./O.D. office where I am once again able to provide full-scope optometry and, therefore, medical eye care. . .

THE DICKENS PROCESS

In building my reputation as an astute clinician at this practice, I underwent the Dickens process. Personal development coach, speaker and author, Tony Robbins, created this personal growth technique based on Scrooge, the fictional character created by Charles Dickens in “A Christmas Carol.” Specifically, just like the old miser, I evaluated the path I was on, identified mistakes and made necessary changes for success.

You should consider the medical model path because the Patient Protection and Affordable Care Act has enabled an influx of patients, who need medical eye care. Additionally, reimbursements for typical optometry services are decreasing and optical revenue is threatened as a result of growing competition. The bottom line: If you want your practice to thrive, it’s time you make it medical.

Here, I discuss the top five mistakes I identified when attempting to build a thriving medical eye care practice, so you can avoid them.

1 I FAILED TO IDENTIFY AND TREAT OSD

Treating dry eye disease (DED) and ocular allergy is crucial in establishing and maintaining a medical eye care practice. The reasons: Doing so shows patients your skills exceed refraction, prompting them to return for future medical eye care, be it glaucoma, AMD or something else. In other words, ocular surface disease is the gateway to treating and managing other medical eye conditions.

In addition, actively assessing and treating patients for ocular surface disease can preserve and grow your contact lens practice. This is because the scientific literature is rife with studies that reveal the number one reason for contact lens drop out is discomfort from dryness, and dryness can result from both DED and worsened by ocular allergy. (Ask your patients whether they experience any dry eye symptoms and you will see how common this disease is.)

Diagnosing and treating DED is very easy to do, and you can easily start a specialty clinic with no capital outlay today. All you need to have is a box of fluorescein and lissamine green strips and a slit lamp. Simply evaluate the lids and lashes, express the meibomian glands, perform corneal and conjunctival staining, TBUT, and any other tests you feel are important.

2 I WAS CONFUSED ABOUT BILLING

If I identified a medical condition during an annual comprehensive eye exam, I questioned, should I bill the patient’s vision plan or medical insurance? I learned that the patient’s reason for the visit, or chief complaint, drives billing. If a patient presents for his or her annual exam, the encounter is billed to the patient’s vision care plan. If the patient makes an appointment due to a medical complaint, dry eyes, for example, that appointment would be billed to medical insurance.

3 I PROVIDED TOO MANY TREATMENT OPTIONS

When I first started actively identifying and treating DED, I would give these patients three to four different artificial tears to “self-test.” This was a huge mistake for a couple reasons. First, doing so made patients question the value in seeing me for their medical eye issue, as I didn’t prescribe a clear, concise and simple treatment plan. I’m the doctor, and my patients see me for my expert clinical judgment. Second, I soon discovered that giving too many samples with several treatment options leads to patient confusion and, therefore, decreased compliance, which can lead to poor clinical outcomes. Be the doctor!

4 I RUSHED THROUGH EXAMS

My entire optometric career has been in medical and surgical M.D./O.D. groups. These practice settings can be extremely busy with high volumes of patients. At my peek, I saw 45 patients a day, and these visits weren’t necessarily lengthy encounters, as I used to rush through patient education to keep from falling behind schedule. The result was often confused patients who returned with stagnant or worsening eye conditions.

The lesson: When you start an initial treatment plan or have a complex case to treat, slow your education, and spend more time explaining how, when and why to take a prescribed treatment to garner patient compliance. This decreases patient confusion and, therefore, increases positive clinical outcomes, which leads to patient satisfaction.

5 I DIDN’T FIND A “YODA”

Don’t jump into medical eye care without picking the brains of one or more optometrists who have successfully done it. Specifically, ask yourself where you’d like the practice to be in five years, and then seek optometrists, via professional meetings, trade shows, online correspondence, etc., who are where you want to be. You want to ask for their expertise and insight. You’ll not only learn at an accelerated pace, you’ll also be able to avoid their mistakes.

LESSONS LEARNED

I was able to rectify these mistakes, though had I not made them to begin with, I would have achieved a successful medical eye care practice a lot sooner. Charles Dickens once said, “The two commonest mistakes in judgment are the confounding of shyness with arrogance — a very common mistake indeed — and the not understanding that an obstinate nature exists in a perpetual struggle with itself.” Don’t allow your pride or your “set ways” to prevent success. Instead, learn from my mistakes, and actively identify your own to create a thriving medical model practice. 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. Email him at drj@gaeyepartners.com, or visit tinyurl.com/OMcomment to comment.