Management Essentials

Are We Taking Refraction for Granted?

For patients, this seemingly basic task defines your approach to care.

By Farrell “Toby” Tyson, MD, FACS

For many ophthalmologists, refractions are the drudgery of the profession. But those who dread the phrase “which is better one or two,” may be surprised to learn this frequently performed, yet undervalued, procedure is slowly changing the way we administer care. It has slowly morphed over the last decade from a small part of our exam into a major component.

Rising Costs

This transformation of the refraction has taken place because, in Medicare’s attempt to pay less, the refraction has been deemed an uncovered procedure. For years, we have charged patients a minimal amount for this procedure, only to incur their wrath as they argue that it has always been covered. The ultimate indignation is that, to get reimbursed for a cataract surgery, we must have documentation of a preoperative refraction and visual acuity. It’s a required diagnostic procedure and yet, it is considered uncovered.

Over time, reimbursements for eye exams and other diagnostics have seen their reimbursement levels drop. To help offset those financial cuts, practices have slowly increased their refraction fees. As a result, the refraction fee may comprise 50% or more of the exam fee. With drastic cuts coming this year, practices may need to reconsider their refraction fees.

True Value

First, a practice needs to understand the value of the refraction. It is not merely a script for glasses. For patients, it is a life-altering formula with true value. If it is performed half-heartedly, the result will be sub-par. The result is unhappy patients and a wounded reputation for your practice.

In addition, it could cost you money by increasing remakes in your optical and repeat refractions in your clinic. On the other hand, a well-performed refraction can be a highlight of your practice where personal care and attention can be showered upon the individual because of the interactive nature of the exam.

Not a One-Size-Fits-All Test

One type of refraction does not “fit all.” Just as there are different levels of intraocular lenses, there can be different levels of refractions. The refraction most of us associate with a basic eye exam is performed on the majority of patients. Ophthalmologists, optometrists and even trained technicians can perform these refractions and price them on the more moderate side.

The next step up is the advanced refraction, which is usually only performed by ophthalmologists, optometrists and some COMTs. Advanced refractions are much more time consuming and involve the use of prisms. Due to the extra effort and the increased likelihood of remakes, this refraction justifies an increased fee level.

Finally, there are low-vision refractions, which are extremely time and labor intensive. They can take up to an hour of an ophthalmologist’s or optometrist’s time and require adequate, upfront counseling with the patient to explain the nature, depth and cost involved. Under these circumstances, most patients will be extremely impressed and grateful with what they consider the best refraction of their life. They were not just rushed through, but were directly involved in the betterment of their quality of life.

Keep Patients Coming to You

Now, with the advent of online eyewear sites, more people are looking to save money by bypassing both your optical and your local competitors. This trend starts to affect your practice when patients start inquiring about their pupillary distance or PD. One needs to remember that measuring the PD is neither part of the refraction nor eye exam. It is part of the eyeglass dispensing process and one component in the price of eyeglasses. A practice does not want to be responsible for a pair of online glasses that were never fit properly or the proper lens selected by a licensed optician.

The refraction is the first impression of your practice for most of your patients. It is important that it is treated with the appropriate professionalism it deserves. Performed correctly, the refraction can easily justify a significant portion of your fee and drive business in an ever-tightening economic climate. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.