Optometrists play an increasingly vital role in the overall health of our patients and the wellness of society as a whole. The average primary care visit today only allows for roughly 10 minutes per patient, whereas optometry visits tend to allot more time, making room to discuss health and wellness with the patient. Working in a community health center can be the perfect mode of practice for optometrists seeking to practice within the medical model of optometry.
In this article, I’ll cover some tips and tactics to do just this, serving as a guide to opening an optometry clinic from scratch within an existing community health center based on my experience this past year.
Optometrists today serve a critical function in educating patients on ocular and systemic health. Optometry also plays an important role in promoting healthy lifestyles, especially with the rise in chronic diseases such as diabetes and metabolic syndrome.
As optometrists, we can often be the first medical providers to spot signs of systemic conditions patients may not even be aware they have. Communication with primary care providers is essential for continuity of care, ensuring patients are receiving adequate attention and care. By providing optometry services in federally qualified health centers, optometrists can contribute to community health and quality care.
What is a federally qualified health center?
Federally qualified health centers (FQHCs) are community-based, non-profit facilities that provide healthcare services primarily to underserved areas and populations. Throughout the country, FQHCs mainly focus on providing primary care, but many also provide specialty care, including optometry.
If a FQHC exists near you, and does not yet provide optometry services, don’t be discouraged. These facilities are looking for someone just like you — eager and motivated to provide eye care to their patients!
Each FQHC is run by a community based board of directors, a chief executive officer/executive director, a chief operating officer and chief medical officer. Contact the executive director and set up a meeting to discuss the benefits optometry can add to their organization, and why you are the best person to provide that care. Once you have the executive director’s approval, they will likely present the idea before their Board of Directors and possibly the federal government for approval to take the next steps.
Next, you’ll need to plan logistics. When you first get hired, plan to spend the first month working out the logistics of running the clinic, including writing policies and procedures for the new department in the community health center.
Where will the eye clinic be located? Are there any unused exam rooms in the health center or any unused spaces that can be retrofitted to an eye exam lane? Does the community health center have multiple locations? If so, which location would be most central for patients to visit?
Brainstorming your ideas and plans with other medical staff can help determine what space is best suited for optometry services. Remember, you’ll ideally need a pre-testing room and space for an optical, too.
2) Choose your equipment
Make a “wish list” of all supplies needed to furnish a complete eye exam lane. (An ophthalmic distribution company can help you develop this list.)
Tip: Separate items on the list to denote what equipment is needed for day 1 of patient care, what is needed in 6 months, and what is desired 1-2 years down the road, once the clinic is more established.
The community health center’s budget will likely guide which model of equipment you receive. Getting refurbished equipment is an excellent way to get “like-new” quality equipment for a fraction of the cost. Don’t forget about frame boards for the optical, pre-testing equipment (NCT/autorefractor), special testing equipment (OCT/VF/camera) and a lensometer (manual or digital).
3) Insurance credentialing
The community health center should have an individual or department that specializes in insurance credentialing. It makes most sense for optometry to accept the same insurances as the rest of the health center, so existing patients can use their insurance in the optometry department as well.
The majority of patients seen in health centers have Medicaid and Medicare as their primary health insurance, but you will also see patients with private insurance or no insurance. Be aware that each vision insurance plan has certain requirements for frames and labs that must be used, as well as fixed reimbursements, so read these details before accepting any new plans.
To make the optometric experience complete, you’ll want to have an optical dispensary. This will enable patients to use their insurance for glasses. I would recommend finding a local optical lab who can give a discounted rate for being a non-profit.
Non-profit discounts allow the health center to offer economic package deals for self-pay patients. For example, we offer a package deal of single vision CR-39 lenses and a Modern frame for $50.00, which is made possible by the discount we receive from a local lab. Keep your pricing as simplistic as possible.
When opening accounts with frame companies, ask if it’s possible to receive the frames on consignment (pay for frames once they are sold with no up-front cost). Also inquire if there are any discounts on frames for being a non-profit organization. Depending on which state you practice in, Medicaid will have specific guidelines on who is eligible for glasses and whether there are specific frames that must be chosen.
You’ll want an assortment of frames from bargain to moderate/high end, skewed relatively 50% budget pricing, 35% moderate, 15% high end for children, women and men, which can be divided according to your patient base. We started off by filling only 75% of the optical board until we had been open for several months and had a better idea of the specific demographics in our health center.
We keep around 475 frames in our optical when it is full, and we can always find something our patients need that is within their budget. The upcharge on glasses, if any, will depend on your practice type, but will likely be significantly less than commercial, retail and private settings, providing a great value to your patients.
5) Fee schedule
You can check Medicare’s website for reimbursement fees in your area for each E&M and CPT4 code. You should be charging at least what Medicare will reimburse you for your exam and procedures. For low-income patients without insurance, most FQHCs offer a sliding fee scale so qualifying patients can receive services at a discounted rate.
6) Patient schedule
The community health center’s finance team can calculate reimbursements from common insurances that will be accepted for your area and will determine the number of patients needed to be seen each day in order to break even. Your goal should be to fill your day so that you can provide quality care to your patients, many of whom will have complicated medical histories.
It’s reasonable to schedule patients every 30 minutes. Schedule at least 1 hour of admin time per day to have time to complete charting, referrals and other administrative tasks.
7) Electronic Health Records and Optical Software
Ideally the community health center is already using electronic health records (EHR) and there should be ophthalmology/optometry templates you can use within the EHR. Optical software that is compatible with your EHR. should be available but may need to be purchased separately.
If the health center’s current EHR. does not include an optical component, there are other companies that can be utilized solely for optical sales, for example, eyefinity.com (which also offers an EHR).
While you may think you can do everything yourself, your clinic will flow significantly better if you aren’t flying solo. At a minimum, you will need a receptionist, who may be shared with other departments depending on the location of the eye clinic. Depending how many doctors will eventually be working in the clinic, you will need a technician to work up patients. An optician is a crucial staff member who can take vital measurements to ensure the patient is satisfied with your glasses prescription. (And if you're looking to hire more doctors, check out these tips on how to write the best optometrist job description.)
Aside from the optician, do not be afraid of hiring someone lacking optometric experience as long as a potential candidate is friendly, has a positive attitude and is willing to learn. You can teach them the skills they will need to complement your optometric team. Plan to cross train your team members so they can fill in for each other on a busy day or if a staff member is absent.
There are some great resources online for training as well. Allaboutvision.com is a user-friendly website that explains most common ocular conditions. If you work with a Hoya lab, you will have access to Hoya University which has online videos explaining everything from refractive error and ocular disease to communicating with patients and establishing a positive rapport.
It’s better to have staff in place before the patient flow gets too busy: this ensures that everyone can be trained and ready.
Once your equipment, glasses, and staff are in place and you’ve started seeing patients, you’ll know when you feel ready to open the floodgates. Start by contacting all staff members, physicians and healthcare providers within the health center to let them know of the new optometry services being offered, what you can and cannot do, and what patients they should send your way. From there, send postcards to all patients at the health center or put an ad in a local paper or website to notify the public.
You may also decide to reach out to diabetic patients already established with the health center and offer them appointments. Once credentialed with various insurance plans, the insurance will list your office on their website, which will notify patients seeking to use their respective vision/medical insurance plans.
Why community health matters
By increasing optometry’s presence in FQHCs across the country, we can better provide comprehensive care to our patients as well as reach underserved patients with little or no access to eye care. With the ever-increasing prevalence of today’s chronic disease, physicians of all specialties are depending on a multi-disciplinary approach to provide quality health care, educate and encourage patients to better optimize their health.
Optometrists have never had a more amazing opportunity to embrace the medical model of optometry. Collaborating with community health centers across the country creates a unique and rewarding career path that significantly impacts the lives of patients while also bringing great value to the healthcare system.