Consider integrating new procedures into your anterior segment practice
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With continuing surgeon fee reductions in reimbursement for cataract surgery and a smaller corneal refractive surgery market, it may seem like an odd time to think about investing in new technology for your practice.
While I agree that this may not be the time for risky investments, it absolutely is a good time to evaluate where your practice is today, where you want it to go and what you need in terms of skills, staff and technology to get to that point.
We are facing a unique confluence of trends. Every day, 10,000 baby boomers turn 65 years old. And with the aging of this huge generation comes a large increase in all the age-related eye diseases: cataract, glaucoma, dry eye, diabetic eye disease and macular degeneration. At the same time, millennials are reaching the age at which refractive surgery demand will likely increase. Just as demand for eye care is increasing, many senior ophthalmologists told Market Scope in a recent survey that they might retire early due to COVID-19. The rest of us will find our efficiency hampered by the continuing need to practice social distancing and increase examination room cleaning between cases.
I, however, remain convinced that challenge also always creates opportunity that can lead to tremendous personal and professional growth. For cataract surgery-dependent practices, finding new revenue streams will be important to future success. Here is my road map for beginning to figure out what those new revenue opportunities should be.
1. Reflect and plan
I have always been an advocate of thoughtfully creating and updating a 1-, 3- and 5-year business plan. Sit down in a quiet room with a notepad and think about what changes you would like to make in the next 1 to 5 years. Write down 20 or 30 ideas. Next to each idea, make a notation about the financial impact, how hard a new practice offering may be to acquire and learn, and how high your interest level might be. Take some time to think about what is working well and what is not working well in your practice today and what you most enjoy doing. If you are in a group practice, you will eventually need to go through this exercise with your partners, as well.
For many small group anterior segment practices, a major decision is whether to grow the practice by adding a partner with a specific focus (ie, oculoplastics or retina) or to broaden the expertise and efficiency of the existing partners in ways that align with their individual interests. For example, in a four-doctor practice, perhaps all four continue to do cataract surgery, but one of the partners decides to learn minimally invasive glaucoma surgery, one leans into medical retina, and the doctor who does corneal refractive surgery begins to offer cross-linking. In addition, instead of adding another surgeon, the practice could hire one or more medical ophthalmologists, optometrists or physician assistants (PAs) to help all the surgeons provide a broader array and better eye care in areas such as optical services and ocular surface care.
2. Consider the value of your time
One of the simplest and most overlooked data points in your decision-making should be your revenue per hour. It can be eye opening to simply calculate what revenue you generate doing each of the things you do and also the hourly overhead costs required. For example, if you see six patients per hour in the office and generate $200 in average per-patient revenue, that is approximately $1,200 per hour, which might actually compare quite favorably to an hour performing cataract surgery, especially in a hospital setting. Get more specific about your revenue-per-hour for each type of office-based or ASC procedure. You may choose to continue performing lower-revenue procedures because they are important for your patients or something you love doing, but at least you know what the tradeoffs are in terms of your time. As an alternative, you may delegate some of them to a medical ophthalmologist, optometrist or PA.
3. Educate patients better
The biggest “bang for the buck” may come from capturing more revenue per patient by better educating patients about treatment opportunities. For example, 10% to 20% of patients undergoing cataract surgery also have ocular hypertension or glaucoma. Every one of these patients should be offered a MIGS implant. Every cataract patient will be presbyopic after surgery and more than half have astigmatism, so getting your astigmatism- and/or presbyopia-correcting IOLs to over 30% of total cataract surgery cases is critical to boosting both revenues and patient satisfaction. In addition, simply seeing one more patient per hour can have a big impact of practice revenue.
4. Consider all the financial factors
When contemplating any new technology acquisition, you need financial data on capital equipment costs and staffing needs, but do not ignore other factors that are critical to success with the new technology. For example, for a practice that wants to start offering cross-linking, having a strong optometric referral network already in place is an advantage because these optometrists will be able to refer patients with early-stage progressive keratoconus who can benefit the most from treatment. The reimbursement path is also essential to understand. After some initial hiccups, third-party payers now have established coverage and payment policies for the only FDA-approved cross-linking platform (Glaukos), making the procedure more economically viable for practices, as well as the only treatment with the potential to halt progression.
5. Extend your own reach
Ophthalmologists need to think carefully about maximizing patient throughput and the use of physician care extenders, such as medical ophthalmologists, optometrists, PAs and technicians. If you currently have one technician per MD, think about what you could do with a second or third. If an added technician allows you to see one more patient an hour, it is a good investment. An optometrist or PA who can work independently can expand the practice’s reach into optical and dry eye care, provide much of the patient education and postoperative follow-up, and facilitate in-office procedures such as thermal pulsation, intense pulsed light or even cross-linking.
We are fortunate to have a highly innovative industry and strong patient demand for services and procedures that preserve, restore or enhance vision. In addition, many patients will pay cash out of pocket for treatments and devices that improve their visual function. This is a great time to look for new opportunities to help better serve the patients in your community, enjoy your day-to-day work more and build an ever more profitable practice. In that context, investing in new technology that fits in with your personal and practice goals makes more sense than ever.
- For more information:
- Richard L. Lindstrom, MD, can be reached at Minnesota Eye Consultants, 9801 Dupont Ave. S., Suite 200, Bloomington, MN 55431; email: rllindstrom@mneye.com.
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