Helping patients who have diabetic eye disease maintain their best vision for a lifetime is a team effort, involving not only the expertise of physicians, but also the support of every staff member who interacts with patients.

We teach patients about potential vision-threatening complications, explain how they can minimize their risks, and describe what we can accomplish with today’s therapies. While we strive to be supportive and encouraging, we also emphasize the importance of adhering to scheduled follow-up visits and treatments and, of course, maintaining control of their diabetes.

We start preparing our staff for these important interactions as soon as they join the practice.

Consistent, Well-informed Messaging

Typically, new employees view a series of training videos — BSM (bsmconnection.com ) has some good options — that explain the basic science of ophthalmology. Specific to diabetes, we make sure everyone has at least a rudimentary understanding of the findings from the Early Treatment Diabetic Retinopathy Study, particularly the emphasis on controlling blood glucose levels.

Having everyone on the same page from the beginning ensures that patients hear the same information from any member of our staff, because as we know, consistent messaging, whether delivered verbally, in print, or online, avoids confusion and is easier for patients to retain.

Continuing education is an important aspect of our staff education, particularly in the field of diabetic eye disease, as we have seen rapid advancements in both treatment and imaging technologies. We offer a number of educational opportunities for our staff; some we require, and some are optional. For instance, we schedule monthly conferences that may include training sessions or lectures by invited speakers — clinical experts or representatives from pharmaceutical or device companies — who present information on the latest developments in the field.

Our involvement in research also offers our staff some unique educational opportunities, as we provide monthly updates on our current clinical trials. This gives the team a preview of what’s in development, and it also highlights how every member of the practice is contributing to the future of eye care. The knowledge and enthusiasm of our staff instill confidence and optimism in patients undergoing treatment.

Efficient, Accurate Imaging

The value of imaging in a retina practice cannot be overstated. Not only do accurate, timely scans and photographs drive every treatment decision, but our staff’s proficiency with this technology ensures smooth patient flow, improving efficiency, and the patient’s experience.

OCT is the workhorse imaging technology in most practices. We use it for almost every patient at almost every visit, which is why everyone in our clinical practice is trained to use our Cirrus OCT (Zeiss).

Fluorescein angiography is also essential in a retina practice. Two or three people in our main clinic and one person in our satellite clinic are specifically trained in-house by our head photographer to perform fluorescein angiography with our Optos widefield technology.

Staff members who perform diagnostic testing are also qualified to scribe and perform patient workups, which adds to our efficiency. As you might expect, cross training is important in our practice. A dedicated member of our staff is responsible for ensuring that all staff members are trained on all of our systems and equipment, including EMR, inventory, patient tracking, and diagnostic equipment. They are required to maintain their COA certifications and to stay current with software updates.

Financial Assistance Expertise

For the most part, patients being treated for complications of diabetes are working-age adults, who must navigate the sometimes confusing, often overwhelming world of private healthcare insurance. Our staff is trained to help.

Given the high cost of the medications we use to treat diabetic retinopathy and DME, we strongly encourage all patients, regardless of their perception of their financial need, to apply for assistance from the various pharmaceutical companies. Our surgical coordinators guide them through the process.

Genentech has several options to help patients pay for ranibizumab (Lucentis) through its Lucentis Access Solutions program. Eligible patients may be referred to the Lucentis Co-pay Program or independent co-pay assistance foundations for help with out-of-pocket expenses. The Genentech Patient Foundation provides free Genentech medications to people without insurance coverage or who have financial concerns and who meet income criteria.

Regeneron helps eligible patients receive aflibercept (Eylea) through its EYLEA4U program. Patients must demonstrate financial need, and they must re-enroll annually for this program. Both Alimera Sciences, maker of a fluocinolone acetonide intravitreal implant (Iluvien), and Allergan, maker of a dexamethasone intravitreal implant (Ozurdex) offer similar assistance programs.

While each company’s level of assistance and criteria for eligibility may differ, we believe it is worthwhile for all patients to apply. One study found that patients with DME incurred $20,000 to almost $30,000 in annual inpatient, outpatient, and pharmaceutical expenses.¹ Annual costs for patients with DME and vision impairment were even higher, ranging from $27,000 to $42,000.¹

Inventory Management

The branded drugs we use to treat diabetic eye disease cost anywhere from $2,000 to $8,500 per dose. An automated inventory management system along with due diligence by staff helps us avoid costly errors that can impact a patient’s out-of-pocket costs or the practice’s bottom line.

We use PODIS (besse.com ), a system that automatically orders medications and uses barcode technology to track each dose from delivery to receipt of payment. It labels drugs that are patient-specific, integrates with our EMR system, and verifies that patients are being treated at appropriate intervals.

While this system streamlines inventory management, saves time, and helps us maintain tight control, we still rely on staff to ensure accuracy. Each scribe is responsible for managing the drug inventory for that day. They match each patient with the prescribed drug through the PODIS system and at the end of the day, our front desk supervisor and our technical supervisor review the day’s activities as a final check.

Value of the Care Team

Our team approach to caring for patients with diabetic eye disease starts even before a patient arrives at the office, with scheduling and insurance verification, and continues through until checkout. To be successful, it takes a team in which every member adds value to the patient’s experience.

Having staff members who understand all aspects of the diabetes journey reassures patients that they are receiving the best care possible. This helps patients feel that their experience is worth their time and helps to ensure that they will return for their next visit. ■

Reference

1. Lanzetta P, Van Nuys K, Tran I, Gallagher M, Colman S, Lakdawalla D. The economic burden of diabetic macular edema from a U.S. private payer perspective. Invest Ophthalmol Vis Sci. 2011;52(14):5532.