Bringing a practice up to speed

Capital investments can seem risky, especially when the economy has been anything but flourishing. And when you are one of few providers in a rural area, it is easy to assume that purchasing the latest computer systems and diagnostic equipment is unnecessary. However, my optometry practice in a small rural town has done just that, and the result has been improved patient care and excellent returns to the bottom line.

Located in western Alabama, my practice is a heavy medical optometry practice with a high percentage of geriatric patients. The patient population is comprised of many low-income individuals and a very high percentage of patients with diabetes. So, the majority of patient appointments are to address diseases such as glaucoma, diabetes, and macular degeneration. Revenue is generated 70% from professional fees and only 30% from optical fees.

Finding the best fit

Over the past 3 years, we deliberately sought new technologies we felt would achieve two goals: improve patient care and increase practice profit.

The first technology that fit the two criteria was a new practice management system with electronic medical records (EMR). This provided a way to streamline practice management as well as get the practice on board with new government requirements. Without proper record keeping and tracking, it is impossible to know if investments in technology are creating a return. In addition, disease patients need to be closely followed, and updates need to be sent to their other healthcare providers. A good EMR system will send out reminders when the patient needs a follow-up appointment, will assimilate diagnostic results over time so that patient progress is easily evaluated, and will automatically generate reports for the necessary co-managing providers.

Once the practice was organized electronically, we made several investments in diagnostic technology. We added improved optical coherence tomography, visual field testing units, corneal topographers, and specular microscopes. These tools not only allow us to diagnose and manage nearly any eye condition, but they also aid against downturns in the economy. Diagnosis and management of ocular disease are typically medical insurance-covered services and can provide a more steady revenue stream as opposed to elective purchases, such as specialized lenses for eyeglasses.

This equipment also allows us to have a very active co-management role with retina and glaucoma specialists. We are fully capable of diagnosing and monitoring disease states as well as providing follow-up care after surgery. The combination of specialized imaging devices and our EMR system allows us to easily share information with surgeons and other medical providers.

Dynamic education

Another area we deemed worthy of investment was high-tech patient education. We subscribe to the Echo patient education program (Eyemaginations Inc.), which provides us with 3D animated videos on a variety of disease states and other eye health topics. We also purchased tablet devices for each of our exam lanes. A tablet is attached to an articulating arm mounted on the instrument stand next to the exam chair. While the patient is waiting for the doctor, he or she can browse the videos available. After I finish the examination, I can select videos specific to the patient’s diagnosis for him or her to watch while I update the patient’s record. The videos generally last a couple of minutes, after which the clinician can discuss any conditions with the patient and answer any questions.

The educational videos cover topics such as glaucoma and age-related macular degeneration, treatment options such as intraocular lenses for cataract surgery, as well as information for traditional refractive patients. There are videos that demonstrate different lens options available for contacts and glasses. Cataract patients who are awaiting surgery come in for a short consultation visit where they are primarily seen by the technician. The technician uses the tablet device to review lens implant options, the patient consent form, and the procedure for follow-up care.

Similar to practice management software, there is no direct fee associated with patient education that allows one to measure a direct return on investment. However, we have seen a number of benefits in our practice. First, it ensures that the patient understands his or her condition and the options for treatment much more effectively than if the doctor used static flipcharts or used only verbal communication. The dynamic education method increases patient compliance and satisfaction, all while saving the physician a significant amount of time.

There are approximately 8,000 inhabitants of the town where our practice is located, and about 25,000 people in the county. Needless to say, we aren’t fighting a lot of competition. Regardless, we received a lot of positive feedback when we started making these changes. Throughout health care, patients are more educated, want more information, and want the best treatment possible. Increased patient satisfaction has corresponded with an increase in referrals.

As an optometrist, managing the diseases that I have been trained to manage is very rewarding, both professionally and financially. Making investments in optometric technology is part of practicing optometry; avoiding those expenditures would cause me to shortchange my patients, as well as my practice. So, despite the capital outlay, investing in technology has allowed me to provide my patients with the best possible care while building my practice.ODT