By Carla Gavilanes Gasparini, OD
June 20, 2018
Glaucoma is an eye disease that’s on the rise, with many of your current and prospective patients at risk. It is estimated that over 3 million Americans have glaucoma, but only half of those know they have it.1 This represents a tremendous opportunity to serve patients and grow your practice.
My 12-year-old practice, which operates independently within a Walmart in Austin, Texas, is finding steady growth in the need to provide glaucoma care. From Jan 2017-April 2018 we screened 224 patients for glaucoma, with an average revenue per patient of $107.63 for threshold visual fields.
Editor’s note: You cannot charge third-party providers for anything other than threshold visual fields (that is called “unbundling,” and could lead to felony charges). You can only charge a third party for threshold visual fields when there is a medical reason to run the test. You cannot do it to establish a baseline without the presence of a medical reason.
I’ve been able to add $24,109.12 to my bottom line in the last 1.5 years just from this glaucoma-related testing. My practice is still in its early years, so I expect this revenue to grow as my practice matures, and these patients grow older with me.
Adding an OCT Can Be Beneficial to Glaucoma Patients and Profitability
The $107.63 revenue per patient is lower than what many other practices are generating from glaucoma care because I am only performing visual fields and retinal photos at this time in my office.
I am in a corporate lease, and I do not currently have an OCT for glaucoma management, so I refer out to another OD for that testing. If I had an OCT I could add $38.04 to my bottom line per patient screened.
An office visit (99211) is bundled with my retinal photography (92250) reimbursement. Additionally, you might be able to perform an anterior OCT on narrow angle glaucoma suspects at $31.58 reimbursement. Per Medicare guidelines, you cannot perform visual fields and retinal photos on the same day as an OCT anterior/posterior, so it limits what we can do per visit.
My corporate office used to do more refraction and referral, but I am trying to change this mindset one patient at a time. My long-term plan is to add an OCT to generate extra income per glaucoma work up.
Become Part of a Health-Care Team
I do the initial glaucoma diagnosis, and then we co-manage with an OD-friendly ophthalmologist if the patient is no longer just a suspect and has glaucoma. Optometrists in Texas must take additional coursework for glaucoma specialist certification, and we are required to consult with OMDs for initial treatment options.
I bought my EHR and retinal camera in mid-2015 and started with initial diagnosis of glaucoma that year instead of sending it all out to local OMDs. Most OMDs charge a minimum of $300 just to walk into the office to rule out glaucoma. I can do it more effectively and efficiently in my office, and I offer weekend hours for those whose work schedules are not 9-5 Mon-Fri.
I perform the dilation, retinal photos, gonio (if I suspect narrow angles) and visual fields in my office. I then refer all patients with questionable results to another nearby OD, who has an OCT, and those results are then sent to me for interpretation.
We typically charge $108 for photos and threshold visual fields (cash pay). The break down is $69 for threshold visual fields with an office visit; $39 photos for 20-30 minute exam slots. I speak to the patient about 5-10 minutes. Subsequent office-visit follow-ups are charged $39 (brief) – $69 (intermediate) depending on the length and scope of the visit.
Medicare is paying us $58.32 for photos and $65.32 visual fields, with the various insurance companies we work with paying us between around $50 and $60 for visual fields.
I offer patients, who are covered by insurance companies whose panels we are not on, cash-discounted prices, keeping in mind that you cannot charge a patient less than what you charge your third-party patients, or I send them to an in-network provider for further testing. Most of my patients have high deductibles, so they pay out-of-pocket for most of our services, or a co-pay/allowable. We are in a mid-to-lower middle income neighborhood, so we try to keep our prices reasonable for all of our patients.
Encourage Word-of-Mouth Referrals & Educate Patients
Most of the growth of my glaucoma services has derived from word-of-mouth referrals of patients. I am a fluent Spanish speaker, and this is huge draw in the large Hispanic community of Austin. Twenty-five percent of my patients are primarily Spanish-speaking.
I’m adamant about patient education, and I occasionally pull out my Will’s Eye Manual and show patients pictures of unhealthy nerves to illustrate the risk to the patient’s eyes. More importantly, I show the patient pictures of their own eyes, noting to them where I see cause for concern.
Fancy pamphlets on diseases like glaucoma seem to only get patients’ attention for a short time. I’ve bought these pamphlets, and given them out, but nothing compares to the doctor showing the patient photos of their own eyes.
If you can show a patient a photo of their optic nerves, comparing it to a person already diagnosed with glaucoma, they will usually listen to everything that you say. Some patients don’t follow up with me, but we make every attempt to have them scheduled for threshold visual field and photos.
Bring in Whole Families of Patients
Long-term glaucoma patients may drift away to see an OMD for a consult, but they often send their family to me for a comprehensive eye exams, so I can check their optic nerves, and provide other screenings and care, as well.
Satisfied glaucoma patients are a huge source of referrals of friends and families for my practice. No one wants to be a glaucoma suspect, but I tell these patients that it’s important to have their family members screened just to be on the safe side. I’ve taken the time to educate them of the importance of properly managing their own eye health, and that of their loved ones, too.
(1) The Eye Diseases Prevalence Research Group, Arch Ophthalmology. 2004;
Carla Gavilanes Gasparini, OD, is the owner of Capital Eye Care & Hill Country Eye Care in Austin, Texas. To reach her: email@example.com