So many options, so little space/time/money . . .
If you’re a new doc (or a not-so-new doc), chances are you’ll need some fancy equipment to make your practice great. Maybe you’re opening cold and need it all. Maybe you’re starting a specialty clinic within an established practice and need a new instrument to help you do your job. Or, maybe your clinic is running out of space and you need to re-evaluate whether what you’ve got still fits your needs.
Regardless of your situation, you should be able to answer yes to at least one of the following questions when looking at any new equipment. The more questions you can answer, the better. Companies will tout how technologically advanced, easy to use, sexy, insert buzzword here, their equipment is. But, you need to have the tools to evaluate their claims and make sure it's not just hot air. Here are the five questions you need to ask yourself before buying a piece of equipment.
Before you buy: can I get paid for using it?
This is usually a pretty straightforward question and one of the better ways to justify buying a piece of equipment. If there is a procedure code (CPT) and if the insurance companies you’re contracted with reimburse for that procedure, it’s very easy to calculate how your investment will pay off. For example, if you’re looking at getting an OCT for $100,000 and the reimbursement rate for the procedure is $40, then you would need to do 2,500 OCTs in order to cover the cost of the instrument. If you’re doing 2 OCTs (macula or optic nerve) per day of work, that’s roughly 500 a year. In this case, it would take 5 years for the instrument to pay for itself.
Unfortunately, there are many cases where new and innovative instruments won’t be covered by insurance (Lipiflow anyone?). But, you can still get paid for its usage if the patient sees the value in it and elects to pay out of pocket. Structuring a charge for using the instrument into a larger global fee for something like dry eye evaluation is another option. There are other creative ways to cover your costs. If you can’t generate explicit revenue, that doesn’t mean you can’t get the instrument. It just means that you’ll have to check a few more boxes on the other items.
Before you buy: will it change how I treat and/or make it more effective?
If our ultimate goal as eyecare providers is to make an accurate diagnosis and provide the best possible treatment to each and every patient, then it’s important to get a piece of equipment that helps us do that. Even if we don’t get paid by the patient or their insurance company to perform it, consider whether it makes sense for your practice.
One of the best examples for this is the routine use of wide field fundus photography equipment, most commonly Optomap. While most patients don’t have retinal findings that justify billing for fundus photos, this equipment does provide a comprehensive view of the posterior pole and peripheral retina. It is an all-around great tool for screening the entire retina. While it isn’t a replacement for 90D or 20D lens evaluation, it can definitely help focus the evaluation and make it more effective.
There are, however, some instruments that you may feel make you treat differently, but really don’t. Let’s look at a hypothetical example. Say a company is selling a meibomian gland expression tool (the one that applies the exact amount of pressure to the gland as would be applied during the blink) for $1,000. You think, “Wow, I’ll know exactly how many glands are working properly and how many aren’t, I can’t wait to start using this equipment!”
But, does that information really change how your plan for the patient? Does knowing if someone has mild MGD vs mild/moderate really change your treatment regimen? If it does, then go for it. If you want to provide a patient with a report of exactly how many glands aren’t up to par, go for it. However, if a patient doesn’t experience a subjective improvement, their buy-in likely won’t last long and they’ll give up their routine lid maintenance.
So before you answer yes to this question, make sure you can say, “If I knew piece of information X, then it would change my treatment from plan Y to plan Z.” If you can’t answer that, the new piece of equipment likely doesn’t change things.
Before you buy: will it save us time?
In the clinic, time equals money and saving time can definitely improve your bottom line. So even if you can’t charge for the procedure and it doesn’t really change how you would treat a patient but it saves time, you still may be able to buy the new equipment you want.
For example, an instrument like the ICare tonometer may fall into this category. Tonometry is part of just about every exam. Hopefully, the pressure reading is the same between Goldmann and the ICare so you won't charge separately for it and it won’t really change your treatment. But, if you are able to save the time you normally would have taken to apply the Fluress, position the patient in the slit lamp, get a reading, and double-check the reading, then you may have reduced chair time by about two to three minutes. That’s not insignificant. If you really have a handle on chair cost and patient cycle time in your clinic, you could actually put a monetary value on how much you're saving with those two or three minutes. It may be worth it!
Before you buy: will it improve patient experience?
This question is definitely the hardest to quantify but can be a difference-maker in the practice. Using imaging (fundus photos, OCT, topography, etc.) to actually show the patient what you’re looking at can take them out of the world of theoretical and make it real for them.
Discussing meibomian gland health in the office doesn’t really have the same effect as showing the patient what their glands look like compared to normal ones side by side. Same thing with optic nerve/visual field analysis. For conditions like glaucoma and mild MGD that don’t have significant symptoms associated with the condition, these visual representations of their conditions are extremely helpful. That’s where new equipment comes in.
Without the visuals, patients don’t get a lot of feedback on their condition. They aren’t in pain if they don’t take their glaucoma drops and they don’t notice a change to their vision which makes it extremely important to educate them on the progression/stability of their condition when they come into the office. Showing as opposed to simply telling can make a major difference.
A few ways to quantify the impact on improved patient experience can be through surveys, recall, and treatment compliance. But, you’re still only getting a proxy for how much of a difference your new instrument is making. If the new instrument you’re considering is only meeting the “improve patient experience” criteria, you really have to make sure you have a way to measure it AND you make it a very clear part of your patient education part of the exam. It makes no sense to do a test/procedure that is supposed to improve patient experience if you don’t say, “Here’s what this test/procedure does for us and this is what value it adds.”
Before you buy: will it save us money?
Just like saving you time, if a new instrument actually directly saves you money, you may not have to directly make money with it.
For example, as we stated previously with the ICare tonometer, you don’t have to instill anesthetic drops which means you save money on all the drops you didn’t have to use to do the procedure. Another example is corneal topography. If you can get accurate enough information from the topography to design an ortho-k lens that improves your first fit success, you not only save time but also the cost of materials and shipping on remakes of lenses.
These simple questions don’t necessarily apply only to new pieces of equipment but also processes and procedures done at the clinic. Doing things a certain way because that’s “just the way they have always been done” may not be the most efficient or practical. You can ask these questions about most everything in the practice.
Obviously, the more questions that you can answer “yes” to for a certain piece of equipment or process, the better. So next time you have a decision to make about equipment or procedure changes, challenge yourself to ask the tough questions and, ultimately, make the right choice!