Optometrist Alex Tan recently purchased a spectral-domain optical coherence tomographer for his practice in Oak Park, Ill., with a goal of providing better care for patients.
“Just four days after purchasing the OCT, a patient came in and I diagnosed cystoid macular edema,” Dr. Tan says. “So, it impacted my practice clinically right away.”
Indeed, four out of five optometrists say that “improving patient care” is their number one reason for investing in new diagnostic technology. That’s a lofty goal in general, yet it hits home when it makes a big difference for a particular patient, as in Dr. Tan’s experience.
New equipment affects your practice in less tangible ways, too. “Patients love new technology. Our patients tell us they feel more comfortable coming to see us because we are ‘up to date,’” says Denise Glantz Arneson, OD, who points to a Marco automated refraction system and an Optos widefield imager as examples of the new technology in her office in Chippewa Falls, Wisc. In addition, she says, “we have Eyemaginations running in our office, and we use iPads for helping patients select frames. Using the latest technology is not only impressive and good for patients, it makes our job more fun, too.”
Nice work if you can get it. But not every OD is having fun with new technology.
Optometrist Michael Maizel finds that replacing old equipment and buying new equipment is putting his practice at a loss.
He replaced an autorefractor/topography unit with a new one—a necessary investment, but not one that provided any new revenue. Similarly, Dr. Maizel replaced a topographer with an OCT—just at the time when the reimbursement went from $75 an eye to $43 for both eyes, which amounted to a net loss in his investment. And installing an electronic medical record (EMR) system was required, but provided no additional revenue.
“We’re at a crossroads,” Dr. Maizel says. “To practice good medicine, you need the technology. But the reimbursement has decreased, so the only way to make up the difference is to see more patients per hour—which was never the goal of optometry or any primary care practitioner.”
Is that the new model of optometry—seeing more patients per hour just to break even? And, if so, can you provide the same quality care?
Amazingly, some ODs are making it work.
And, with new technology, they’re providing even better care while building their business.
For instance, Tom Carton, OD, of Lunenburg, Nova Scotia, bought a whole array of new equipment: a visual field analyzer, an aberrometer, a digital fundus camera, a scanning laser ophthalmoscope, a topographer and an automated refraction system—“all purchased to allow greater patient volume, without compromising patient care, and to justify higher fees,” Dr. Carton says. “The benefit has been surprising. A thorough exam and a caring attitude, coupled with state-of-the-art technology, has produced a word-of-mouth reputation that has generated 30% patient growth per year for the past four years and shows no signs of letting up.”
To that end, here’s a roundup of the most wanted instruments that ODs are buying, according to our Annual Diagnostic Technology Survey, which was based on the responses of 310 optometrists to an email questionnaire.
Digital Fundus Camera
A digital fundus camera “definitely has a ‘wow’ factor,” says Margaret Stolarczuk, OD, of El Cerrito, Calif. Some 43% of respondents say they recently bought one or are considering buying one.
A digital fundus camera not only wows patients, it wows practitioners, too. “It improves patient care—in terms of diagnosis, documentation and patient education—and also provides increased revenue,” Dr. Stolarczuk says. Plus, it also increases profits because it drives more referrals, she says.
A fundus camera—as well as a pachymeter and a perimeter—have been great for managing glaucoma and increasing profitability, says Mona Patel, OD, of Apopka, Fla. “Also, the technology has helped me move into the medical billing model much more smoothly.”
OCT
“OCT has dramatically changed my confidence in glaucoma diagnosis,” says Riley Austin, OD, of Northport, Ala. “Being at a Walmart in west central Alabama, I would say I get a high percentage of the lower income population that is, unfortunately, also more at risk for glaucoma.”
Other ODs agree. “While it is only one piece of the glaucoma puzzle, OCT certainly aids in determining when to follow and when to treat,” says Robert J. Dittoe, OD, of New Lexington, Ohio.
Also, “there have been numerous instances when the OCT has revealed that the 20/20- patient has vitreomacular traction or an early subretinal neovascular membrane,” Dr. Dittoe says. “It gives me the ability to confidently follow or appropriately refer these patients.”
Because he practices in a rural setting, having that ability is an advantage. “After using OCT for a few years, I can easily say that it is an instrument I would never want to practice without.”
“This versatile machine has increased my abilities to diagnose and follow ocular diseases beyond anything I have done in the past,” Dr. Jones says. “If you don’t have one, get one—plain and simple.”
EMR
An electronic medical record system has become something of a necessary evil, thanks to the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act will essentially penalize those doctors who aren’t using an EMR by 2015.
“It has reduced the number of patients I can see in a day, and I spend more time fiddling with it during non-patient care time,” says Sarah Paikowsky, of Surprise, Ariz. “So I’m working more but getting reimbursed much less.”
But, take heart, Dr. Paikowsky! Some optometrists have gotten over the implementation phase, and now the system is working for them—instead of the other way around.
Bruce Kiraly, OD, of Richmond, Va., says his cloud-based EMR system saves time and money by increasing efficiency between his two offices, by reducing staff time handling charts and by providing the ability to view records remotely. Also, Dr. Kiraly says, “it give patients the idea that we are progressive (we are!), and allows for a patient portal, which they love.”
While improving patient care is the main reason to invest in new technology, be aware that 69% of survey respondents also increased their profitability with their most recent investment in new equipment.
• B-scan ultrasound.
“You don’t need it often, but it’s indispensable when you do. And, it
is paying for itself,” says Larry Gunnell, OD, of Wichita Falls, Texas. • Visual evoked potential/pattern ERG systems. “The ability to
take care of serious conditions, such as optic neuritis, papilledema,
glaucoma, macular degeneration, amblyopia and pseudotumor cerebri, for
our patients is dramatic,” says Oliver Lou, OD, of Cedar Park, Texas.
“When we pass along our findings to neurologists,
neuro-ophthalmologists, ophthalmologists and other specialists that we
comanage with, there is a profound impact on the care and communication
for our patient.” • Specular microscope. “I had a plethora of non-compliant
contact lens wearers who were coming in with blatant contact lens
overwear and edema,” says Teresa Vigario, OD, of Elizabeth, NJ. “The
specular microscope has helped me diagnose and treat even the most
minimal of underlying changes, and helped me to physically show patients
how non-compliance is affecting their ocular anatomy. When they see the
difference between a normal cornea and theirs, they change their
compliance immediately. Some people need to see it to believe it.” • Widefield scanning laser ophthalmoscope (Optos). “It
immediately improved my ability to detect ocular and systemic pathology
and at an earlier stage,” says Barry Morrison, OD, of Martinsburg, WV.
“It also made it easier to follow progression of disease.” • Rebound tonometer (Icare). “It’s a big improvement in
patient comfort and accuracy,” says Kevin Krajewski, OD, of Lakewood,
Colo. “It took the most uncomfortable part of the exam and made it
tolerable.” • Tear film osmolarity test (TearLab). “We have a large
elderly population and thus deal with a large amount of dry eye,” says
Matthew Miller, OD, of Lawrenceburg, Tenn. “We are the only office in
our county that has TearLab and the patients have noticed. It’s also
nice that we can bill for it.”
Other 'Fun' Equipment
