Practical Pearls

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

The Early Manifest Glaucoma Trial showed that each additional 1mm of IOP reduction is associated with a 10% reduced risk of disease progression ……Find it!

The best time to diagnose glaucoma is in the pre-perimetric phase, before any visual field loss occurs. Then your targets don't need to be as aggressive. Instead of a 40% reduction, maybe 25-30% is enough ……Find it!

When implementing EMR, a gradual rollout makes for a smoother transition. Consider launching the system only with new patients requiring complete eye exams, then phase in existing patients later ……Find it!

The Collaborative Intervention Glaucoma Treatment Study noted that trabeculectomy patients achieved lower IOPs than medically-treated ones (14.2 vs. 17.5, on average), but after 5 years there was no difference between the groups on visual field testing ……Find it!

Senior citizens feel more secure in a safe office environment. Mark any change in elevation to prevent falls, make sure lighting is adequate and provide an escort to the parking lot in inclement weather ……Find it!

If a patient complaint during a postsurgical visit is unrelated to the surgical procedure, report an unrelated evaluation and management service (992xx) using modifier 24 ……Find it!

Office restrooms can be hazardous for seniors. Have non-slip mats on the floor, handrails where appropriate, bright lighting and emergency pull-cords for immediate assistance ……Find it!

Unlike hospital-based procedures, with your own ASC you select the staff you want to work with, offer patients a guaranteed time for their procedures and provide extra amenities such as premium drinks and snacks ……Find it!

Communicating clinical trials results to patients engenders a great deal of confidence in your treatment recommendations, even if the patient is not noticing visual deterioration ……Find it!

In a study of 22 patients with progressive keratoconus upon whom collagen cross-linking was performed, investigators demonstrated no progression of keratoconus in all eyes, improved visual acuity in 15 of 22 eyes and flattening of K-max by 2 diopters in 16 of 22 eyes ……Find it!

The quality of a fundus camera's lens and optical system is more important than the number of pixels in the image produced ……Find it!

To help retain your staff, you have to determine what compels them to stay with you ……Find it!

The recession-proof nature of glaucoma might seem pretty appealing right now to some corneal and cataract specialists who've seen fluctuations in their billings as patients scale back on out-of-pocket procedures ……Find it!

Because society equates eye surgery with visual improvement, glaucoma patients will be misinformed and must be educated about the likely outcomes of glaucoma surgery ……Find it!

Your ASC can provide a warm, welcoming and easy-to-navigate environment, unlike a large, impersonal hospital where elderly patients can become confused and concerned ……Find it!

Combining collagen cross-linking with Intacs lenses for treating keratoconus may achieve a greater reduction in cylinder and steep K than by using Intacs alone ……Find it!

Because glaucoma is an ongoing process, not an acute problem, specialists develop long-term bonds with their patients. "In glaucoma, you are done when the patient dies." ……Find it!

The challenge with glaucoma surgery has not been its effectiveness, but rather the long-term complications and the intensity of care required after surgery ……Find it!

To be successful, a mentoring relationship demands of each partner total respect, absolute commitment, limitless patience and occasional compromise. Absent these qualities, the relationship cannot function for long ……Find it!

Unlike elective procedures, a growing number of cataract patients are coming to a practice near you. It's recession proof and that's why there's no time like the present to start preparing your practice for its promising future ……Find it!

When coding for surgical care, diagnostic tests (including radiological procedures) are not included in the global surgery package. Modifier 24 should not be used to report such tests in the global surgery period unless you are specifically instructed to do so by the payer ……Find it!

Successfully converting patients to premium IOLs requires significant increases in time spent on staff training, patient scheduling, practice flow and overall patient education ……Find it!

When patients have a good experience in an ambulatory surgery center, they tell a few people. When they have a bad experience, they tell even more people ……Find it!

Until there is surgical advancement in glaucoma, it will be difficult to compete with other subspecialties. The field is not right for personalities looking for instant gratification, but it is a wonderful, passionate field ……Find it!

Ophthalmologists in rural areas are seen by patients as more than just their doctor—you're a real person who participates in the community. This strengthens the doctor-patient relationship, improving the experience for both ……Find it!

Continuing education for your staff can be a win/win as it allows growth for the employee and added value to the practice ……Find it!

The Ocular Hypertension Treatment Study had a 20% IOP reduction average, but even with that, 5% of patients still developed glaucoma. So if a patient fits into the OHTS group, set a target pressure reduction of at least 25% ……Find it!

Although UVA radiation is cytotoxic to corneal endothelial cells, studies suggest that collagen cross-linking is safe in corneas that have been adequately saturated with riboflavin and are at least 400 μm in diameter ……Find it!

One of EMR's greatest advantages is decreased transcription costs, eliminating need for scribe systems and cutting down on paperwork by automatically generating letters to physicians ……Find it!