Putting Medical Optometry into Practice

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Putting Medical Optometry into Practice

• Paul S. Jensen, O.D.
• Renton, WA
• Renton Vision Source
• www.lacrimology.com
• www.eyesmartz.com
• jensen_at_rentonvision.com

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Putting Medical Optometry into Practice

• Some people were born on third base and think
  they hit a triple.
• Home run hitter Cliff Silverman, O.D.

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Why Bother Practicing Medical Optometry?

• Dont change your mode of practice if
• - You are happy with your current income and
  effort level
• - Your patients are getting the scope of
  services that they want/need
• - You can sell your practice for the amount you
  want
• - You are having fun practicing

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What Do You Need To Get Started?

• Knowledge of reimbursement systems
• Reliable professional relationships
• Some equipment
• Time daily for patients and physicians
• Time years of work for your practice to develop

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Alphabet Soup
HMOs

• Providing care to HMO pts requires a contract
  with a medical group (IPA)
• Billing goes through the IPA
• Expect discounted rates
• I do not accept capitation

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Alphabet Soup
PPOs

• Billing goes through the payor
• Expect better, but discounted rates
• In-network is best

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Evaluating a plan using RBRVS
I have to do math?

• Hours X Miles per Hour Miles
• RVU X CF

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Evaluating a plan
RVU X CF

• Medicare
• 2006 CF 37.8975
• 2007 CF 36.1610
• To bill medical eye exam 92004
• RVU X CF Value
• 3.8 X 37.8975 144.01

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Billing

• Start by billing vision plan
• Bill medical even if payment isnt expected

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Where will your patients come from?

• Medical Eye Care is a specialty 2o care
• PCPs refer to specialists

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Which Services to you want to perform?

• Topical meds conjunctivitis, allergy, dry eye
• Chronic diseases glaucoma, vascular disease
• Injury, acute care (RD, PVD)
• Binocular/VT/Low Vision (stroke, rehab)

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Which Services will PCPs want you to perform?

• Services that they cannot perform
• - allergy, conjunctivitis?
• Services that they know their patients need
• - glaucoma?
• Services that others have not performed
  adequately (satisfied pts, communication)

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What fits the MD and OD needs?

• Diabetes
• MDs understand the need of diabetic eye care
• MDs know that dilation, ophthalmoscopy (SLO) are
  required
• MDs want immediate, clear, and concise feedback
  and a plan

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What the optometric practice needs

• Diabetes
• Patient care that ODs do well
• Chronicity

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Technology

• What you already have
• - Slit lamp Volk, BIO, tonometer
• Photography, Optomap
• SLO

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Pearls

• Write lots of letters
• Dont try to impress anyone
• Dont whine
• Respect and acknowledge the chain of referrals

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Pearls

• Use sub-specialty eye care providers
• Vitreo-retinal
• Cornea
• Pediatric
• Glaucoma
• Oculoplastic
• General practice

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Pearls

• Your Office
• Staff communications
• Patient communications
• Billing, avoid routine
• Referrals get preferred scheduling
• Embrace your OD personality

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Glaucoma

• Integrated into local primary care
• Education and licensing
• Instrumentation
• Staff and office

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Glaucoma

• When to treat?
• How to treat?
• When do you give up on a drug?

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Glaucoma

• When to refer
• Exhausted pharm options
• - continuing to get worse with tx
• - intolerant to drugs
• Pt is unable to treat themselves with gtt
• Cost of treatment?

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Glaucoma

• Disaster Patient
• Last eye exam 30 years
• Notices VF changes
• Referred to you by glaucoma specialist

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Thanks!

• Special thanks to Cliff Silverman, O.D.

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www.eyesmartz.com