By Ian G. Whipple, OD
August 4, 2021
New treatments and technologies can deliver better care while creating higher profitability. Here are a few treatment additions to my practice that I project will both help patients and increase our annual revenues.
I project that, at a minimum, each of the following investments will generate an additional $24,000 in revenue annually.
Botox
I am constantly looking for new non-insurance-based revenue sources. Botox could add additional revenue and also help me expand my advanced clinical skills.
I injected Botox in three family or staff members as practice, and just implemented it with cash-pay patients.
Aesthetic optometry is a hot topic and I know many ODs are interested in implementing Botox, intense pulse light (IPL) and other beauty treatments in their practices. ODs are capable and primed to be experts in aesthetics because we understand the anatomy of adnexa and many of us have been involved in fashion (spectacle frames) and beauty (contact lenses, cosmetics, etc.) for some time. Botox is a service that many of our patients are already pursuing. Now they can get it in our office.
Projected cost: I budgeted $2,000 for training and $500 for initial materials such as needles, syringes and other supplies. Botox appears to be the optometric aesthetic application with the lowest entrance cost. After a weekend of training, I felt confident I was ready to offer this service to our patients.
I have attended CE lectures on Botox and relied heavily on advice and assistance from my Botox mentor OD. My hope is that if Botox takes off in my office we’ll be able to branch into other aesthetic clinical offerings. We have an additional exam room that is not currently being used. We could easily convert that room into an aesthetics/injections room.
Projected ROI: I expect to price Botox units at a ~40-50 percent profit margin. I project breaking even within the first 600 units, which could be in as few as 15 patients. I definitely expect that I’ll be even more efficient as my technique and comfort levels improve.
The first three Botox patients have experienced tremendous results. I hope that some will turn into repeat customers. Botox could become an insurance-independent profit center which could yield healthy margins for the practice. These patients will take an appointment spot from the normal clinic hours, but the time required for injections is minimal. These patients do not require the extra staffing resources of opticians, technicians or billing staff. Those employees can assist other patients while I perform injections at the end of the day.
Perhaps the greatest opportunity in Botox is to increase my comfort level working with needles. ODs who become comfortable in handling and using needles may be more able to implement other advanced surgical procedures as they become legislatively available.
Check First with Your OD State Board
We recommend checking with your state board and your professional liability insurance carrier to verify that any new procedures you want to add to your services are permitted under the optometry laws and regulations of your state.–ROB Editors
Intense Pulse Light (IPL)
IPL could be an easy second foray into the aesthetic optometry world. IPL can be used to rejuvenate skin by evening out pigmentation. It is also helpful in reducing fine wrinkles and skin blemishes. IPL can be extremely helpful in the treatment of meibomian gland dysfunction and dry eye issues as well.
IPL would allow us to offer more aesthetic treatments and would complement our existing dry eye clinic. It is another non-insurance reimbursement based revenue source for the practice. I hope to implement IPL in our office concurrently with Botox, so within the next few months, I expect to be using IPL in my office.
Projected cost: IPL options range from ~$60,000 to in excess of $150,000. I plan to evaluate specific devices at the Vision Source Exchange meeting this month.
Financing higher-cost instrumentation typically makes more sense than purchasing outright. Cash-flow issues may arise after large purchases. Financing will spread the cost burden out, and the IPL machine could generate enough to cover the monthly payments with as few as two cash-pay patients per month.
I anticipate this significant penetration into the aesthetic world will increase the workload of my scheduling staff. It will require doctor and technician time, but optical staff and billing staff members would be much less impacted. We could use our additional exam room as an aesthetics room for both the Botox injections and IPL treatments. No additional physical space in our office should be necessary.
Projected ROI: At just a few patients per month we would likely be able to cover the costs of the device and training. Anything above that is profit. I would hope for a couple of treatments per week to justify this purchase. IPL treatments in my area range from $700-$1,200, so busy use could lead to high profitability.
Like Botox, IPL ties into the cash-pay model, which I love. It allows our practice to be less reliant on insurance reimbursements. I do not have to pay staff for billing time, and patients would be able to pay with cash, credit, health spending accounts and other means.
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Providing a patient with new glasses or contact lenses helps a patient feel more confident in the world around them. These beauty services could also help a patient feel more confident and comfortable. We will most likely start by marketing these services to the same clientele we already market to, namely, mothers. Mothers make many of the decisions about where their family obtains healthcare, so we’ve always tried to appeal to them.
Kenalog Injections for Treatment of Chalazion & Hordeolums
I have referred all lid lumps and bumps to ophthalmology for years. Optometrists are capable of diagnosis and management of many of the more benign lumps and bumps. I have attended continuing education courses on kenalog injections of Chalazion and I already have the materials necessary for the injections. I expect to add this treatment to my office by the end of this summer.
Any time I have an opportunity to keep a patient in our office, rather than refer, it can be beneficial to the patient and the practice.
Projected cost: Now that I have purchased needles, syringes and other supplies for Botox, the cost of adding kenalog is minimal, just the cost of the medication. I have a good working relationship with my local pharmacist, and I plan on ordering all supplies directly from his pharmacy. I expect the cost of implementing kenalog injections of hordeolums to be less than $100.
The training for chalazion injections requires exactly the same needle training I have already received for Botox. No additional training is needed to perform this procedure.
Projected ROI: With such a small investment outlay, nearly every injection will be pure profit. I plan to bill CPT code 11900, which has a Medicare allowable of $57.17 for my region. This code can be billed together with an office visit.
This is an add-on procedure. It will lower the cost of healthcare if I can inject steroid into the chalazion rather than refer the patient for a separate visit with an ophthalmologist. I recognize this cost-savings is small, but it could add up over time. I expect to perform only a handful of these injections per year. However, there is still a potential ROI, and my patients will have greater trust in me as a medical model optometrist.
Ian G. Whipple, OD, is the owner of Vision Source of Farr West in Farr West, Utah. To contact him: iwhipple@gmail.com
