Time, Money, and the Patient Experience

Top technology purchases meet three strategic goals, while delivering a distinct clinical advantage.

BY ERIN MURPHY, CONTRIBUTING EDITOR

Feeling today’s economic pressures and facing changing regulation, ophthalmologists have been forced to find ways to increase their practices’ profitability. There are many ways to approach this, including some relatively simple changes with major benefits.

Dr. J.C. Noreika, the managing partner of Excellence in Eyecare in Medina, Ohio, has taken a very straightforward approach. “I’m one of my practice’s revenue generators. The more tasks I can delegate, the more energy I can expend on high-level, well compensated work and the more profitable the practice will become. New technologies like the EPIC make this possible,” he says. “I purchased the EPIC because it offers sophisticated clinical advantages while meeting my three strategic criteria for evaluating the purchase of new technology. The results have been rewarding and can be replicated in other practices.”

Achieving the Big 3

Economic pressures make purchasing decisions weightier than ever. Dr. Noreika approaches his decision with a concrete set of criteria in mind. “For new technology to justify investment, first and foremost it must improve patient outcomes compared to our existing devices,” he says. “Beyond that clinical advantage, the investment only makes sense if it meets three measurable objectives: it saves time, saves money and enhances value and satisfaction for the patient.”

According to Dr. Noreika, the EPIC improves outcomes and it excels at all three goals. The clinical advantages include not only very accurate refractions, but also enhanced data for diagnosis, surgical decision-making and post-operative evaluation.

It’s clear to Dr. Noreika how the EPIC saves time and money. “We use it on all new patients, saving time over manual refraction. Surgical workups also take less time because patients are afforded a variety of tests at a single workstation. The need to move patients, a measurable source of wasted time, is kept to a minimum,” he explains. “Money is saved in many ways with the EPIC – most notably in time saved and the ability to use staff with less expertise to perform the straightforward yet sophisticated procedure.”

The EPIC also meets Dr. Noreika’s third goal, enhancing the patient experience with the technology’s “wow factor.” When people come in for their exam and see the EPIC, they recognize that the practice embraces cutting-edge technologies. This helps differentiate it from the competition, particularly commercial vision care providers. Dr. Noreika finds that this also results in referrals, as patients tell their family and friends. In this sense, the EPIC is part of the practice’s internal marketing efforts. It impresses patients and attracts new customers through word-of-mouth without the added cost of media advertising.

Opticians Performing Refractions

“Staffing is my largest cost center,” Dr. Noreika observes. “Cross training is a way to make the most of that cost by enabling staff to work where they’re needed during periods of downtime or when a coworker isn’t available. The ease of training and use of the EPIC has allowed me to take cross training to a new, more profitable level.”

Dr. Noreika has trained all three opticians in his practice to perform refractions with the EPIC, a task which they have readily adapted because of their familiarity with optics. By performing the refraction, the opticians have an unprecedented opportunity to “own” the vision correction process from start to finish. They spend about 10 minutes preparing the patient and performing the EPIC refraction – 10 minutes in which they also establish a relationship and identify the patient’s vision needs. Next, they hand the patient over for the clinical examination, and then reunite afterward to transition to the optical area.

By guiding the patient through the entire visit, Dr. Noreika has found that the opticians significantly enhance the capture rate. At a time of decreasing reimbursement for clinical services, it’s an enormous benefit to grow the dispensary’s economic contribution in this way. Patients benefit as well because the opticians better understand their individual needs. For example, one optician is dedicated to refracting all post-operative cataract patients, walking them through the process, from determining their optical needs, performing the EPIC refraction, selecting frames and lenses and finally to dispensing a product.

“The role of our opticians has become a key piece of the practice’s efficiency,” states Noreika. “I’m surprised I didn’t implement this sooner, but I couldn’t have cross-trained opticians to do this with a manual phoropter. The EPIC creates this valuable opportunity while reducing the dependence on hard-to-find, highly compensated technicians and optometrists who had performed our refractions in the past.”

Another advantage of this model is an increase in the opticians’ job satisfaction. According to Noreika, other personnel who are cross-trained on the EPIC like their jobs better, too. “One of my most important staffers who had more than 20 years vested in our practice needed a change from her administrative role. She is now our best refractionist. Her work has been revitalized, and rather than losing her, I gained an asset.”

Premium Expectations

Another challenge facing ophthalmologists in all areas of practice is the entwined nature of technology and expectations. For example, cataract patients have far more choices today than they did even 10 years ago. Standard, toric and multifocal IOLs and limbal relaxing incisions have the potential to deliver unprecedented vision after surgery. Therefore, patients expect to be wowed by their vision after surgery, and they don't want to encounter unforeseen issues. The high out-of-pocket price tag for premium IOLs cements those expectations. There is little margin for error.

Dr. Noreika has found that the EPIC is critical for patients who choose premium IOLs because the pre-operative workup leaves little room for error. An accurate refraction, corneal topography and wavefront analysis, combined with accurate A-scan axial length ultrasonography and OCT help him achieve the best outcomes.

To balance the clinical advantages of technology against its cost, the practice prequalifies patients for premium IOLs. “When we identify the need for surgery, we give patients a thumb drive that explains their premium lens options, the processes involved, and the cost. Our senior citizens have become digitally adept; they review the information at home and share it with family,” says Dr. Noreika. “Once a patient’s interest in a premium lens solution is determined, their decision guides the next step in the process.”

At the cataract surgery workup visit, patients with an interest in premium lenses follow one protocol while patients who want standard lenses follow another. For example, premium lens patients get an OPD scan and more time for face-to-face discussion with the doctor.

The high standards for outcomes change the postoperative model as well. In Dr. Noreika’s practice, opticians perform the post-op refraction, directing both premium and standard lens implant patients through the EPIC and the OPD, and then meeting up to assist the patient in the optical dispensary after the clinical exam.

Dr. Noreika says that this post-op visit is a key juncture in ensuring patient satisfaction. “The last thing I want is to perform successful surgery and then have the patient experience issues with their eyeglasses,” he says. “If eyeglasses are required after cataract surgery, our office will supply them, which means the limiting variables are the quality of the refraction, the selection of frames, the lenses and their fitting. The EPIC and the opticians remove these question marks. And I avoid the expensive proposition of spending 20 minutes listening to a patient who has eyeglass problems.”

Positioned for the Future

In addition to its significant clinical and financial benefits today, the EPIC is a keystone of Excellence in Eyecare’s strategic plan for future profitability. Dr. Noreika says that the Affordable Care Act means that vision care providers will have to accommodate many more patients, while the newly insured patients will be younger and healthier because older patients already have health insurance through Medicare.

“The EPIC is an excellent fit for this situation. Not only does it help us see more patients efficiently, but the refraction is quickly performed on those younger patients. At the same time, this patient cohort embraces technology and has high expectations. The EPIC excels here as well,” he says. “All in all, I know that the EPIC has meaningful clinical and financial advantages today. I’m confident that it will be increasingly useful in a changing and unpredictable healthcare environment.”

J.C. Noreika, MD, MBA, is Managing Partner at Excellence in Eyecare, Inc., Medina, Ohio.