February 23, 2019
2 min read

Medical model of optometry promotes doctor-patient relationship

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NEW ORLEANS – The medical model of eye care is doctor-patient centric and entails dilated eye exams, problem-focused care, therapeutics, treatment strategies, contact lens fitting and doctor-driven dispensing of optical lenses and frames, Maria Sampalis, OD, said here at SECO.

The model also entails working with other providers in the area as well as hospitals and labs, she said.

Sampalis’ presentation was part of the Practice IQ series, which Primary Care Optometry News sponsored in part.

Maria Sampalis 
Maria Sampalis

Educating patients, investing in diagnostic tools and treating eye disease will allow you to grow your practice revenue and increase patient retention, Sampalis said.

Be sure patients are asked specifically why they are calling to set up an appointment, she said.

“If patients say their eyes are tearing or red, that’s a medical visit,” Sampalis said. The type of billing is driven by the chief complaint.

“If they say they’re there for a routine exam, and you find glaucoma, do the routine exam and have them come back for the medical visit/glaucoma,” she said.

Imaging is part of providing medical care, Sampalis said, including anterior segment photography in contact lens wearers [if you have established medical necessity for taking the photo].

“Once you show patients what’s there, it’s better patient education,” she said. “They will also come back to your practice if you have their images.

“Technology is a great way for medical models to increase reimbursement but also practice better,” Sampalis said.

She outlined action points:

--Train your staff to determine patient needs when they call for an appointment.

--Invest in diagnostic equipment (“OCT has become standard of care in glaucoma,” she said).

--Review pretest protocols.

--Schedule follow-up visits (“Medical model patients typically need to be seen more often than annually,” she said.).

--Monitor fees.

--Perform a chart audit (Be sure to do everything in your exam necessary to bill for a certain code).

“Make sure your staff understands the difference between vision and medical plans,” Sampalis said. “Your vision plan only covers routine exams, but a Blue Cross Blue Shield plan covers diagnosis, management and treatment of disease.”

Certain same-day testing is allowed, she noted.

“You can do retinal photography and visual fields on the same day,” she said. “You’ll be reimbursed [providing that your documentation supports the need to perform both tests].

“You can earn more income per patient in follow-up visits; you see more patients per hour,” Sampalis added.

She advised scheduling appointments that involve more time with the technician during the doctor’s lunch break so that when the doctor returns, he or she can immediately review the results.

Small practices that may not have an OCT can send the patient out to another practice for the test and still get paid for evaluating it, she said. “You just have to find the right practice to work with.”

Diagnosis and treatment of dry eye can boost revenue in any practice, she continued.

“With computer vision syndrome and digital eye strain, it’s a great practice builder,” Sampalis said. “Don’t ignore dryness in contact lens wearers. Addressing dry eye symptoms increases patient retention and loyalty for your practice.” – by Nancy Hemphill, ELS, FAAO

Editor's note: This story was updated to indicate that anterior segment photography in contact lens wearers can be performed only after establishing medical necessity for taking the photo and that retinal photography and visual fields can be performed on the same day providing that documentation supports the need for both tests.


Sampalis M. Medical model: Set up your practice for medical optometry. Presented at: SECO; New Orleans; February 20-24, 2019.

Disclosure: Sampalis reported no relevant financial disclosures.