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Issue: May 2008 Building a Therapeutic Practice

Building a Therapeutic Practice

Taking these steps will help improve your care of allergy patients and grow your practice, too.

Dr. Karpecki: It's estimated that optometrists write only 15% of the $500 million spent each year on topical ophthalmic prescriptions for ocular allergies. Approximately 20% of the population suffers from some form of allergies,1 and as many as 18 million people with allergies wear contact lenses.2 Even if 1 in 6 of these patients drops out during a 10-year period, the economic impact translates to hundreds of millions of lost dollars for us. How can we do a better job of keeping these patients in contact lenses?

Proactive stance

Dr. Devries: Optometrists need to identify and meet their patients' primary care needs. To do this, have patients fill out questionnaires before their visit. In addition, your patients need to know you provide therapeutic treatment of allergic and chronic dry eye disease for contact lens wearers. You can advertise your therapeutic services in the Yellow pages, with signage in your office, with telephone "on-hold" messages, on your Web site and in recall letters and billing statements. It's also beneficial to get your staff involved in what's called "lunch and learn meetings" with reps who can discuss new information about medications you're prescribing.

Dr. Gaddie: Keeping allergy patients in contact lenses starts with strong leadership from the doctor. Too often, I hear optometrists say they don't have patients with glaucoma, diabetes or other serious medical issues. I'm afraid they're not asking the right questions.

Dr. Nichols: You may need to add questions to your patient history form, creating sections for ocular surface disease and other conditions.

Open communication lines

Dr. Karpecki: How can we communicate more effectively with the patient's pediatrician or allergist?

Dr. Gaddie: On our patient information sheet, we ask patients to identify the doctors they see on a regular basis. I write letters to my patients' doctors to inform them about the treatment I'm providing to augment their care. I believe we must inform other healthcare providers that we're managing their patients' ocular health.

Following up

Dr. Karpecki: It's common for optometrists to go long periods without seeing certain patients. However, if you want to build a medical eyecare practice, you'll need to follow up with patients regularly.

Dr. Devries: If you don't follow up with allergy patients, you'll risk losing them to other practices. I explain to patients that I'm taking a step-wise approach to treatment and that I need to see them again in 1 or 2 weeks to determine if additional treatment is needed.

Dr. Gaddie: I agree. I might even ask them to return in 3 to 7 days if I'm still in the process of differentiating between dry eye and allergy.

Dr. Karpecki: Of course, we also need to continuously educate the patient on why more frequent follow-up is needed.

Infrastructure required

Dr. Karpecki: How can optometrists build a strong infrastructure to establish a therapeutic practice?

Dr. Gaddie: You need to give your staff the resources it needs to expand patient care and accommodate increased patient flow. Make sure you don't fall into the trap of being too conservative when estimating the increased traffic demands and efficiencies needed to schedule additional exams. Once you have the correct billing, coding and bookkeeping mechanisms in place, expansion shouldn't be difficult. I'd recommend at least three exam rooms per doctor to simultaneously treat multiple patients and handle complicated cases. Consider converting your private office, any extra room or even a large closet for this purpose.

Dr. Devries: The idea of equipping an additional room might concern some practitioners, but all it takes is just a few extra patients with medically-related issues to cover your costs.

Dr. Karpecki: In addition, you need to bill for medical care. Always obtain health insurance information from every patient to help identify the best plans available for your practice.

Ultimate benefits

Dr. Karpecki: Besides the economic benefit, a therapeutic practice provides a source of pride and fulfillment. You'll take full advantage of your optometric training and provide the best possible care to patients. Your insights on how to manage allergic eye disease in contact lens wearers will help your fellow optometrists improve patient care and grow their practices. OM

  1. Jacob SE, Castanedo-Tardan MP. Pharmacotherapy for allergic contact dermatitis. Expert Opin Pharmacother. 2007;8:2757-2774.
  2. Efron N. The case against rigid contact lenses. Eye Contact Lens. 2003;29:S122-S126; discussion S143-S144, S192-S194.
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