Ancillary personnel enhance care, bottom line
Robert J. Weinstock
Hiring optometrists, hiring ancillary personnel such as physician
assistants, for some ophthalmic practices, can be very advantageous,
profitable, and improve the overall efficiency and quality of care. Nurses and
technicians play a vital role in the operation of a successful, efficient
practice. Co-management with optometrists outside a practice can also ease the
growing burden of caring for so many patients.
Physician assistants (PAs) can perform valuable, revenue-producing
services. Some practices use PAs as surgical assistants. For more complex
retinal and glaucoma cases, there is a reimbursable code for this role. If
trained properly, PAs may see clinic patients independently and bill for these
services, just as a doctor would. A PA can obtain hospital privileges to see
consults, make patient rounds, and perform preoperative histories and physicals
on surgical patients. This gives the surgeon peace of mind and adds to the
revenue stream. If trained properly, the PA can truly be a jack of all
trades within the practice and add to the quality of care, profitability
and efficiency of a practice, potentially performing more roles than an
Nurses also have a significant potential role in a growing ophthalmology
practice. In practices affiliated with an ASC, nurses are needed in the preop
and postop areas and the OR. For practices that have taken an interest in
clinical research, without a nurse research coordinator, it is difficult to
secure significant studies and their associated revenue.
Co-managing clinical and surgical care with optometrists outside of the
practice can be effective in delivering quality care to a larger population of
patients, provided there is good communication between the providers and the
patients understand the process.
Robert J. Weinstock, MD, is a cataract and refractive surgeon
at The Eye Institute of West Florida, Largo, Fla. Disclosure: Dr. Weinstock has
financial interests in Bausch + Lomb, Ista, WaveTec and TrueVision.
Optometrists provide surgical referrals
While optometric co-management may not be ideal for a comprehensive
ophthalmology practice, it makes sense for a practice focused primarily on
surgery. Optometric co-management accomplishes three things. It brings in
patients who are likely to be surgical candidates, reduces patient chair time
and allows surgeons to see more surgical patients and do more surgery, and
limits the number of different services the practice provides, allowing the
practice to streamline resources and reduce overhead.
A practice that relies primarily on advertising and/or patient referrals
may see patients come in for surgical consultations who may not be surgical
candidates. For example, some patients may come in for a cataract consultation
in hopes of getting an IOL to help their near vision, but they may be plano
presbyopes with excellent distance vision and no sign of a cataract. Other
patients with poor vision due to AMD or glaucoma may come in for a cataract
consultation hoping to improve their vision, but their cataracts may not be
visually significant. This can be sorted out by a good optometrist who can
refer patients who are likely to benefit from cataract surgery.
Patients coming from an optometrist may already be educated about what
to expect during and after surgery and the different IOL options. An
optometrist may have been seeing the patient for years and may have tried
different optical solutions. He or she may know that the patient did especially
well with monovision, for example, and know the amount of monovision that
worked for the patient. An optometrist may have discovered that the patient
either loved or hated multifocal contact lenses. This information may be useful
in guiding the surgeon to decide what type of IOL is best suited for the
patient. A well-informed optometrist can save a surgeon a lot of time.
Postoperatively, the optometrist can answer many of the patients
questions as well.
It takes time, effort and money to run a practice that provides multiple
services, which may be so different that it is like running several distinct
businesses. Running an optical dispensary within an ophthalmology practice is
one example. Outsourcing some services may allow the practice to streamline
operations, reduce overhead and save money.
Ella Faktorovich, MD, is director of the Pacific Vision
Institute, San Francisco. Disclosure: Dr. Faktorovich has no relevant financial