Disclosures Medical Model Do or Die Current relevant disclosures Ocuhub, SolutionReach, imatrix, RevolutionEHR, J&J Vision Care, OptometryCEO Non-current but previously relevant disclosures Alcon, AOAExcel, Essilor USA/Essilor Canada, Marchon Necessary Endings Shimer CEO of Welch Allyn What is the medical model?
Vision benefits, discount programs, self-pay Traditional Optometry Practice Testing not associated with disease and all detected medical concerns referred Basic testing with communication focus on glasses and contact lenses, binocular vision, and vision therapy What is the medical model? Incorporating medical eye care into your practice Treat and manage eye care conditions such as glaucoma, diabetes, dry eye, and urgent care Refer medical eye patients expecting to get them back. Philosophy of practicing as a fully licensed optometrist Coding and Billing appropriately Scheduling mindset shift Is refraction lost in the medical model? Patient satisfaction increases More attractive for potential buyers Remain competitive amongst other ODs Increase volume of patients Provides opportunities for associate Keeps patients in your practice Remains a staple of practice NOT either optical or medical Refraction coding increases (92015) Urgent care patients c/o decreased vision
Patient Patient Benefits Insurance Owner Convenience (less need for multiple doctor s) Satisfaction increases Available care - Weekend and Evening Acute Care Most appropriate care Practice Practice Benefits Owner Benefits When patient satisfaction increases, practice perception increases When the practice grows, staff members benefit from bonuses, production, job stability, and fulfillment of helping more people Acute Care grows and brings new patients into the office. Medical typically has higher margins of profit Practice growth increases value and profits Medical reimbursements sustain a practice Attract top-notch associates b/c they are looking for a practice to utilize their education fully
Seller Benefits Practice value increases Relevant to buyer Gross collected should be higher More instruments = greater asset value More attractive in competitive market Profession Benefits Optometrists are equally aligned so other healthcare professionals know what they are getting with an optometrist in their network. Optometry reinforces it s position along with medicine and other healthcare providers. Optometrists are viewed and respected as eye physicians among patients and media. Insurance Benefits Reduced cost to the insurance by having multiple doctors patient must see Coding and Billing by optometrists for medical eye conditions improves perception of our profession Start today Electronic Medical Records Change patient perception Train staff Equip the practice Intentional study by doctor (you)
Electronic Medical Records (aka: EHRs) Patient Perception Component of a successful Medical Model Makes transitioning to Medical Model easier Has components necessary to chart medically Scheduling Appointment Health History form Insurance Cards? Preliminary Testing Exam Room communication Follow-up Care Scheduling Communicates the medical model Comprehensive Eye Exam Medical Eye Encounter Acute Eye Care Primary Eye Care Glaucoma Encounter Health History Forms Meaningful Use (MU) requirements good reflection of medical eye information. If you are not doing MU consider the difference in patient perception of health history forms. Collect all Vision Benefit and Medical Insurance information - tell patients why - great time to educate both verbally and online
Staff Training Medically necessary visits vs. routine vision care Culture is caught, not taught Create templates to handle patient confusion (triage, scheduling, front desk arrival of patient) Use staff meetings to communicate full-scope optometry (we do this regularly) Verify you are on the correct medical insurance panels for your area Collect both vision benefits and medical insurance Website - does is communicate you treat medical eye problems? Does your office communicate this with brochures, equipment, testing done prior to exam Communication with your patients in the exam room (define different parts of your exam so patients think medical) Follow-up Care Vision Benefit exam discovers the medical eye problem like dry eye. Medical Insurance follows up and continues to manage the condition. 2 options for transitioning to full Medical Model 1. Define differences for patient vision benefit and medical insurance - do exam they are expecting 2. Primary complaint = vision benefit or medical insurance filed Equip the Practice Are you equipped for Medical Eye Care?
Surgical Ophthalmic Equip for Glaucoma Tonometer Pachymeter Threshold Visual Field Analyzer Gonioscopy Lens OCT Intentional Study Glaucoma Diabetes Macular degeneration Optic nerve pathology Choroidal Nevi CHRPE Hypertensive Retinopathy The more you learn the more you will apply Choose a pathology each quarter and study all you can on that subject (MGD) Utilize questionnaire in pretest or online OSDI Compare and contrast with peer groups (i2i) Read journals focused on medical eye care Advance Ocular Care http://www.bmctoday.net/advancedocularcare/
Coding and Billing Sample Medications Dedicated coding and billing staff Pay good to get the best staff member Outsource billing AAPC (American Academy of Professional Coders) Contact company and request sample fax form Have staff monitor for expiration dates Staff can send in fax forms once a month Eliminates need for sales rep if you don t currently have one calling on you Supplements Dry Eye Glaucoma Diabetes Macular Degeneration Educate Patients Vision Benefit and Medical Insurance
Are you aware of the difference between Routine Vision Benefits & Medical Eye Insurance? Vision Benefit This is a routine exam that addresses a glasses and contact lens prescription along with assessing the overall health of the eye. If eye health problems are noted a follow up exam would be scheduled and your medical insurance would be billed. Medical Insurance This is an office visit for such conditions as glaucoma, diabetes, macular degeneration, and dry eye. Most complaints of pain, redness, swelling, itching, loss of vision are related to eye health and would most likely be diagnosed as medical. In the past our office has utilized your Vision Benefit for both routine and medical eye at your yearly exam. Due to the ever changing landscape of healthcare we will be forced to split your eye care into the two designations above. We apologize for any inconvenience this may cause you, but we are unwilling to compromise the integrity and excellence this office has provided to patients over the past 50 years. Thank you in advance for your cooperation. To start the exam The reason you are in today is for your yearly exam for glasses and an eye health evaluation. At the conclusion of the exam we should know if changes in your glasses prescription is necessary and/or if we need to follow up on any eye health concerns. Doctor Communication (cont d) I will be assessing your eye health to see if there are any problems we would need to follow up on. After I check your eyes for any glasses or contact lens changes, I will do a wellness exam to rule out any eye disease that would require a follow-up appointment. Prepare Patients in Advance Type of visit depends on Primary Complaint expressed to doctor. Patients have most likely been trained to expect all their eye care in one visit, just like we used to get all our systemic health addressed in one physical. Some practices hire a staff member to explain at the end of the exam the difference between their Vision Benefit and Medical Insurance. Plant seeds vs. transplanting a tree
Returning Patient for Care There are signs of dry eye today and based on your feedback you are experiencing symptoms of dry eye. Dry eye is a medical condition. Should you agree to treating it, I will have you start on Artificial Tears 4xd in both eyes and ask you to return for a medical eye visit in 1 month to assess the need for more aggressive treatment. What your doctors and staff say matters. Comprehensive Eye Exam Routine Vision Exam Routine Vision Exam and Eye Health Assessment Medical Eye Encounter Acute Medical Eye Encounter Defining our Profession Communication Internal Examination Equipment How does your office communicate medical eye care? Exam Room
Communication We need to make a copy of your vision card and medical card Online scheduling and forms include all information for both vision and medical - get them both all the time signs of high blood pressure can show up in the back of the eye, today the doctor will be checking your vision and eye health a decrease in vision may be the first sign of eye disease which could be a medical concern the doctor has requested a photo of the back of your eye for an eye health concern, this is considered medical and will be billed to your medical insurance
who is your primary care doctor? If Dr. Smith notes a medical concern during your eye exam, he will want to communicate this to your PCP so that your PCP is aware of how Dr. Smith is managing your eyes Dr. Smith would like to evaluate you for a dry eye follow up in 1 month, today your exam was billed vision, when you return it will be billed toward your medical Examination Equipment Diabetes is the leading cause of blindness before the age of 65, whether you have a vision benefit or not, you need to see me every year and I will bill your medical insurance, diabetes is a medical condition Perception is reality
Exam Room Data Collecting or Educating Contact Lens Evaluations Exam time is opportunity to educate Do less data gathering and more time educating your patient Advantage of scribe = more educating Do patients know why you chose a particular contact lens for them? Do patients know that Contact Lens complications are Medical? Call you? If surveyed, what would your patients say about contact lens wear?
One Big Idea Most patients only take one or two things home with them (what they remember) New Doctor Mistake telling the patients too much information without keeping patient focused on the main take home point Experienced Doctors Don t tell the patients enough information or the right (what patient came in for) information All patients should be educated about pathology you are ruling out Discuss eye pathology Discuss systemic pathology Discuss what you see (scribe helps with this - patients like) Captured audience - educate, educate, educate Dilation Always Summarize (One Big Idea) If you forget everything I said today, the one thing I want you to remember that is most beneficial for your eyes is.wear sunglasses all the time If you have any eye problems, I am your primary eye care provider, call the office. One of our doctors is on-call evenings and weekends. Online Awareness Other Professionals Education Opportunities External
The Hub glasses and contacts? medical eye care urgent eye care access number to call easily and links for phone browsing test non-eye people to get impressions about what your website communicates about your office detailed resource for most common eye conditions patient s will experience Photos Communicate medical eye care? Glasses and contact lenses only? Does patient know when to see you and when to go to ER or ophthalmology? Social Media Blog Regular posts about eye disease Statistics on getting eye health evaluated Medical concerns with contact lens wear Educate..Don t advertise Local opportunities Heavily read by women Have more credibility than Facebook, Twitter or Pinterest (study) Guest post about a medical condition and need for following by OD Comment on blogs
Links InfantSee See to Learn Mother or Baby care local stores Local health associations Find where other ODs are not Ask, ask, ask - all you can be told is no Isolated Practice or Integrated Network Positioning Your Practice within the Healthcare Model Think big group, remain independent. Are you a part of an Eye Care Community which links to a Health Care Community Referrals from PCP for diabetes eye care.
Integrated Eye Care Models Other Professionals? I want an easy to read quick reference of the patient s eye health Medical Model Practices get Referrals Are you getting regular referrals from PCPs for eye problems? Does your practice receive referrals from specialist for primary eye care? Diabetes eye exams should all be done by primary eye care - optometry? Does your relationship with PCPs and specialty OMDs reflect this? Are you receiving test results from PCPs? You PCP
Letters/Notes send to PCP on every patient that has or needs a referral send to PCP on all acute/ urgent care What do you expect from the specialist Do you want them to return your patient to your care? Would you like them to follow the disease indefinitely? Specialists need to know what kind of optometrist you are 1. Manage medical care and are comfortable monitoring, and EXPECT your patient released back to your care. 2. Routine vision exams only and pathology should be monitored by specialist. Patient Handouts Diabetes Eye Packet Personalized handout about your services that reflect practice website You control primary content they first read. Handouts recommend trusted websites for reference What can the PCP/ Endocrinologist expect from you? Sample Diabetes form Sample pictures of diabetic retinopathy Statistics sheet Online ability to schedule appointments
Education Opportunities (External) Health Fairs Schools & Associations 1-2 year Chamber of commerce or Search Engine minimal costs associate doctors can help and benefit face-to-face still best for ODs Medical is discussed and branded Teach the children - educate the teacher and school nurse American Academy of Professional Coders Retirement Communities (great in small towns) Technical Schools - train people to be healthcare assistants Diabetes Support Groups
Unique to your area Local hospital care package for new mothers Adoption agency care recommendations for child care Diabetes associations Diabetes education classes (more going on than you may realize) Macular Degeneration classes/support groups Find local glaucoma screening health departments Practice Value Medical model practices typically have higher net profits. Younger ODs want to buy practices that they have the best chance of success. Experienced ODs in purchasing practices know how difficult it is to retrain patient s mentality. Optometry offices already in the medical model have referral relationships that support continued growth. THPs 1. Patients are a product of what they hear and see. 2. Medical model is an evolution that requires continual communication with patients. 3. Future success depends on today s decisions. 4. The value of an optometry practice rises and falls on successfully incorporating the medical model. 5. All optometrists are in this together, as more ODs practice the medical model, the profession strengthens it s position in medicine. Thank you Chad Fleming, OD, FAAO