Adding a dry eye center of excellence

Take Home
Adding a dry eye center is not only beneficial to patients, but can also increase revenue to practices.

By Rose Schneider, Content Specialist, Ophthalmology Times; Reviewed by Marguerite McDonald, MD, FACS

New York-Physicians should consider establishing a dry eye center of excellence at their practices because it will not only help patients, but also expand the practices’ patient base, create better surgical outcomes, and increase profitability of the practice, said Marguerite McDonald, MD, FACS.

According to Dr. McDonald, half the American population suffers from clinically significant dry eye disease as defined by hyperosmolarity.

“Dry eye is much more prevalent than previously recognized, and if left untreated, it profoundly impacts the quality of life for patients,” said Dr. McDonald, clinical professor of ophthalmology, New York University Langone Medical Center, New York, adjunct clinical professor of ophthalmology, Tulane University Health Sciences Center, New Orleans, and cornea/refractive surgery specialist with the Ophthalmic Consultants of Long Island, Lynbrook, New York.

Untreated dry eye can lead to IOL power miscalculations for cataract surgery, unhappy postoperative patients after multifocal IOL lens implantation, and can alter the way lasers are programed for LASIK and PRK, she added.

“(Luckily) it is much easier to manage patients these days with new diagnostic tests and treatment therapies,” Dr. McDonald said.

Tools to begin a dry eye center

When starting the practice’s dry eye center, Dr. McDonald recommended beginning with tear osmolarity testing, as it is the most sensitive method of diagnosing dry eye compared to other standard tests.

There is also no capital investment in adding the tear osmolarity test to one’s practice she added. The test units are installed at no charge, and one must only commit to buying a certain number of test cards. The technology was also noted to be the most accurate way to diagnose dry eye in the American Academy of Ophthalmology’s preferred practice patterns white papers on dry eye disease, Dr. McDonald continued.

Once the technicians are comfortable with tear osmolarity, Dr. McDonald said the practice could then look into adding more diagnostic tools to expand the dry eye center, such as the Keratograph 5M (Oculus).

The instrument, which evaluates corneal topography, as well as dry eye, is a useful addition to dry eye centers, she said.

Automated tear film breakup time, tear meniscus height analysis, automatic grading of conjunctival  erythema and ciliary flush (when present), assessment of the thickness of the lipid layer of the tear film, tear film particle movement analyses, and meibography of the eyelids are additional Keratograph 5M tests that practices can utilize in the newly formed dry eye centers as well, she added.

The recently released InflammaDry (Rapid Pathogen Screening)-a four-step rapid, disposable, in-office test-is yet another important diagnostic tool that can be added to the dry eye center, Dr. McDonald said.

“It takes technicians about 12 minutes to collect a sample, assemble the test, run it, and get the results for (the physician) to read,” she explains.

Increasing practice profitability

By adding these diagnostic and therapeutic technologies, Dr. McDonald said the practice would see an increase in revenue due to the number of dry eye patients’ office visits:

·      The initial testing and identifying the source of the patients’ problem.

·      Visits to discuss and implement the patients’ treatment.

·      Ongoing visits for follow-up treatment.

“Most of my dry eye patients come back two more times, and there are 12 month recalls, so basically four visits in their first year (alone),” she explained.

Dry eye patients also tend to experience further conditions, such as seasonal allergies, cataracts, myopia, and glaucoma, which would increase their office visits and thus the practice’s revenue as well, Dr. McDonald said.

Understanding the value of having dry eye patients in your practice is an important step in establishing a dry eye center as well, she said.

First, adding dry eye patients involves minimal effort, Dr. McDonald said. For example, there needs to be very little marketing effort on behalf of the practice. Technicians can wear buttons that say, ‘ask me about dry eye,’ or one-page flyers announcing the dry eye center can be tucked into the invoices that are mailed to patients’ homes.

“It’s very low cost marketing,” Dr. McDonald said. “It’ll be fairly easy to bring in 1,500 more of these patients to the average practice.”

Additionally-citing Bruce Maller’s assessment of the value of having more dry eye patients in a practice (assumes 2014 national Medicare rates)-Dr. McDonald said the total annual revenue per patient increases:

·      New patient, comprehensive exam: $140

·      1 month follow-up exam: $69

·      3 month follow-up exam: $69

·      12 month recall and follow-up exam: $69

·      Total annual revenue per patient: $347

·      Other potential dry eye treatment revenue: $211

Further profitability pathways

Practices can also gain revenue through reimbursements through Medicare, which average $400 per patient, Dr. McDonald explained. It is important to note, she added, that laboratory fees are billed under the medical plans, not vision plans, and there International Classification of Diseases-9 codes exist for dry eye (i.e. 375.15).

“The bottom line is it’s good medicine to treat dry eyes, as we have better diagnostic technologies and better therapies, which lead to happier patients and better surgical outcomes,” Dr. McDonald said. “But it’s also good business to treat dry eye because of the direct profits and the halo effect of referrals, and there is virtually no medical or legal exposure treating dry eye patients.

“Patients will stay loyal to our practices for their surgical procedures,” she added.

Marguerite McDonald, MD, FACS

Phone number: 516 593 7709

Email:margueritemcdmd@aol.com

Dr. McDonald is a consultant to TearLab, TearScience, and Oculus.