Practical Pearls

A Handy Guide to the Best Take-Home Tips in the August 2009 Issue of Ophthalmology MANAGEMENT

To prevent embezzlement, clearly separate duties involving the practice's finances so that no one person has complete control over cash receipts and disbursements………Find it!

Preop NSAIDs use helps maintain pupil dilation intraoperatively and stabilizes the blood-ocular barrier. This way, the trauma — even minimal trauma from normal surgery — will not trigger a chain of inflammatory events that could lead to postop inflammation or elevated IOP………Find it!

Now that manufacturers cannot provide post-op cataract kits for free, surgeons wonder if they can charge patients for them. Because kits aren't covered by Medicare, physicians can provide them for a reasonable price, but shouldn't charge for any kits they received for free………Find it!

The Devgan Axis Marker eliminates the need to mark the patient in the operating room and can mark the patient preoperatively using anterior stromal puncture………Find it!

Topical anesthesia improves cataract outcomes and efficiency. There is no risk of hemorrhages, IOP spikes or postop ptosis, and it relieves preop delays of waiting for the anesthesiologist to medicate the patient and for the injection to diffuse sufficiently before starting surgery………Find it!

A billing company's staff is their major investment, so they work to attract the best and brightest and pay top salaries in order to ensure optimization, accuracy and compliance………Find it!

Adding audiology allows the practice to bill the insurance companies for the hearing and balance evaluations, thus eliminating the need for hardsell tactics on hearing aids………Find it!

Outsourcing your billing maintains service during periods of vacation or employee turnover. If your surgery center has ever had a key member of their coding or billing staff leave, you understand the disruption that occurs when coding/billing does not get done regularly, if at all………Find it!

Shortly after the close of the day, cash can too easily be embezzled if the cash-paying patient's visit is simply allowed to disappear because those records are incomplete or not available. Patient visit slips ought to be pre-numbered and reconciled against a sign-in list, running day sheet and the master daily schedule………Find it!

Give cataract patients dilating drops to put in their eyes the morning of their surgery. This can be a huge time saver, as they'll come to the ASC with their eyes already dilated………Find it!

When using one phaco machine split between two ORs, you can avoid delays between cases due to shutting down and restarting the machine by plugging it in to an uninterruptible power supply device with a battery. Then it can be moved without the need to power down first………Find it!

Steroids following cataract surgery provide a swifter reduction than NSAIDs of the cellular response and ciliary body discomfort that patients can get with photophobia. But while steroids block prostaglandins and leukotrienes, they aren't a complete block………Find it!

Adding retina services to a general practice requires significant capital investment and risk, but brings in a totally different cash flow than cataract surgery. Scheduling retina days when the cataract surgeon is at a satellite or in the OR can lower overhead significantly………Find it!

If a cataract patient with mild dry AMD and average mesopic pupil size is highly motivated to obtain a presbyopia-correcting IOL, Crystalens may be the preferred choice following extensive discussion of potential limitations………Find it!

Many EMR projects are essentially doomed from the beginning by a practice's lack of specific goals for the system………Find it!

Offering Latisse can provide a low-risk entry into aesthetic services, an avenue more ophthalmologists should explore, as your training, credentials and credibility will ensure a high level of trust from patients who seek these services………Find it!

A modified cross-action mechanism allows the Ernest Micro Nucleus Cracker — a forceps designed for cataract surgeons who utilize a nucleus-cracking technique through a microincision — to crack the nucleus through a 2 mm incision without stretching the wound………Find it!

The intracameral antibiotic injection site that makes the most sense is in the capsule, whether on top of the implant or behind it. The injection should occur at the conclusion of surgery so that the drug remains in the eye as long as possible without dilution………Find it!

A thief is typically a well-trusted, long-term, seemingly honest employee who eventually "goes bad" when presented with access and an opportunity to embezzle………Find it!

Most states allow physicians to dispense medications like Latisse directly from their offices. Doing so will allow you to create an additional and extremely profitable revenue stream and also enable your patients to better familiarize themselves with your overall practice……Find it!

A difference between the ESCRS endophthalmitis study and common US practice that makes some surgeons reconsider its impact: in the ESCRS trial, antibiotic drops weren't started until 24 hours after surgery, so the patient went home with a patch and shield, and didn't even start antibiotic therapy until one day later………Find it!

A few surgeons have reported implanting the apodized diffractive ReStor IOL in patients with advanced AMD with a target of −2D and the goal of achieving an add of +5.2D………Find it!

As the practice's EMR champion, you may not get all the doctors to be enthusiastic evangelists of EMR, but that is not necessary. What you do need is for them to buy into the project………Find it!

A number of studies on intracameral antibiotic use showed that regardless of the agent used — Vigamox, vancomycin, cephalosporin — all resulted in about an 80% reduction in infection no matter what the baseline rate was………Find it!

The key elements that distinguish a first-rate billing company include reputation, longevity, experience in billing for your ASC's specialties and positive references from industry leaders, associations and clients………Find it!