Practical Pearls

A Handy Guide to the Best Take-Home Tips in the April 2011 Issue of Ophthalmology MANAGEMENT

Your net collections divided by the number of full-time equivalent staff should fall in the range of $110,000 to $160,000 to be considered in the “healthy range” for staff productivity……Find it!

Patients with positive angle Kappa can have trouble with multifocal IOLs, as they often will end up looking through only the first ring of the lens, even if the IOL is perfectly centered ……Find it!

For allergy sufferers, a cool drop in a hot eye simply feels good. Suggest that patients put their artificial tears in the refrigerator……Find it!

Each degree of inaccuracy in toric IOL placement reduces astigmatic correction by 3.3%……Find it!

Contact lens wearers who keep their lenses in overnight are three times more likely to have GPC than those who remove them……Find it!

If an ACO fails to achieve savings, it incurs no penalties and will continue to receive fee-for-service payments from Medicare. However, HHS reserves the right to enforce a partial capitation model to assign risk to the ACO ……Find it!

Geographic location may have little bearing on premium IOL conversion rates. Even practices in less-than-affluent regions can succeed when armed with the right strategies ……Find it!

In a growing solo practice, adding a physician assistant could be a cost-effective way to preclude or postpone the need for bringing in a second ophthalmologist……Find it!

Alcohol consumption exacerbates dry eye, with one study finding that TBUT shortened from 14.3±8 to 6.4±6 seconds after drinking. Encourage patients to limit alcohol intake, or encourage aggressive lubrication if they plan to consume alcohol ……Find it!

Medicare patients will not be “locked in” to any one ACO. This seemingly undermines the opportunities for cost savings and is an as-yet poorly explained concept in the ACO model that bears further scrutiny……Find it!

Unlike E/M guidelines, eye exam codes do not specify required history elements. The guidelines simply indicate that a medical history is required and leave it up to the provider to document what is appropriate for each patient ……Find it!

Family history of ocular allergy is compelling. If both parents have a history of allergy, the offspring has a greater than 50% chance of a predisposition to allergy ……Find it!

Costs will be among the quality performance standards used to measure ACO performance. Benchmarks will be based on the most recent three years of per-patient expenditures for Medicare A and B for the beneficiaries assigned to the ACO. If the ACO performs below the benchmark, it will share in those savings……Find it!

Using a physician assistant from your practice as part of your surgical team (rather than relying on hospital-only staff) creates continuity of care and helps ensure that the OR staff is familiar with ophthalmic procedures……Find it!

Some topical antihistamine/mast cell stabilizers have a muscarinic effect that dries the tear film, and oral antihistamines are notorious for their drying effect……Find it!

Partial to one premium IOL? Don't bash the ones you dislike to your patients—you may end up losing their business entirely……Find it!

Counsel dry eye patients not to use generic tear supplements. They contain preservatives, are not as well regulated as brand-name drops, and can vary in pH, active ingredient concentration and other factors that affect performance……Find it!

One full-time equivalent staff member per six to eight FTE physicians is a good benchmark of adequate staffing levels ……Find it!

ACOs may run afoul of physician self-referral laws and federal anti-kickback statutes, although provisions allow for some waivers of responsibility for compliance with these laws ……Find it!

Ectropion, lagophthalmos, lateral canthal ulceration, cracking and madarosis are all eyelid signs of atopic keratoconjunctivitis……Find it!

Only 5% or less of practice collections should be spent on computers, software, data services, phone systems and tech support in order to optimize profits ……Find it!

Don't think you can skip E/M codes and use eye exam codes exclusively; most eye exams fit within the requirements, but not all ……Find it!

Patients who have undergone cataract surgery in the first eye experience a 20.8% gain in quality of life for the remainder of life……Find it!

One staff member can usually perform surgical counseling for up to 1,000 combined outpatient surgeries and in-office laser procedures per year at a typical practice……Find it!

Discourage allergy patients from rubbing their eyes, as that causes mast cell degranulation that exacerbates their symptoms ……Find it!

Meibomian gland dysfunction may be the most common cause of evaporative dry eye and may also be associated with aqueous-deficient dry eye, so a complete exam should include symptom evaluation, clinical assessment of the glands, meibomian gland expressibility and evaluation of the quality of secretions ……Find it!

Some tasks that can be performed by a physician assistant include preop and postop evaluations, patient education, telephone triage, changing prescriptions, assisting in surgery, plus eyecare-specific exams and procedures that can be learned after appropriate training……Find it!

Many successful cataract surgeons are bundling post-procedure refractive touch-ups with their premium IOL price to increase patient confidence in the technology……Find it!

Histamine binding to the H1 receptors in the conjunctival nerve endings causes itch, while binding to H1 and H2 receptors in the conjunctival vasculature is responsible for vasodilation and increases in vascular permeability……Find it!

Instead of denigrating monofocal IOLs in an effort to sell premium lenses, articulate a compelling reason why a premium lens is better than the already excellent basic lens. This accurately portrays both options so the patient can make a decision without feeling bullied ……Find it!

The highly variable nature of patient flow patterns can make for a chaotic and unpredictable situation, resulting in suboptimal utilization of resources and causing longer wait times. Real-time tracking of patient flow reduces bottlenecks……Find it!

Practice mergers, an increasingly valuable means of improving efficiency and cost savings, offer a viable alternative to joining an ACO ……Find it!