One of the biggest questions for many practitioners centers around the optometry equipment and technology he or she should be buying and implementing within the practice.
In the constantly evolving world of technology how do we keep up and pick out the “practice changing” diagnostic equipment from the simply glamorous and well-pitched?
There are many things to consider before purchasing optometry equipment in your future practice or existing practice.
In this article and video, we'll cover that topic and more.
1. Select your optometry equipment for the right reasons
These days, so many doctors are being distracted by the noise of healthcare reform and bench markers like meaningful use, MACRA, MIPS, etc. Companies have recognized this and market their software, diagnostic equipment, and products with the claim that they can help you, the doctor, navigate the muddy waters of these government criteria.
This should not be the driving force behind a decision to purchase new diagnostic equipment. In fact, in most cases, an emerging OD will not even see enough Medicare patients in his or her early years to be significantly affected by the penalties carried by these benchmarks.
Instead, the doctor should ask themselves, “how can this diagnostic technology help me work with my patient to use the data to make informed decisions about their health?”
By focusing on this goal, you can use optometry equipment technology to grow your practice, and by the time you do have enough patients to create a significant impact in government driven initiatives, these companies may have improved their products in drastic ways, truly being able to help you navigate MACRA, MIPS, and any other changes coming down the pipeline much more easily.
Tip: Consider checking out the CIRRUS HD-OCT from ZEISS. It's a clinical powerhouse and provides the wide range of OCT capabilities you need at an affordable price!
2. We should select optometric equipment that drives clinical decision making and patient engagement
In the past, data was used primarily to document a patient’s current state. You could engage the patient’s imagination through showing him or her a photo, but true visual understanding of pathology was often not achieved.
This is simply not enough anymore.
When considering optometry equipment for a practice, an OD should consider whether that piece of equipment will provide form data versus functional data.
Structural data, such as an OCT, is much more objective and allows the eyecare provider the ability to filter out nuances of the test through more accurate reliability measurements. These machines are used in a detection role, identifying changes and disease markers that in turn drive treatment decisions.
For example, an OCT (particularly one equipped with angiography capabilities) can give the practitioner viable markers for optic nerve (ONH), ganglion cell (GCC), and retinal health, as well as some information regarding the anterior segment. This information can then be used to track progression or changes over time and tell us where a patient’s vision is going before subjective vision loss occurs. Understanding the differences between structural and functional data will help the OD select equipment that fits the role he or she needs most clinically.
In addition to the type of information a diagnostic tool can provide, anyone considering new optometry equipment should consider how that equipment’s software will allow for patient education.
Due to the ubiquity in the use of computers and digital entertainment devices, patients these days are more visual than they once were, making it important for us as clinicians to be able to utilize interactive tools to demonstrate the state of a patient’s ocular health.
If an OD can engage the patient through the testing performed, information has a much higher chance of sticking beyond the exam room.
In other words, data will drive the consciousness of the patient, as well as the care of the provider. This is important to consider when getting ready to purchase new optometry equipment or when changing your strategy on existing equipment.
Check out this in-depth guide examining ocular diseases with Optical Coherence Tomography (OCT)
3. Optometry equipment and technology should be utilized in a baseline eyecare exam
Traditionally, a refraction and slit lamp/fundus exam constituted a baseline visit. However, in today’s practice world, ODs are implementing diagnostic data into their baseline exams more than ever before by utilizing analytic tools with normative databases to track change over time.
Baseline testing provides foundational building blocks and comparable data over time and demonstrates value to the patient of the importance of gathering data about their eyes. It allows the doctor to capture information regarding the patient’s optic nerve head, retina, vasculature, and anterior segment which can then be referenced and accessed for years to come. This creates an objective and accurate measure of the development or absence of pathological changes down the road.
One very important thing to keep in mind when implementing baseline diagnostic testing within your practice is that it can provide your practice with additional revenue, even when there is not a billable code attached.
Practitioners should develop a fee schedule for each baseline test for which the patient is responsible.
This not only puts value on the testing you are performing, but it requires the patient to invest in their ocular health. Not every patient will agree to this and undergo testing, but that is understandable. If you offer a valuable test, educate your patient, and focus your baseline testing protocols to reach out to the patients who find value in it, you will grow your practice with these types of engaged patients.
Align your best quality of care for your patients and you will find yourself with the opportunity to change patients’ lives and/or be a catalyst for the changes they will make themselves.
In addition to being important within your own practice, baseline testing will also allow for much easier transition of care. Patients these days relocate more often than in the past. By having baseline testing to send with them, you are providing a much more comprehensive view of their previous ocular health than is possible with refraction and exam notes alone. This allows the patient’s new doctor to be able to plug in the data and analyze it for themselves.
4. The future of eyecare imaging is integration
With the introduction of new technology such as the Carl Zeiss Meditec ultra-wide field camera, it is more important than ever to be able to integrate testing.
Previously, photography would provide a great surface view of what was happening within a patient’s retina. Now, with the ability to integrate angiography with the wide field image, a much more comprehensive clinical picture is available and able to be documented. Pairing of testing modalities such as angiography, autofluorescence, infrared, and retinal photography can give a great overview of the posterior segment.
Additionally, integration of multiple tests lowers the footprint of diagnostic optometry equipment a practitioner needs to be able to accomplish his or her goals. Now instead of several machines, a doctor may be able to purchase only one and perform the same tasks.
5. While some industry is moving in the right direction, others are hesitant when it comes to data exchange
In a world where technology and patients change by the day, we need the ability to exchange data through utilizing new software for analytics and accessing information across multiple platforms. There are a few companies understanding and embracing this need; many are fearful of the risk of profit protection. They must be able to recoup their investment within a small industry, which leads to many companies keeping their optometric equipment close to the chest.
Doctors need to keep this in mind and challenge those companies to make their data more portable and integrated, allowing for better storage and integration.
Companies have the ability and responsibility to create new systems by which providers can drive utilization of data in new ways. These workable platforms that combine different systems and perspectives would allow for a much broader clinical picture for the eyecare provider and the patient.
6. DICOM compatibility in eyecare is a useful marker for the future value of a diagnostic device
DICOM, Digital Imaging and Communications in Medicine, is a term that is often thrown around in today’s technological society; however, many practitioners don’t fully understand what it means. In basic terms, utilizing DICOM means that you are creating and storing data from diagnostic testing in a common communication language that can be utilized by other software.
When a company tells you that their diagnostic tests are DICOM compatible, it assures you that the data will be both storable and portable over time. DICOM compatibility is the litmus test for whether an eyecare company is truly developing solutions to the information exchange problem. They are creating the transferability of old data through updates that allow for that data to be woven into new software, expanding the ways in which we can care for our patients in the future.
7. It is important to avoid cutting corners when it comes to data storage
With all of the cloud based storage options available today, many ODs have developed a false notion of security in relation to the electronic health information of their patients. Unfortunately, cloud or dropbox storage with a simple password protection setup is not enough anymore to make certain that data cannot be compromised, and a breach into your files can mean serious HIPAA violations for you and your practice.
Every practitioner should make absolutely sure that their data is stored through encryption or protective software so that they can avoid living in fear of a HIPAA violation.
The cheapest option is often not your best option.
Invest in your security, and you will rest easy knowing that you have protected your patients and yourself.
Tip: Consider checking out the CIRRUS HD-OCT from ZEISS. It's a clinical powerhouse and provides the wide range of OCT capabilities you need at an affordable price!
8. Staff understanding and training is key when implementing new optometric equipment
Choosing to bring a new diagnostic tool or any other optometry equipment on board in your practice can be exciting. However, without the right training and participation from your staff, your new machine can result in decreased efficiency in patient flow, as well as poor data collection that can render the additional testing pointless.
Fortunately, there are two considerations a practitioner can make on the front end that will help avoid these potential negative outcomes.
First, select a company that will be involved in making sure your staff is prepared and well-trained.
The company should be able to provide on-site training for you and your staff with real patients, as well as online training and resources. Pay particular attention to the company’s reputation when it comes to training and customer support and make sure their systems show thought regarding the equipment’s user interface. Is the machine easy for both staff and patients to understand? If not, it’s best to move in another direction.
Secondly, hire staff with technology in mind.
When you are hiring optometry staff, screen candidates for their knowledge and adaptability regarding optometric equipment up front. Many diagnostic machines have no user flexibility, leaving the staff member to be required to follow a specific set of engineered directions. Screening can be achieved through simple tasks such as making sure they emailed the application correctly or having them complete a set of technical directions during the interview. If the potential new hire cannot successfully perform on these tasks, they are likely not going to be able to adapt to new technology well either.
Here is a tip: One great way to get a sense of how technologically inclined a person is during your interview process is to ask them “What technology, outside of phones or social media, have you picked up in the last six months, and why are you using it?”
Try implementing this question in your next interview!
9. Financial considerations when buying new optometry equipment should go beyond the fee-for-service model
Traditionally, and often times still today, the fee-for-service model has been used to decide the affordability of a new diagnostic tool. In this approach, the provider determines first how much the monthly cost of the machine would be and then runs an analysis of how many patients in his or her practice present with disease applicable to that diagnostic data.
This allows the OD to get a sense of approximately how many times the test would be run in a typical month and use that information to estimate whether the income generated is enough to cover the monthly note and provide a return on investment (ROI).
Unfortunately, this method can also lead to significant stress down the line if the practice has a slow month, reimbursement schedules decrease, or your patient base shifts as your estimates are then less valid. To avoid that potential stressor, the fee-for-service model should not be the only consideration you make when equipment shopping.
The “ripple effect” of advanced testing should also be factored in. The ripple effect is twofold.
First, effective use of diagnostic testing increases the patient’s confidence in you and your practice and translates to higher revenue generated in other areas of the office, such as optical and contact lens sales.
When a practitioner can communicate the importance of testing to his or her patients, those patients then become more engaged and “buy in” to your clinical competency on a deeper level. This means that they will also take your recommendations regarding other areas (spectacle lens recommendations, contact lens purchases, etc.) more seriously and be much more likely to keep business within your doors.
Secondly, increased patient confidence results in increased patient referrals.
Once patients have become engaged through higher level testing, these patients often show their loyalty and confidence in you with word-of-mouth referrals. With the recommendation of your office to friends and colleagues who are similar to themselves, a new patient base is generated who will be more prone to “buy in” as well. Through these two “ripple effects,” your practice revenue is increased, and the ROI associated with your new optometry equipment purchase is also elevated.
Tip: Once you have looked at both the fee-for-service model and the ripple effect for your office and you have made the decision to purchase, make sure the purchase terms are realistic and allow you to be aggressive with payments if you desire. Terms should not be longer than the expected relevant lifetime of the machine.
For example, if you expect to need an updated OCT every five years, the term when you purchase should not be seven years long. Additionally, you should have the option to put more than the required amount toward your payment to decrease the length of the term if you choose to do so.
10. An informed patient is an engaged patient
We’ve all been there...you’re talking to a patient regarding their ocular health, and even though you’re doing the best you can to explain the topic, all you’re getting in return is a glazed over look. It’s sometimes unavoidable in healthcare; however, when it comes to diagnostic testing and optometry technology, it is important to break down that barrier so that the communication lines can be open and clear. In order to achieve this, the doctor must first gain an awareness of what connects with the patient.
Many patients like numbers as it gives them benchmarks that they can easily understand year after year.
For example, if you show a patient an OCT scan of the optic nerve and explain that you want the disc symmetry to be 75% or higher, that is a simple number for that patient to understand and reference at your next follow up scan.
Some patients, particularly engineers and detail-oriented personality types, love seeing the screen. Showing these patients change analysis graphs can be interesting and captivating for this group.
Other patients, such as parents, prefer to know how the scan relates to their own or their family member’s visual status. If you can show a mother that her son’s baseline scan demonstrates a healthy macula and that because of that great result, his vision should remain uncompromised in the coming years, she is likely to become invested in that testing and desire to continue to follow her son’s health using diagnostic tools in the future. You can even capture a child’s attention with colorful maps or 3D displays.
However you choose to relay your data, finding two to three go-to pieces of information that most patients relate to will help you get your clinical point across more effectively, as well as develop loyal, informed, and engaged patients for years to come!
If you have any questions on purchasing optometry equipment, just comment below!
Dr. Lech and all of us at NewGradOptometry.com know that navigating your optometry equipment strategy can be a challenge. However, if you keep these tips in mind the next time you’re ready to expand your practice’s capabilities, you will find success!
For even more information regarding this topic, check out this video with Dr. Aaron Lech filmed at Vision Expo East 2017.