By Kathleen M. Andersen, OD 
Enhanced instrumentation allows you to scan for early detection of disease. Offering a vascular health screening adds value to your comprehensive eye health exam and expands your scope of practice.
In March I purchased a carotid artery ultrasound screening system for vascular fitness. The system allows my office to perform a non-invasive procedure which measures the thickness of the carotid artery intima layer–widely accepted as an ideal indicator for early detection of cardiovascular disease. Studies show that by evaluating the carotid artery intima thickness (CIMT) physicians obtain a good indicator of vascular disease elsewhere in the body. The ultrasound technology employed is a B-scan which is safe and can be repeated as many times as needed. In addition to measuring the artery thickness, the screening protocol also results in the reporting of the presence of plaques, their characteristics, whether soft and fibrous or hard and calcified, and the percentage of stenosis.
CIMT allows us to evaluate the health of the arteries that supply blood to the eyes, and given the prevalence of cardiovascular disease in this country, should be the standard of care within a comprehensive exam.
ROB Bottom Line: Carotid Artery Ultrasound Screening
Cost of Instrument
$20,000 to $25,000
Fees and Revenues Generated
$150/scan for 2-4 patients/week = $300 to $600/week or $15,000 to $30,000/year
Length of Time to Recoup Instrument Cost
2 scans/week = 67 to 83 weeks
4 scans/week = 33 to 42 weeks
Practice Builder: CIMT
The CIMT screening is a great practice builder because it gives you another opportunity to talk to patients about their general health. My patients see great value this discussion. You can show patients a fundus photo and talk about health risks seen visually, but this powerful tool allows the optometrist to evaluate health risks we can’t see. I explain to patients that it often takes 8-10 years of disease existence before I begin to see diabetic retinopathy so the test helps us detect ocular disease before it becomes apparent during their eye exam.
The “Report Card” which is generated for each patient makes it easy to understand how well the patient’s current treatment plan is working. It gives the patient a sense of where they stand today and how they might benefit from making lifestyle changes. It also can give critical information about life-threatening conditions which might otherwise be missed in asymptomatic patients.
A Revenue Stream of $600 per week, $31,200 annually
I purchased the my CIMT system for approximately $20,000. There is a newer model available for $25,000. The purchase price included installation and training for me and my staff, which includes one half day for instruction. The instruction included basic anatomy information and hands-on practice. My staff quickly learned with the excellent training provided to administer the protocol in less than ten minutes for most patients. The cost of the screening at my practice is low at $150 per scan. I’ve been told that cardiologists charge between $250-$350 for the same screening. Occasionally patients will present with history of TIA, or transient ischemic attack, and then we attempt to bill their major medical insurance. We have had some success in getting reimbursed for this diagnosis code. Approximately two to four patients per week currently opt for screening. We are able to bill major medical for the test for another one to two patients per week.
Best practices to implement CIMT screening
1. Commit your practice and staff to educating your patients on their individual risk of heart attack and strokes, which are the #1 and #3 killers of Americans.
2. Review patient charts for signs of family history, medications, current disease management, etc., which will help identify patients ideal for screening.
3. If you suspect a patient is at risk, ask the question, “Have you ever been screened for cardiovascular disease?”I’ve been surprised at how many high-risk patients have never been screened.
Review Results in Follow-Up Visit
Wereceive the results by e-mail within 72 hours of sending the scans to the lab for evaluation. The patient returns for a follow-up appointment to discuss the results. At this visit, the patient receives a booklet outlining the latest information about making positive lifestyle changes to diet and exercise. The patient is counseled to return to their primary care physician or cardiologist if they have one. I remind patients that this screening gives valuable, tangible information that they can use to make lifestyle changes. This reinforces the message they get from their physician.
In addition to the cost of the ultrasound system, there is a per report fee. With only internal marketing, I broke even the first month I had the test available for patients. We are still only marketing the test internally and have made a profit every month since beginning. For those ECPs who have a large percentage of their patient population between the ages of 40 and 65, the screening is an ideal incremental service offering.
Enhance Pre-Testing Evaluation
Every patient receiving a comprehensive eye exam or glaucoma work-up in my office has their blood pressure checked as part of the pre-testing evaluation.This opens the door for me to comment on their present health status. I review their medications and family history at the beginning and the end of the exam when I present my findings. I inform them that even though I have just looked at their blood vessels, it is not always possible to see disease. I discuss the benefits of having the screening and offer it as an elective procedure for those patients who may be interested in discovering their risk for cardiovascular disease. For patients already on medication for hypertension or high cholesterol, I remind them that it may be possible, with the help of their physicians, to reverse the progression of atherosclerosis with lifestyle and dietary changes. I inform them that the screening will assist them in learning what risks may still be present and allows them to see physical progress as they work towards this goal.
OD Use of Ultrasound: Check With Your State Board of Optometry
Part of the due diligence prior to implementing CIMT technology is to understand scope of practice issues. In California, the State Optometry Act specifically includes the use of ultrasound by an OD in Section 3041(h): “Nothing in this section shall limit an optometrist’s authority to utilize diagnostic laser and ultrasound technology within his or her scope of practice.”
HeartSmart Technologies, the company providing the technology, has been working with the American Optometric Association, and the majority of states do not prohibit the use of ultrasound by optometrists. However there are a few states that are very restrictive on scope, so it is best to double-check with your state board and state AOA chapter before purchasing the instrument.
Create Practice Focus onEarly Detection and Prevention
Because no other health care providers are exclusively focused on early detection and prevention, I believe this is a huge opportunity for our profession of optometry. Because of our patient flow, we can detect disease earlier and be the catalyst for getting patients the treatment or education they need to avoid what could be a costly and debilitating heart attack or stroke.
Offering CIMT screenings can help set an optometrist apart from other practices.Patients begin to see their optometrist as an important member of their primary care team dedicated to preventative care. It elevates our standing in the medical community and generates referrals from other physicians as well as happy patients–who themselves are the best source of referrals.
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Kathleen M. Andersen, OD, has been in practice in Rancho Santa Margarita, Calif., for 20 years. To contact her: info@rsmvision.com.
