By Vittorio Mena, OD, MS
Jan. 11, 2023
The New Year is here! It’s time to put into action new goals for practice improvement and growth. That can sometimes be done with new investments. Here are a few investments our practice will be making this year, including how these new additions to our office will help patients and increase our profitability.
Intense Pulsed Light (IPL)
Dry eye bothers more people every day, and this disease is diagnosed more than glaucoma every year. We tend to recommend preservative-free artificial tears and then upgrade to prescription eye drops to treat this disease, but it often gets costly for patients, who may also experience adverse reactions to drops or do not get it into their eye at all, which is a complete waste.
We need to get to the root cause of the inflammation. To do this, our office is bringing in intense pulsed light (IPL) therapy from Lumenis. This light penetrates the tissues in our bodies and is distributed in different wavelengths ranging from 400-1200nm. It uses a specific wavelength to help with different skin conditions, hair removal, and, of course, dry eye symptoms.
A side benefit of IPL is that it can have aesthetic benefits. When marketing this device, we tell patients about photo rejuvenation to the face that can not only help a patient look younger by removing wrinkles on the skin, but also treat dry eye disease. This technology is FDA-approved for treating dry eye, and during the trial, the study showed “significant improved tear break up time, meibum quality and meibomian gland expressibility.” Another study published in June 2022 stated that “IPL improves signs and symptoms of dry eye disease due to meibomian gland dysfunction.”1
IPL technology costs around $100,000, and the average cost per treatment to a patient nationally is $375, which is an out-of-pocket expense. Each patient needs at least four treatments, spaced 3-4 weeks apart typically, to see results. If you see one patient in the office with at least four treatments at $375 per treatment that would be $1,500 to the office. If you saw only one patient for IPL per week with those four treatments throughout the year, the practice would generate $78,000 at the end of the year. If you saw five patients per week, the practice would generate $390,000 at the end of the year.
Depending on how many patients you see, IPL pays for itself within one year or sooner, and if you were to charge more per treatment, then the breakeven point on the device would be much faster. It only takes 4-7 minutes from beginning to end to administer to the patient, so it does not require much chair time. This includes the prep time which a technician can do (2-4 minutes) and the pulsed therapy that the doctor would perform (2-3 minutes).
The more patients we can help get to the root cause of dry eye disease, the more patients we are helping to live healthier, happier lives.
Supplement to Reduce Severity of Floaters & Decrease Vitreous Opacities
We are bringing in VitreousHealth supplements into the practice to help reduce the severity of floaters or decrease vitreous opacities. It is the first scientifically proven supplement that is a non-invasive solution to treat eye floaters. When patients come into the office they often complain about “something flying in their vision,” “I feel like cobwebs moving around” or “I see floating spots that continuously come and go.” Up until now we had nothing in our arsenal to help our patients with this. We often tell our patients that this is a normal phenomenon, which they will typically experience more as they get older. We let them know that they are most likely to experience this when they look at a bright sky, white walls or computer screens.
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To “get rid of them,” we tell patients to just quickly move their eyes left and right to get them out of their field of view. We also ask patients if they experience any flashes in their vision in hopes that they do not have any possible detachment in their retina, which would need to be checked by dilation and a thorough fundus examination.
Now, because of the first study developed, “Floater Intervention Study” (FLIES), we can offer a better solution. According to the study, “67 percent of patients recognized an improvement in their symptoms within six months with a noticeable enhancement in contrast sensitivity and visual discomfort.”2 The 90-day supply bottle that is taken once daily costs, on average, $64.95 to the patient. The general cost to the eyecare practitioner is $32.50, and if you are a member of a buying group, prices differ.
Every bottle that is sold based on those numbers above would profit the practice $32.45. If you sold only one bottle a week for an entire year, the practice would have made $1,687.40 on a total of 52 bottles sold. If you sold the bottle to 500 patients (only buying the bottle one time; three-month supply) who complained of floaters in your exam chair, in that year the practice would have generated $16,225.
However, the recommended dosage to sell is a six-month supply to a patient, so in reality, double those numbers. The only training needed is to educate the entire staff in the office that this supplement exists, so when staff hears the patient complaining about floaters they have an opportunity to speak to the patient about the supplement before they even see the doctor. The doctor would prescribe the supplement in the exam chair, and when they escort the patient to the front, they would let the employee doing check-out know what should be ordered for the patient.
Wearable AR/VR Diagnostic Device
High on the list of instruments we plan to add to our practice in 2023 is Heru, an augmented reality/virtual reality device created by an ophthalmologist at Bascom Palmer Eye Institute, to help patients with visual disorders such as glaucoma and macular degeneration, which many patients do not know they are walking around with. Age-related macular degeneration (AMD) is the top reason for vision loss in older adults. We need to be able to detect this disease as soon as possible since it can lead to irreversible vision loss.
Also, having a lightweight (less than one pound), portable headset device allows you to travel with it for home visits or to remote areas. This device can test for color vision with a D-15 farnsworth test, contrast sensitivity which is crucial as we get older, and for operating a vehicle as well as sports performance on the playing field. It also offers visual field testing. In addition, it would allow us to keep pace with the growing trend of using dark adaptation testing to help diagnose macular degeneration at a much earlier rate.
There are five CPT codes you can utilize with this device that can be billed to insurances and are also co-billable. For visual fields: CPT 92081, CPT 92082, CPT 92083, color vision: CPT 92283, dark adaptation: CPT 92284. The national average reimbursement rates for visual field testing ranges between $33-$63, color vision testing around $55 and dark adaptation around $60. The device costs $4,900, and if you were to purchase a second device, the unit would be 50 percent off. To operate the tests, it would cost $99 per month for the visual field, contrast sensitivity and color vision testing. If you want to offer dark adaptation to patients, it would cost an additional $399 per month, which is an optional feature.
The device may be eligible as a write off under Section 179 of the U.S. federal tax code. Dark adaption testing would be done for patients who experience any of the following: difficulty seeing in low lighting, difficulty with driving at night, patients who are 50 years and older and have family history of AMD and also for patients who have been diagnosed with AMD to monitor progression of the disease. There are two options with the test: the first is a screening that takes about 4-5 minutes to conduct. The second option is an extended screening that takes about 20 minutes.
When billing to insurance companies the average reimbursement rate for dark adaptation is $60. To break even on the device with the stated monthly payment you would need to see at least seven patients a month. Any other patients the practice sees over that number would start to pay off for the device. We all have at least seven patients in our offices per month who have trouble with driving at night, and that is not including people who have a family history of AMD. For glaucoma testing with a visual field, you would need to see at least three patients a month to break even with that monthly payment before you start to see a return on your investment. The beauty is that the technicians in the office would run the tests and the doctor just needs to interpret the results once completed.
Bottom Line: Projected Improvement in Care AND Profitability
In conclusion, by offering these three products and services in-office we will provide better care because we will be detecting diseases sooner, getting to the root cause of inflammation and potentially helping patients with a problem they wish they never had to begin with. I hope 2023 brings you, your practice and patients a happy and healthy New Year!
- Toyos, Rolando et al. IPL improves signs and symptoms of dry eye disease due to meibomian gland dysfunction. PLoS One. June 2022
- Enkamah, A et al. Dietary intervention with a targeted micronutrient formulation reduces the visual discomfort associated with vitreous degeneration. Transl Vis Sci Tech. Oct 2021