Do You STILL Need Technology? DO YOU STILL TECHNOLOGY? The Challenges in The Challenges in FEC s Production Reports 2012

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1 DO YOU STILL TECHNOLOGY? Craig Thomas, O.D West Wheatland Road Dallas, Texas (972) NEED Do You STILL Need Technology? Why do we need to buy technology like a $10,000 autorefractor when the retinoscope they made me buy in optometry school still works just fine? The Challenges in 2013 The Challenges in 2013 Increased competition from ophthalmologists Refractive surgery Presbyopia surgery Increased focus on primary eye care Constant efforts to take away from our scope General shenanigans Increased control from vision insurance plans Increase in low-pay to no-pay vision plans Increase in closed-panel medical plans Increased difficulty in controlling the delivery contact lenses Internet sources Corporate sources Increased competition from optometrists New optometry schools New technologies to increase productivity Increase in regulatory audits from all entities of FEC s Production Reports 2012 New Technology Acquisition Procedure Quantity Fees Specular Microscopy 425 $ 45,152 (25%) Visual Field Examination ,608 Retinal Laser Scans ,804 Visual Evoked Potential Tests ,767 Fundus Photography ,309 B-Scan Ultrasound 46 4,210 Total Diagnostic Testing $ 177,269 (10%) Total Production $1,769,000 (down 2.8%) 2008 Accutome B-Scan 2009 Konan specular microscope 2010 Carl Zeiss Meditec CIRRUS OCT retinal laser 2010 Topcon autolensometer 2011 DIOPSYS VEP Testing Device 2011 icare indentation tonometer 2011 TelScreen slit-lamp imaging system 2011 Accutome UBM (anterior segment ultrasound) 2011 Konan RAPDx automated pupillographer 2011 Carl Zeiss Meditec FORUM Data Management 2011 Electronic Health Records (certified*) 1

2 Return on Investment Paperless Electronic Workflow Front-End Money Back-End Money Practice Management Software Diagnostic tests 10% of gross income Improved office productivity allows patients to be seen faster Improved office productivity allows more patients to be seen Improves office efficiency Reduces costs Helps achieve practice goal of having a Paperless Electronic Workflow OfficeMate Electronic Health Records (certified) ExamWriter Image Management System FORUM Eye Care Data Management Connects all your diagnostic systems central server-based software in a Electronic Health Records The HITECH ACT 2009 Economic Stimulus Bill Law includes incentive payments for doctors to use certified electronic health records (EHR) Doctors must show meaningful use health information technology of Medicare payments will be eventually reduced for doctors that do not adopt a health information technology system Electronic Health Records Doctor, Are My Eyes Healthy? 26 years of paper Paperless conversion began on 8/28/ square-foot office 17 computer stations I have replaced everything at least once since I started I have replaced some things twice (e.g. servers, work stations) Estimated costs = $100,000 Estimated grief = priceless Return on Investment Less office supplies to buy Less office staff* More efficient operations* Meets patient expectations Meets industry guidelines Connectivity to patients Produces incentive payments $54,000 in 2012 to our practice $36,000 in 2013 to our practice 2

3 Medically Necessary Services Optical Coherence Tomography The clinical application of diagnostic testing is the documentation and treatment of any pathological conditions that affects the eye, adnexa, and/or the complete visual system The evaluation of abnormal ophthalmologic and/or symptoms The evaluation of abnormal neurologic signs and/or symptoms The treatment of known ophthalmic disease The treatment of known ophthalmic injury signs CPT codes and Costs = $40,000 to $75,000 5-year lease = $1,200/mo Average fee = $45 Glaucoma and glaucoma suspect Diabetes and diabetic retinopathy Macular degeneration Neurologic disease Visual disturbances ROI = 1-2 patients per day Return on Investment Do you have 1 patient per day that you think may have something wrong with them? Approx $45 per test reimbursement 1 test per day will pay for the instrument 2 or more tests per day will make money Cost of having an OCT? Cost of practicing without an OCT? B-Scan Ophthalmic Ultrasound B-scan ophthalmic ultrasound uses transducer scanning and electronic processing to image the internal structures of the eye and orbit CPT code is Cost = $9,000 5-year lease = $300/mo Average fee = $97/eye ROI = 4 eyes per month Clinical Indications for B-Scan B-Scan ophthalmic ultrasound is used when clouding of the ocular tissues prevents proper visualization and examination of the structures of the eye To determine the composition and contours of ocular and orbital structures To evaluate the retina when a dense cataract prevents good visualization To evaluate patients with vitreous floaters, deposits, hemorrhages, and/or degenerations Patients with the signs and/or symptoms of retinal detachment Specular Microscope Computer-assisted morphometry to analyze the size, shape and population of endothelial cells CPT code is Cost = $12,000 to $29,000 5-year lease = $490/mo Average fee = $85 ROI = 2 patients per week 3

4 Clinical Indications for Specular Tests Anterior Segment Imaging (OCT) Identification and follow-up for patients who: Have the signs and/or symptoms of corneal disease Preoperative risk assessment Postoperative management Uveitis Subjective visual disturbances Glaucoma Eye injury Wear or want to wear contact lenses Angle of the anterior chamber Non-contact technique Measure angle width Assess iris configuration Determine if there is an obstruction to the aqueous outflow mechanism Determine risk of angle closure Classify glaucoma type Anterior Segment Imaging (OCT) Topcon Auto Lensometer CPT code is Average fee = $36 Lens-induced angleclosure is a common cause of increased IOP in older people Increased lenticular thickness pushes the iris forward Best treatment option is cataract surgery Cost = $4,000 Average fee = $0 ROI is on the back-side Increased efficiency on something we do times per day in my office Decreased errors Integration into electronic health records Visual Evoked Potential Testing Device CPT code is Cost = $40,000 5-year lease = $750/mo Average fee = $167 ROI = 5 patients per/mo VEP testing measures the speed and strength of the visual evoked response along the visual pathway Clinical Applications of VEP Testing As with all ancillary tests, VEP testing may be considered reasonable and medically necessary based upon the following: Patient symptoms Clinical signs of illness Clinical signs of injury In diseases that affect the structure and function of the afferent visual sensory system, visual evoked potential testing is performed to assess the integrity of the visual pathways 4

5 icare Indentation Tonometer Slit-Lamp Digital Imaging Cost = $3,950 Average fee = $0 Cost per use = $0.82 Have you ever been puffed No topical anesthesia No fluorescein needed More accurate Better patient acceptance Better patient attitude CPT code = Cost = $20,000 New photo slit-lamp New Computer Stand-mounted monitor Software 5-year lease = $660 Average fee = $25 ROI = 30 patients per month Anterior Segment Ultrasound (UBM) Clinical Indications for UBM CPT code is Plateau iris syndrome visualized with ultrasound biomicroscopy Costs $15,000 to $25,000 5-year lease $450 to $600 Average fee $101 per eye Return on Investment 4 eyes per month High-risk glaucoma suspect Anatomical narrow angle Glaucoma associated with angle anomalies Relative pupillary block is the most common form Aqueous pressure behind the iris plane forces the iris forward and obstructs the aqueous outflow mechanism Best treatment option is peripheral laser iridotomy Convex iris plane configuration RAPDx Expanded Pupil Diagnostics Benefits of RAPDx Testing Automated pupillographer designed to detect a relative afferent pupillary defect No CPT code Cost = $19,950 5-year lease = $332 Average fee = $0 ROI = 1 new diagnostic work-up per month When used in a screening mode, the RAPDx may enhance your ability to detect glaucoma and other eye diseases RAPDx technology represents a paradigm shift in pupil testing Remarkable sensitivity for detecting glaucoma Sensitivity = 81% Specificity = 90% RAPDx results correlate with VF and RNFL tests Significant wow factor Chang DS. The Detection of Glaucoma Using Pupillography. Glaucoma Center of Excellence & Dana Center for Preventive Ophthalmology. Wilmer Eye Institute. Johns Hopkins University. Baltimore, Maryland

6 Streamline Your Workflow FORUM Data Management Save Time Digital communication between instruments with FORUM Eye Care Data Management System All exam data stored to the FORUM Archive All exam data accessed with the FORUM Viewer Save Space Less storage space needed, no filing cabinets Save Costs Reduced annual costs for ink, paper, toner Data Archive FORUM Viewer Combined Report: Visual Field & RNFL Facilitates clinical case visualization Prepares ophthalmic data and images a specific manner for specific visits in Provides fast, at-a-glance comparisons of ophthalmic data from different technologies Presents data in case-specific clinical displays Combined reporting Comparative analysis Glaucoma progression Doc, you sure have some technology Patient History / Preliminary Testing Procedures are usually performed by staff RAPDx or corneal topography results displayed on FORUM Viewer Discussion of the test results is a good way to begin the examination RAPDx test results displayed with FORUM software 6

7 Clinical Case Visualization Clinical Case Visualization FORUM Combined Report At-a-glance Comparisons of Data Implementation Process Practice Benefits FORUM Image Management System Two or more viewing stations Connection to electronic health record system Helps in medical decision-making Faster data acquisition Multiple visits viewed at once Easier side-by-side comparisons Better decision-making Connection to diagnostic instruments On-site installation and training Several days to weeks of computer guys Wow factor is off the chart Patient education Staff training Doctor consultation 7

8 Web-Based Practice Resources DecisionMakerPLUS.com DecisionMakerPlus.com Uses an online platform to deliver health information at the point-of-care Patient education Staff training Evidence-based reference sources Improve medical decision-making skills Narrow gaps between knowledge and practice Improve patient outcomes DecisionMakerPLUS.com Benefits Case Report Directory Interpretation and reports Billing and coding CPT Code Directory Documentation requirements Covered diagnoses Coding guidelines Utilization guidelines Approved fees Disease Glossary Natural history Classification Differential diagnoses Treatment guidelines EyeForms Examination forms Disease assessment Informed consent Operative reports Improve patient outcomes with clinical support from experienced eye doctors Eliminate billing and coding mistakes Increase reimbursements without seeing more patients Deliver web-based patient information via doctor or staff Access evidence-based resources to help with your medical decision-making Protect your practice from audits and recoupments Point-of Care Doctor Consultation Point-of-Care Doctor Consultation 8

9 Staff-Oriented Patient Education Staff Training Return on Investment We Are Done! Cost = $2,499 for a one-year subscription ROI is on the back-side Wow factor is extremely high Modern patients want modern communications No more expensive or inaccurate brochures No more manuals or books to carry around Real images of real patients no drawings, cartoons or animations $500 per year to renew after the first year 9