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Before long, you'll make a profit from your topographer
A corneal topographer can prove both clinically useful and profitable. In fact, it can pay for itself in just a few years. That is what two optometrists, Dennis W. Kennedy, OD, of Westland, Mich., and Burt Dubow, OD, of St. Cloud, Minn., have found in their practices.
According to Kennedy, "It is no longer a question of whether you should buy a topography system, but when. The benefits to you and your patient are immediate."
He added that his increasing involvement in the comanagement of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) patients necessitated the purchase of a system.
Dubow said corneal topography has added tremendous value to his practice. "It is a testing procedure that is very emotionally appealing to the patient, is very visible and gives valuable information on corneal health. So we can actually sell it to the patient above and beyond their exam."
About 90% of Dubow's patients have some form of third-party benefits, so examination fees are not as controllable as he would like.
"Managed care plans require us to see more patients in less time, and utilize our staff and equipment better. We needed an instrument that creates value for the patients and profit for our practice," he said.
Corneal topography provided the answer. Dubow said his three systems, two EyeSys units and one Tomey machine, are providing profit above and beyond the managed care system.
"Patients pay extra, out of pocket, for the test, rather than depending upon their managed care plans to pay for everything," Dubow said. "We did the same thing for fundus photography for years when we sold it as an extra test."
Screen for corneal health
Kennedy said that once he purchased his Alcon EyeMap for refractive surgery care, he decided to use it for all of his contact lens patients, as well as for screening for various corneal diseases, dry eyes, etc. To his satisfaction, he found that an additional fee for each exam allowed him to quickly meet his $500 monthly payment for the machine and bring in $975 in profits. He bases this on a monthly caseload of 20 gas-permeable contact lens patients and 60 soft contact lens cases at an extra $10 each, 10 corneal dystrophy or keratoconus patients at an extra $30 each and 5 refractive surgery patients at an extra $75 each.
According to Kennedy, corneal topography can help demonstrate the importance of compliance with regard to the proper maintenance of contact lenses. One patient complained that her "vision was a little worse." The fact was that her rigid gas-permeable lenses had significant deposit build-up due to poor lens hygiene.Topography clearly demonstrated corneal warp
One month after her lenses were resurfaced, normal corneal integrity was restored. She was presented with both sets of corneal maps so she could see for herself how her corneas had improved.She now understands the importance of good lens hygiene and has since become more compliant. This visual demonstration was far more effective than a "verbal reprimand," he added.
Extra fee justified
Dubow performs topography on all new contact lens patients and yearly in existing contact lens cases, repeating the procedure if the cornea is problematic. "Corneal shape or health problems are picked up, and gas-permeable and complicated toric lenses are easier to fit. This way we can charge more and justify it," he said.
His staff recommends the procedure to all patients for corneal health screening. While most third-party insurers will cover topography for suspected keratoconus or other medical reasons, vision plans normally do not. Dubow said, "I like keeping the fee out of the system. That way we can provide a valuable service for which we charge extra."
Kennedy added, "There is no question that corneal topography will be the standard of care with the comanagement of refractive surgery. It will also become the standard of care for contact lens care and management."