When it comes to the management of glaucoma, we, as eye care providers, need to think about how this disease affects the management of both the patient and the practice.

To effectively and efficiently manage glaucoma, then, we must make alterations to both our normal clinical and business protocols to best serve these patients.

Here, I discuss both the overall management of these patients and the business side of the practice as it relates to glaucoma.

OVERALL MANAGEMENT

When it comes to patient care, there are many considerations: How does it affect your clinical workflow and, thus, what scheduling alterations will need to be made? What additional clinical information will be necessary to adequately and effectively diagnose and treat each glaucoma patient? How will you, the provider, coordinate the care of each glaucoma patient with their primary care doctor or other subspecialists?

Let’s start with identifying what your “standard clinical work-up” is for suspected or already confirmed glaucoma patients. Does this differ from the standard of glaucoma care? Is there medical necessity to do each test you order?

It may be worth taking a few minutes to identify and evaluate what diagnostic tests need to be done to provide better care. (See “Diagnostics” on p.22.) This is also a great time to evaluate whether certain diagnostic tests, like blood pressure, should be taken and recorded, since many glaucoma patients have concomitant disease. Are these tests and the time they take medically necessary, and do they provide information regarding the diagnosis or management of the diseases state?

Lastly, what is the process for care coordination with other medical specialties? As mentioned earlier, since glaucoma is usually associated with one or more other diseases, best practices deem it necessary to actively coordinate care and share information with other members of the patient’s health care team.

THE BUSINESS SIDE

As glaucoma care relates to the business side of the practice, there are four major items that need to be evaluated:

1. “Finding” glaucoma patients. Essentially, we are discussing the marketing of your medical specialty glaucoma practice. There are a few different “recruitment” avenues to consider. Obviously, you can identify these patients from your current patient base. The second way is to market that your practice specializes or has a specialty clinic for the management of glaucoma. This route is a little more expensive, in terms of external marketing costs, but can be very productive if used in a very targeted manner. Third, can you build referrals from other local doctors who have patients who are at increased risk for the disease or are looking for a different eye care provider? This method requires disseminating education about your scope of practice and follow-up with the local doctor.
2. Determining the “needed” technology. OM has discussed this many times through the last few years, so I would reference those articles for more details on determining which devices to acquire and what the break-even points are from a financial perspective. (See http://bit.ly/2AP4rEq and http://bit.ly/2Dke1lx .)
3. Pricing your services. Find out what it costs you to see the “average” glaucoma patient through the course of one or two years. This simple exercise may assist you in determining how actively you want to pursue developing that side of your specialty practice.
4. Involving staff. How does glaucoma affect your staff? What additional training needs to be provided and by whom? Are there new processes or protocols that must be created and implemented?

HAVE A PLAN

Developing a glaucoma specialty practice can be very rewarding, both in terms of providing care and creating revenue, but just like any other subspecialty, it does require a plan to go from where you are now to where you want to be. Take the time to develop that plan, and then implement and adjust as necessary. OM

DR. MORRIS is an international speaker, educator, author, management consultant and chief optometric editor of Optometric Management. He is well known for his experience in ocular surface disease, technology and practice management.