THESE FOUR TIPS CAN YOU TREAT A GROWING POPULATION BASE
TODAY, THE number of people in the United States with glaucoma is 2.7 million, though the blinding disease is expected to reach 4 million by the year 2030 — 13 years from now — according to the NEI. As the number of patients who have this disease increases, it makes sense to consider offering glaucoma care. (See “Assess Your Market,” p.39.)
Here, I provide tips on how to develop a glaucoma practice.
1 DEVELOP YOUR KNOWLEDGE
First, increase your knowledge base. This can be accomplished through live meetings (national, regional or state), Optometric Glaucoma Society meetings (http://optometricglaucomasociety.org ) and related print and online journals.
Specifically, you want to brush up on the disease: its cause, epidemiology, diagnostic methods (including related documentation requirements) and treatments, including drops and surgeries, such as minimally invasive glaucoma surgeries and filtration surgeries. Surgeries are an area of continuing knowledge development, as these patients place a high value on being educated on what to expect upon their referral to an ophthalmologist.
2 ACQUIRE TOOLS
The key categories of tools for success are:
- Patient education. Buffer your explanation of glaucoma with print brochures, treatment cards, in-office videos and Internet educational tools that link a patient to a specific website that discusses the treatment he or she is receiving.
- Staff education. Communicate your goals of why managing and treating glaucoma is important to the practice, so your staff members “buy-in” and, therefore, want to help.
Next, provide staff with the knowledge they need to assist you. A great way to accomplish this is to have 10- to 15-minute sessions, at the beginning or end of the day, that focus on one sub-topic within glaucoma, such as patient medical history questioning. You may even want to train as a group and develop a script, so all staff is on the same page when talking with patients about glaucoma. Once you feel staff is ready, designate responsibilities related to glaucoma, such as diagnostic instrument operation, so that each staff member understands his or her role in glaucoma patient care. - Procedural protocols. Determine what tests, questions and education you want each glaucoma patient to undergo. This should be a standard, and something all staff members know and understand. Depending on the technology in your office, you may instruct your staff to obtain a VF, OCT, pachymetry reading and fundus photo as well as to dilate the patient before you enter the room for the evaluation and discussion.
- Diagnostic equipment. A perimeter, gonio and non-contact slit lamp lenses, OCT and pachymeter are standard-of-care devices for glaucoma.
To start, perimeters provide a subjective and functional measurement of central and peripheral vision via VF testing. (Cost: $5,000 to $15,000.)
A gonio lens is essential in helping to differentiate glaucoma subtypes, such as primary open-angle glaucoma, narrow-angle glaucoma, pigmentary glaucoma and angle-recession glaucoma. It also aids in making decisions on treatment. Non-contact slit lamp lenses allow you to visualize and assess the optic nerve head for damage. (Cost for both: $250 to $600.)
OCT facilitates earlier diagnosis and, therefore, allows for the earlier management of glaucoma. A variety of OCT technologies exist on the market: SD-OCT, OCT-A and SS-OCT. (See http://bit.ly/2iBXhME for additional information.) (Cost: $10,000 to $60,000.)
A pachymeter aids in determining central corneal thickness value, something that the Ocular Hypertension Treatment Study clearly demonstrates is a substantial and independent risk factor for the development of primary open-angle glaucoma. (Cost: $2,000 to $3,500.)
Other tests to consider include fundus photography, corneal hysteresis (CH) and pattern electroretinography (PERG).
A fundus camera is important, as it enables imaging of the optic nerve head to help diagnose a patient and to aid in assessing and monitoring for glaucoma progression. Fundus cameras are available as small handheld devices, able to be mounted to smart phones, or as larger standalone desktop versions. (Cost: A few hundred dollars up to $20,000.)
CH is a measurement of the ability of the cornea to absorb and dissipate energy. Multiple studies show that a low CH measurement is associated with or predictive of glaucoma development and progression. (Cost: $16,250.)
PERG measures retinal ganglion cell function and, therefore, has been shown to aid in the detection of glaucoma at its earliest stages. Retinal ganglion cell damage has been shown to precede optic nerve head and retinal nerve fiber layer structural changes. (Cost: About $43,000.)
3 ORGANIZE YOUR SCHEDULE
Initially, glaucoma exams may need to be made between comprehensive exams. One way to setup the schedule is to have 10-minute time slots through the course of a day. A comprehensive exam will likely take longer than a medical exam. This means two 10-minute slots should be allocated for a comprehensive exam, and a medical exam/glaucoma exam will take up one 10-minute slot. In one hour, you could perform two vision exams and one medical exam/glaucoma exam. You will need enough technician support to perform the necessary tests for the glaucoma exams. General time guidelines for some of the main tests done in a glaucoma evaluation:
- VF: 20 minutes
- OCT: 10 minutes
- Fundus photos: 5 minutes
As your glaucoma practice builds, it may be possible to dedicate a morning, afternoon or even a full day for glaucoma evaluations and follow-up appointments.
Assess Your Market
When considering additional glaucoma-related services for your practice, answer the following questions:
- “What does my current practice demographic look like?” If 75% of your practice demographic is younger than 40, you may find it challenging to develop enough volume of glaucoma patients to justify an investment in glaucoma-related equipment and services.
- “What are the demographics of the community I practice in?” Research the demographics of the community age 65 and older. If this percentage is high, you could make the assumption that many of these patients are on Medicare and compare that to the demographics of your current practice. If the community demographics are a higher percentage than the practice demographics, focusing on marketing in the community would be important.
- “Who are the major employers in my community, and what are the major managed care plans?” You will want to be a provider for the major health plans in the community so you are available for a majority of patients. If you only accept one major managed care plan in the community, that will reduce the opportunity for glaucoma patients. To find the major employers and major managed care plans, conduct online research or call your local chamber of commerce.
4 MARKET THE SERVICE
Finally, to make both current and prospective patients aware of your glaucoma services, focus on internal and external marketing:
- Internal marketing. Effective education and in-office merchandising are essential to growing your practice. A few areas to consider are phone etiquette (ability to answer questions regarding glaucoma), signage, staff word-of-mouth and patient education (outlined above).
- External marketing. Some areas to consider here are blogs (allows the practice to raise awareness of glaucoma and boost reputation); educational events (hosting or attending for networking and promotional opportunities); practice website (rife with information on the services you provide) and social media (posts about glaucoma developments and your practice’s role in diagnosis and care).
BRINGING IT ALL TOGETHER
Finally, by following the four tips outlined above, you have an excellent chance of building a thriving glaucoma practice that is effective, efficient and profitable. OM
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