What You Need to Get Started

Implementation of dry eye care into today’s busy practice

At Bowden Eye & Associates, we provide a range of premium services, but we don’t consider our dry eye care to be a premium service. We consider it a necessary medical service, provided in a premium manner. While we’ve grown into quite a large practice, even the smallest practice should have a dry eye component. You don’t need to be a full-service specialty dry eye office that offers comprehensive diagnostics, treatments, and products. You could choose to share care by diagnosing dry eye and offering related products but referring out for treatments. Or, you could choose to be purely referral-based by recognizing the condition and referring out for treatments and products. Whichever type of dry eye practice you choose to be, ensuring that your patients receive the dry eye care they deserve is of the utmost importance.

So, how should you begin? The good news is you already have the necessary first component: the patients. They walk through your door every day.

Use the Five Ps as Your Road Map

In order to truly treat dry eye in your practice, you have to look beyond the patients who present with red eyes. Not all cases of dry eye involve red eyes, or any symptoms at all for that matter. Every patient is a person potentially in need of dry eye treatment, and to identify and help them you need to have in place your people, products and diagnostics, procedures, process, and payment process (Figure 1).

Figure 1: In order to treat dry eye in your practice, you need the 5 Ps: people, products and diagnostics, procedures, process, and payment.

PEOPLE

For a practice to successfully treat dry eye, its leaders need to develop clinical protocols, i.e., a standard of care. All staff members need to be trained and engaged in that standard of care. It helps to have an administrator who can make things happen. As our practice’s CEO/administrator, I’m quite strict in this regard. I expect that if we put a protocol in place, everybody on the team is going to learn the protocol, and everybody on the team is going to follow the protocol. Otherwise, patients aren’t being fully cared for and revenue and outcomes become subpar.

Patti Barkey, CEO, COE
Bowden Eye & Associates Jacksonville, Fla.

It’s important to appoint someone to the role of implementer of the dry eye program. This person should direct the dry eye services by making sure all of the parts are in place and running as intended. When anything new is added to the standard of care, he or she shares the message with the rest of the staff and ensures that the patients are receiving the right messages, too. If something isn’t working smoothly or as intended, the implementer is the one to figure out how to change it. A counselor should be part of a practice’s dry eye culture as well. A cataract counselor can take on this role. It isn’t difficult for someone in that position to learn how to educate patients about dry eye.

It’s worth repeating that staff buy-in and education are crucial, and training needs to be ongoing. All of the vendors who have dry eye products on the market offer training and related resources. Take advantage of that. If you’re making a purchase with them, rely on them to help make it work for you.

PRODUCTS AND PROCEDURES

Comprehensive dry eye care requires a practice to adopt a portfolio of products, not just one, in order to accurately diagnose dry eye and treat it in all its forms.

Having a nutritional supplement to recommend in order to address the root of the condition is important. We chose HydroEye (ScienceBased Health) for our practice and have utilized all of the training, webinars, and so forth, the company provides to help staff members understand the product.

Your providers must be prepared to address blepharitis and meibomian gland dysfunction (MGD), and for that purpose we find BlephEx (Rysurg) effective for lid exfoliation and discouraging demodex and easy to incorporate. We also consider the in-office Cliradex Complete Advanced Lid Hygiene Kit (Bio-Tissue) to be essential for managing demodex as well as blepharitis, MGD, rosacea, dry eye, chalazia, and other lid margin diseases. Each kit comes with eyelid and eyelash cleansing wipes for patients to take home. And one of the most effective therapies for MGD is LipiFlow thermal pulsation therapy (TearScience), which we use in our practice as well. Punctal plugs are a proven treatment for dry eye and we’ve also added to our arsenal the Prokera Slim biologic corneal bandage (Bio-Tissue). This cryopreserved amniotic membrane device contains hormones, growth factors, and antimicrobials that work together to expedite healing of a damaged corneal surface.

On the diagnostic side, in addition to osmolarity testing (TearLab), we find meibography to be an indis-pensable tool. The LipiView II device with Dynamic Meibomian Imaging (DMI) (TearScience) not only gives our doctors a way to quickly assess meibomian gland structure and function, but also has been amazing for helping us to demonstrate for patients why they need treatment and opt to have it.

PROCESS

In our practice, the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire begins the dry eye standard of care process. The technicians fill it out with the patient. From that, they glean what to do next. For example, does the patient need an InflammaDry test (RPS)? Does the patient need DMI?

Other advice I give about the dry eye care process is that it’s necessary to decide how you’ll inventory the products you’d like patients to use. Along with that, you don’t have to limit the items you offer to just one per category. For example, we sell several types of eye masks (Eyeeco; Bruder; or Fire and Ice, Rhein Medical) because our patients like to choose which type they want. Furthermore, you can package certain products, such as lid wipes or gauze pads, and send them home with patients so they have everything they need to begin their at-home therapy. You can tie this into your marketing by creating a branded bag to use as your packaging.

PAYMENT

Being paid for the dry eye services and products you offer is, of course, crucial. Some are patient-pay and others are covered by insurance. I encourage any practice that is serious about dry eye care to not worry about that.

Don’t avoid using a product or treatment you feel would benefit your patients only because insurance isn’t covering it. Set your standard of care and set your fee structure and get started.

File what you can with the carriers, know what you can’t file, educate patients about the importance of the test or therapy, have them sign advance beneficiary notices when necessary, and collect your fees.

Be Ready to Greet the Future

At our practice, we feel strongly that eventually everyone in the community will soon recognize the importance and benefits of providing real dry eye care.

In the meantime, we’re happy to have our strategy already in place as an early adopter so our patients are getting the care they need and we’re expanding as a result. ■