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Issue: March 2009 Seeing Profit Potential in a Common Problem

Seeing Profit Potential in a Common Problem

More than 40% of your patients may have ocular allergies. Here are strategies to help identify them.

By John M.B. Rumpakis, OD, MBA

I present lectures about the science of allergy and the strategies of effective billing and coding. Afterward, attendees always approach me and mention the one point they believe I missed. They say, "It's great to hear how to treat allergy and make more money doing it. But how do we bring these patients into our offices? Where do we start?"

Certainly, allergy is one of the simplest ways to build your practice. The numbers of allergy patients show there's an enormous opportunity waiting for us. The key to attracting allergy patients is marketing. Internally, you can set goals and bring your staff up to speed. Externally, you can communicate your role to new and existing patients. Once you understand what brings patients in the door and learn to market a contemporary allergy practice, you'll continue to enrich the health of your practice for many years.

In this article, I'll discuss the prevalence of allergy in the United States and among your existing patients, the opportunities optometrists have to be the chief prescribers of ocular allergy medications and the huge potential for practice growth in this often under-tapped area of optometry.

General Allergy
■ Estimates from a skin test survey suggest that allergies affect more than 50 million people in the United States.1

■ Allergic disease is the 5th leading chronic disease in the United States among all ages, and the 3rd common chronic disease among children under 18.2

■ A recent nationwide survey found that more than half (54.6 percent) of all U.S. citizens test positive to one or more allergens.3

■ The costs associated with allergic disease are extraordinarily high: one analysis estimated it at $7.9 billion per year, of which $4.5 billion was spent on direct care and $3.4 billion on indirect costs, related primarily to lost work productivity.4

  1. Gergen PJ, Turkeltaub PC, Kovar MG. The prevalence of allergic skin reactivity to eight common allergens in the U.S. population: results from the second National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 1987;80:669–679.
  2. "Chronic Conditions: A Challenge for the 21st Century." National Academy on an Aging Society, 2000.
  3. Arbes SJ, Gergen PJ, Elliot L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the U.S. population: results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 2005;116:377–383.
  4. Stempel DA. The health and economic impact of rhinitis. A roundtable discussion. Am J Manag Care. 1997;3:S8–S18.

Finding Allergy Patients

Aside from acute allergic reactions, such as to bee stings or peanuts, generally we don't think of allergy as a significant condition in medical terms. Allergy is simple to diagnose and easy to treat with today's state-of-the-art medications. But what the condition lacks in medical complexity, it more than makes up for in vast population size.

Over 50 million people in the United States suffer from allergies.1 In fact, allergies are the fifth leading form of chronic disease and the third most common chronic disease in children under 18.2 Allergic rhinitis and asthma are among the leading causes of absenteeism from school. More than 10,000 children miss school every day because of allergic rhinitis. And in the United States, we spend $7.9 billion a year on allergies, including $4.5 billion in direct care costs and $3.4 billion in indirect costs, such as reduced productivity.3

Ocular allergy represents a strong component of this overall picture. Allergy sufferers typically complain of stuffy nose and sinus pain, while itchy, watery eyes are the third most common symptom, affecting about 12% of patients.4

What's more, we now understand there's a strong link between rhinitis and ocular allergies. Patients account for about 16.7 million office visits a year for rhinitis.5 In addition, most allergy sufferers have seasonal allergies, which may have an ocular component, and about 25% have skin or eye-specific allergies.4

Some of the new nasal sprays claim to treat ocular allergy, although they're not indicated to do so. So if you're considering prescribing a nasal spray, such as olopatadine hydrochloride (Patanase, Alcon Laboratories Inc.) or a similar drug, understand the role it might play.

If we look at what people use to treat their allergies, oral medications are number one.4 Of course, these can cause severe ocular drying, which concentrates the allergen on the ocular surface and exacerbates the allergic response.

People also lean strongly toward OTC allergy medications. In 2007, Americans bought over 55 million units of OTC topical allergy medications for ocular use, compared to 8 million units of prescribed ocular allergy medications.6 Only 2% of prescriptions were allergy-specific eye drops.6

Interestingly, optometrists didn't prescribe all of the ocular allergy medications. General practitioners prescribed allergy medications about 69% of the time. All specialty groups, including optometrists, ophthalmologists, pediatricians, allergists and others contributed just 4%.4

In short, allergy is abundant in the marketplace, people self-treat ocular allergy more than they seek professional treatment and optometrists don't dominate ocular allergy patient care. Based on the types of medications used most commonly, patients may not be getting the relief they want from ocular allergy symptoms.

Who's best positioned to change this state of affairs? Optometrists.

Your Growth Potential

Based on a sample of over 8,000 optometrists, the American Optometric Association (AOA) estimates that the median gross income per optometrist in the United States is $440,000 a year, and the median net income is $140,000.6 However, adjusted for inflation, our median income growth in the past 20 years has been only about $11,000.6 So we need to increase our profitability. Allergy has enormous profit potential.

Let's consider chair cost, which is what it costs you to practice every hour you provide services. Currently, the average break-even point for an optometrist in the United States is $92 an hour.7 To turn a profit, you have to earn more than $92 an hour for the services you provide.

An ocular allergy patient typically returns about $647 per hour in net profit.7 That's how lucrative your knowledge of ocular allergy treatment is.

Consider this breakdown of potential allergy-related profits based on AOA averages:

• According to the AOA,6 optometrists see 3,400 patients a year on average. The American Academy of Allergy and Asthma says that about 1,411 patients (41.5%) suffer from ocular allergies.

• Patients who see their optometrists for ocular allergies typically have two allergy-related office visits a year.6

• In Orlando, Fla., a sample reimbursement location, reimbursement from Medicare for an allergyrelated optometry visit (a mid-level evaluation and management visit) is $58.60.6

• If you captured 100% of your ocular allergy patients — an average of 1,411 people — for two allergy-related visits per year at $58.60 each, you'd gross an additional $165,000 a year.

• More realistically, if you enhanced your marketing to communicate your role in allergy treatment, you could capture 50% of your patients with ocular allergies.7 That's an additional $80,000 a year, just from existing patients.7

This model, based on your existing patient base, illustrates perhaps one of the most advantageous aspects of ocular allergy marketing. You don't need to start from scratch to become more profitable, and you don't need to give patients something they don't need or want. Serving their needs better serves your needs. OM

  1. Gergen PJ, Turkeltaub PC, Kaovar MG. The prevalence of allergic skin reactivity to eight common allergens in the U.S. population: Results from the second national Health and Nutrition Examination Survey. J Allergy Clinical Immunol. 1987;800:669–679.
  2. Chronic Conditions: A Challenge for the 21st Century. National Academy on an Aging Society, 2000.
  3. Stempel DA. The health and economic impact of rhinitis. A roundtable discussion. Am J Manag Care. 1997;3:S8–S18.
  4. Allergy and Asthma Foundation Of America, Annual Report, 2005. Visit Last accessed February 2009.
  5. CDC. Fast Stats A-Z. Vital and Health Statistics, Series 10, no. 13. 1999. Visit Last accessed February 2009.
  6. American Optometric Association. Caring For The Eyes Of America, 2007: a profile of the optometric profession.
  7. Practice Resource Management, Inc., 2008. Calculated values from Caring for the Eyes of America, 2006.
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