Developing the medical model

Article Outline

 

Over the course of a year, a Texas vision care practice was transformed into a state-of-the-art medical model optometric office. With January observed as National Glaucoma Awareness Month, now may be the time for other practitioners to consider such a transition.

“It happened after 9-11,” Texas practitioner Tom Annunziato, O.D., recalls. His then-traditional, vision care–oriented optometric practice “basically collapsed—as a lot of practices did.” Uncertain about the future, people were putting off vision care. Then Dr. Annunziato realized that medically oriented optometric practices were continuing to prosper. That was because, he concluded, patients with serious eye problems cannot put off care. Over the following 12 months, Dr. Annunziato radically transformed his 2 offices into state-of-the-art “medical model” optometric practices, realizing a 40% net revenue increase in the process. “I made it my objective to provide my patients the complete scope of care I am authorized to provide them under law,” he said.

Today, Dr. Annunziato's practice, which 8 years ago was 90% to 95% vision care, is at least 40% to 50% medical care. It ranks among the state's top 5 optometric practices in the prescribing of glaucoma medication. Dr. Annunziato believes any optometric practice can make a similar transition. The keys to success are:


•Planning—Tour the offices of optometrists who have developed medical model practices. (Dr. Annunziato visited 3 that quickly became models for his own.) Attend continuing education courses on the development of a medical model practice and consider retaining practice management consultants who can assist. (Dr. Annunziato opted for an intensive week-long course offered by a West Coast consulting firm.)


•Instrumentation—Dr. Annunziato completely re-equipped both of his offices to provide GDx™ scanning laser polarimetry (Carl Zeiss Meditec, Inc., Dublin, California), retinal cameras, and a complete range of the latest diagnostic capability—a move that also increased practice efficiency. Initial cost: approximately $300,000 but with at least a 10-to-1 return on investment, he says.


•Staff—Dr. Annunziato hired 4 new ophthalmic technicians—all experienced veterans of area ophthalmology practices—to supplement his optical and reception staff. “They brought the medical model with them,” Dr. Annunziato says. Proper utilization of staff is critical, he emphasizes. The ophthalmic technicians are charged with performing all pretesting, taking patients' histories, and “scribing” Dr. Annunziato's notes. “I am basically shadowed by an ophthalmic technician who accompanies the patient through the practice and into the exam room.”


•Record keeping and billing—Record keeping and billing systems were completely revamped. The practice's traditional 1-page patient records were replaced by a 4-page record, typical of those used in medical offices, with separate pages for:

•Insurance or billing information


•Patient history


•Test results, and


•Examination results.





A consultant was brought in to establish the medical practice billing system and teach the staff how to use it. Claim rejections have subsequently been rare, Dr. Annunziato reports. Dr. Annunziato sees patients under 12 to 15 medical eye care plans. (Additional guidance on claim filing for eye care services is provided in the “Optometric Economics” column in this month's “Practice Strategies” section.)

The medical practice has grown almost entirely from treating eye health conditions diagnosed in new or existing vision care patients who in the past would have been referred to other practitioners for care, Dr. Annunziato reports. (Suggestions regarding the counseling of patients on eye conditions are provided in the AOA Eye Disease Management Kit. See the “Patient Education/Community Outreach” article in this month's “Practice Strategies” section.)

With January observed as National Glaucoma Awareness Month (see the “Promotions Calendar” in this month's Practice Strategies section), now may be an appropriate time for optometrists to consider the development of a medical model practice, according to Dr. Annunziato. “I wish every practice could undergo such a transition,” he says. With the careful planning, proper instrumentation, well-trained staff, and the proper record and billing system, any practice can, he believes.

Today, successful optometric offices are being developed around the nation, based on a variety of practice models, Dr. Annunziato notes. Among them: vision therapy, low vision rehabilitation, contact lens, and sports vision practices (see the AOA Web site “Career Options” page at www.aoa.org/x5762.xml). Probably no single mode of practice could be considered optimal for all practitioners. However, the full medical model practice—specifically developed to be conducive to the providing of a full range of eye and vision care on-site—is one that optometrists should definitely consider, Dr. Annunziato believes. AOA surveys consistently show that optometrists continue to grow in importance as providers of a wide range of medical eye care, as well as vision care, in their communities. The 2008 AOA Scope of Practice Survey found that over a typical 6-month period, an optometrist will now diagnose an average of 104 cases of anterior segment disorders—including 24 cases of glaucoma—providing all of the treatment for four fifths of those anterior segment patients and two thirds of the glaucoma patients. As a result, optometrists now perscribe or dispense pharmaceuticals to patients more than 400 times over a typical 6-month period (and more than 1,600 times in the most actively prescribing practices). That being the case, the full medical model—with all the instrumentation, staff utilization and practice management efficiencies necessary to facilitate convenient, full-scope eye and vision care in the optometric office—is an option that pracititioners should not overlook, Dr. Annuziato believes.