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Optometrical Practice Management Monthly Newsletter - Tips & Reviews. Volume 4. September 2005

Business Tip: Charging Outside the Medicare Schedule for High Tech Instruments.
Finally the grey area is now black and white.  An optometrist can charge for their consultation time and separately charge for the use of a diagnostic instrument such as a digital retinal imaging camera. 

Read on for more.


 

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Therapeutic Review: Contact Lens induced inflammations and infections.
Most of the red eyes we encounter in clinical practice are either contact lens induced or viral.  This month we will discuss the contact lens red eye.

More Detail.



 

Product Review:
The Etnia Barcelona frame range from General Optical really makes a difference in our practice. The colours are irresistible.
Read on and find out why.

Enquire here for information from General Optical

 

 


Business Tips: Charging Outside the Medicare Schedule for High Tech Instruments.
This is probably the most important business decision you can make for your future.

We have been charging outside the Medicare schedule for more than six years. 

I have always been confident that the use of high tech instrumentation could be billed outside the schedule and therefore did so.

All billings have been for diagnostic instrumentation that are used outside of the consultation room and are delegated to our staff to perform. Examples of these are:

  • Screening Visual fields
  • Threshold Visual fields (there is now a Medicare item for this)
  • Digital Imaging of the optic nerve and the posterior pole
  • Corneal Topography
  • Corneal thickness
  • Tomography of the optic nerve and/or macula

To successfully implement the billing of consultation fees outside the umbrella of Medicare one needs to educate the patient in the consultation room on exactly what each test entails and its specific purpose. Personally I believe it is imperative to perform computerised visual field screening and a digital image of the posterior pole of every patient at least every three years.  In our practice a fee of $68.75 is charged and individually itemised as not rebatable from Medicare.

   

Many practitioners have said that it is viable in my practice because I am in the city centre. The reality though is that I have many, many pensioners that travel into the city and they happily pay out of pocket because they perceive value in ruling out eye disease using high tech instruments.

Any patient that is a glaucoma suspect, has diabetes or has the beginning of macula degeneration is immediately scanned using our StratusOCT (yes even our pensioner patients). Our fee for this is $95.  Approximately 40% of my patients now pay $200 plus for their consultation. It has nothing to do with my practice being in the city.

My billing outside Medicare started six years ago. By the 4th year it was common for patients to ask for the photo of the back of their eye. They came to expect it.

From tomorrow you need to buy a new instrument and start charging for it. Your only pre-requisite is to believe that it adds value to the testing process. Once you believe it, your patients will believe it and eventually expect it.

From a business perspective the most important piece of equipment that can be used outside the consultation room is the retinal digital imaging camera. A high resolution image of the retina is not only your best protection against medico-legal problems but also is a wow factor for the patient. If I was purchasing a camera today, I would probably go for the Zeiss Visucam. Soon to be networkable, it would link with our OCT and Matrix Visual Field Analyser to form one searchable database.  This could be called up through our practice management software, so we could have all scan and test results at a press of a button.

   

Don't do what I did. I spent 3 months psyching myself up and fearing that my patients would leave me in droves. Some of my consultation only patients did leave, but most of these non-productive patients stayed on. They still did not purchase product from me but at least now I was earning a reasonable remuneration for my time. The patients that did purchase product, also were happy with the extra consultation fees. They are now definitely getting the best possible eye examination and can be sure that if anything was astray it would not be missed.

Register for Business 2005. This seminar in mid-October will concentrate on charging outside the Medicare schedule, nurturing productive, responsible staff and take home business tips that are bound to increase your efficiency and your bottom line.

 

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Therapeutic Review: Contact Lens induced inflammations and infections.

This is an extremely important subject in the current climate. This is because we are currently evolving into ocular therapeutics and the increased use of silicon hydrogels and continuous wear modalities have significantly enlarged the frequency of inflammatory incidents that we see in our practices.

Contact lenses currently belong exclusively to optometrists. We therefore need to protect this important slice of clinical practice and do everything we can to increase its presence in the market place. To do this we also need to be competent in dealing with the occasional inflammations that can occur.

Dealing with these inflammations are relatively easy depending upon corneal presentation.

If we have minimal corneal involvement look at:

  • Dry eye
  • Do lid eversion to rule out GPC (more common with silicon hydrogels)
  • Enquire into current cleaning regimen, as solution toxicity occasionally pops up.
  • Be suspicious of home brand solutions, as the formulation can change, whilst you and the patient think they are still using the same product.

Treatment with minimal corneal involvement:

  • For GPC, discontinue contact lens wear and start treatment using a mild steroid like FML tid and a mast cell stabiliser such as Zaditen or Patanol bid.

                       

  • Continue for a minimum of 10 days and then reintroduce a different design lens, which will have a different edge profile and in most cases be less likely to flare up the lids.
  • For solution toxicity look for diffuse superficial epithelial staining and a papillary response of the lids. Discontinue current solution, change to another and a fresh set of lenses. Depending on sensitivity I often find that a 5 minute soak in an unpreserved sterile saline such as Lens Plus before lens insertion works miracles in making lenses comfortable all day.

If we have corneal involvement look for:

  • Inflammation and swelling around the limbus. This is called limbitis and responds beautifully to mild topical steroids tid, as it is an immune response.
  • Peripheral corneal infiltrates and more central infiltrates cause the most confusion, as we now have a decision between an infective or inflammatory process.
  • There are many recipes for this, but one that I have found useful is taken from:
  • Trans Am Ophthalmol Soc. 1995;93:49-60; discussion 60-4;
    Peripheral corneal infiltrates associated with contact lens wear.
    " Peripheral corneal infiltrates in contact lens wearers appears to be more common in patients wearing extended wear soft contact lenses. While often considered "sterile" in the literature, a significant number have been shown to be culture-positive. The organisms that have been associated with peripheral infiltrates appear to be less "pathogenic" than those that have been reported to be associated with central corneal ulcer. However, it is probably advisable that patients with peripheral corneal ulcers secondary to contact lens wear should be initially treated with topical antibiotics."
  • Even though the vast majority of infiltrates are inflammatory and just prescribing a steroid would be appropriate in most cases, this piece of literature is important from a medico-legal perspective. Depending on the presentation I will start corneal infiltrates on a bacteriostaitic antibiotic such as Chlorsig qid for a few days. A fluroquinolone such as Ciloxan qid for a couple of days will be used if my suspicion level of bacterial infection is high.
  • With peripheral infiltrates the introduction of a steroid such as FML or Flarex 2 days later qid will immediately suppress the inflammatory component, but remember to continue with the antibiotic for prophylaxis.

Peripheral infiltrate                              Severe Pseudomonal infection

 

  • 10 days of treatment is usually more than enough to clear the peripheral infiltrates.
  • Central infiltrates or ulcers are trickier, as you don't want to be sitting on a pseudomonal infection near the visual axis. Start the patient on Ciloxan every 15 minutes and refer these cases to a corneal specialist, as soon as possible.
  • Other rare conditions in the differential diagnosis are:
    • Herpetic keratitis
    • Fungal keratitits

Herpetic Disciform Keratitis                 Fungal infection

Contact Lens induced inflammation will be discussed in detail in a future day seminar devoted entirely to introducing ocular therapeutics to your practice.

Register you interest for this here

 

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Etnia Barcelona is available now from General Optical. Arrange for one of the General Optical frame representatives to visit your practice as soon as possible and freshen up your whole optical display.

Phone: (02) 9699 8080 

Send enquiry now and

Visit www.etniabarcelona.com

David Pellicer Ramo - designer of Etnia Barcelona


Product Review: Etnia Barcelona from General Optical

Etnia Barcelona is a recent launch of new designer optical frames in the Australian marketplace and our practice was one of the first to take on this fresh and vibrant collection from General Optical.

What caught our attention were the brilliant colours. At the time (about 6 months ago) we were looking for a range that could slot in for the younger patients aged 16-25. This group tends to look for something funky yet reasonably priced. The Etnia range fitted our profile perfectly.

Etnia Barcelona is a range that incorporates fresh, vibrant colours and new colour combinations. The frames are simple yet stylish in design and very light and comfortable to wear.

This range has had so much attention since we introduced it into our practice. To our surprise, the Etnia Barcelona range took off as soon as it arrived. In fact we had not yet priced it when we sold our first frame.  My daughter wears two different pairs and three of her friends have come into the practice from the suburbs to specifically purchase Etnia frames.

Our initial motivation was to find a range for our youth market, we have been most surprised at how well it has served a wider age group right up to the 50 year olds. Let's face it, the baby boomers today are significantly more active and want to look youthful. The luminous colours and modern style of the Etnia range not only appeals to the youth but also the young at heart.

To date our youngest patient wearing Etnia is 12 years of age and our oldest patient is 54.  I think the reason for its appeal is that they are hip and funky on the young yet fun and fresh for the mature individual.

It is amazing how much attention the Etnia range attracts; patients can’t help but to try these exciting frames on.  With virtually every frame selection that occurs in our practice, we find that one of the Etnia frames is on the short list.  What this tells me is that not only is this range extremely popular, it also helps differentiate our practice; having modern, exciting frames to choose from.  There is no doubt in my mind that the introduction of Etnia Barcelona at The Eye Practice, our patients are more likely to purchase their new eye wear from our dispensary, even if the choice is not an Etnia fame.  This range just spices up our whole retail area.

Call General Optical today on (02) 9699 8080.

 

 

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