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Avoid the confusion over adding intentional ocular surface disease services
ODs follow 3 steps to add dry eye care to their practices: Create a starting outline, ensure consistent messaging and patient materials, and screen all patients every time.
One of the biggest hinderances to expanding dry eye care in the average optometric practice is the confusion of where to start.
These 3 steps will allow ODs to intentionally add ocular surface disease treatment to their patient services.
1. Make a 30,000-foot plan
There are many great resources now available, but that too can sometimes be overwhelming and confusing. I challenge ODs to explore and utilize the resources available through vendors, education programs, and dry eye leaders. These resources are available for when ODs know this is an area of expansion they want to pursue in the most expedited and painless way.
ODs who are just testing the waters do not need every detail planned out. They need a starting outline that addresses flow, scheduling, and staff and patient education.
When it comes to flow and scheduling, my best advice is to start out scheduling dry eye evaluations only in the last time slot before lunch and the last one before the end of the day. This will give you presence of mind without wondering how many people are waiting or who else is on the schedule. It also allows the OD to take the extra minutes if needed to further educate the patient.
As ODs begin, their exams may run long. Do not get caught up in how many minutes spent on this visit or how many dollars patients spend. This will be the core foundation to the entire relationship and their loyalty to the OD and the treatment plan. While ODs may need to allow a little extra time for dry eye evaluations, the follow-ups should fall right into the normal scheduling template.
Start thinking about space and flow. This will not be a concern at the start, but it may be as the word of dry eye services spreads. It is important, even now, to position diagnostic devices in the smartest way possible to limit patient back-up and keep staff onboard.
2. Educate now
For the plan to have teeth, consistent messaging must start at the top and trickle down to every position in the office. Now, before truly getting started, is the time to educate staff on the need for increased dry eye diagnosis and improved outcomes. It is important to talk about their roles in this new mission. Their roles are essential in order to uniformly screen patients, properly advise patients regarding dry eye visits and protocols, and coach patients on their treatments.
Consistent messaging can be accomplished by creating a simple 1-page protocol regarding screening, scheduling, and billing, and a summary page for each of the OD’s go-to treatments. Aim to spend at least an hour walking the entire staff through expectations for each role within the plan and highlighting the accolades of each product prescribed or sold.
Now is also the time to gather patient education material. When I started out, I used pre-filled folders containing every brochure I might want to give the patient. This way, instead of digging around looking for a specific brochure, I simply removed the ones I did not need for that patient. This technique saved me significant time and ensured that the patient left well educated. How ODs educate their patients is critical, but many doctors perceive dry eye visits as taking too long, so little things that shave time are valuable.
Dry eye patients often arrive frustrated because of the duration of their disease and confusion about why it is happening and what options are available for treatment. Excellent patient education is a single service that carries significant weight in differentiating a practice’s dry eye care.
It is important to educate patients from the very beginning. While it is certainly more helpful to create an additional 1-page checklist with instructions for patients, at least collect the brochures for the products and treatments recommended so they are not leaving empty handed.
When it comes to means of excellent education, if ODs are sure they want to dive into dry eye care, I suggest buying an anterior segment camera. For dry eye care, it is preferable to choose one with a built-in patient education platform and printable patient report (I use Oculus 5M Keratograph and Crystal Tear Report). The reason I say to do this now is because it can be a tremendous aid in creating buy-in at the start from both staff and patients, which may prevent initial struggles and disappointments. It also serves as an obvious investment and visible tool to demarcate the practice’s intent to implement a new service and protocol.
3. Make a few rules
First, screen every patient every time. That’s right, every one, every time. This is where it all begins. Screening uncovers the need and creates accountability to do something about it. Ideally, I found it even better when the screening is based on structural concerns instead of symptoms.
Here is why: While surveys can be valuable in documenting what the patient feels, the patient may adopt the perspective that the OD’s recommendations are made based on those symptoms. At that point, the patient may make an uneducated decision that she doesn’t “need” to do all that the doctor recommends. Other times, the patient may get a good start with at-home treatments but stop as soon as she starts to feel better because she thinks she is treating because of the symptoms.
Instead, try to incorporate a screening that shows patients their clinical presentations in a way that is both clear and motivational. I print a report for patients that shows red flags and why I am asking them to return for a dry eye evaluation or a specific treatment. This visual will help inspire compliance and longevity of treatment more than allowing patients to base decisions solely on symptom control.
Universal screening needs to be the first hard rule. As part of that, write down what the screening will be, who will execute it and interpret the results, at what point it will occur in the exam and where, and the conversion criteria that brings the patient back for a dry eye evaluation and the necessary scripting to do so.
Secondly, never conduct a dry eye evaluation on the same day as the current exam or follow-up visit. It is too important to not give the dry eye evaluation its own space and time. Dry eye must seem important to the OD before it will seem important to the patient.
Consider the patient’s perspective: He had to worry about vision insurance, refraction, dilation, and glasses. Ocular surface disease is too complex and critical to throw on top or squeeze in the middle of that. At my office, we tell the patient we want to get to the bottom of the concerns and make lasting changes. But in order to accomplish this, we will need time to run the necessary diagnostic tests.
ODs planning to charge an out-of-pocket fee for this service should make sure they have the equipment to justify the charge. They also need to ensure that they are not billing both the patient and the insurance carrier for this extra time or testing in the dry eye evaluation. This is when an anterior segment camera with analysis and reporting features comes in handy because with it the OD is doing more than just 92285. Always make sure patients sign an advanced beneficiary notice (ABN) beforehand.
Ultimately, ODs interested in adding dry eye and ocular surface disease treatment don’t need every detail spelled out. Remember that progress is more important than perfection, so waiting to start until everything is figured out will be the biggest shortfall.
Draw up a draft of these key pages with bullet points to guide the first steps:
– A 1-page protocol on scheduling and fees
– An educational summary page for each go-to treatments and products
– A 1-page guide on what is part of a dry eye screening, who will execute it and interpret the results, at what point it will occur in the exam, and the conversion criteria that brings the patient back for a dry eye evaluation and the scripting for that discussion
– A 1-page treatment guide of when to use what. I list a good, better, and best option for each ocular surface disease category to provide me with clarity of thought in the exam room