ECP Network Special Projects Consultant
“I can’t get no respect” was an often used statement by the late comedian Rodney Dangerfield. Certainly the statement does not apply to optometrists and their profession. Periodic independent polls typically rank optometry as top ten and positive among all professions. Here’s the problem. Consumers in general do not respect primary eye care as a first priority in their health and wellness. They do not get the connection between total physical and mental well-being with being sure eye and vision health are in top form. Eye health can’t get no respect!
Most consumers also have a disconnect from the monetary value of primary eye care. Few, if any, expenditures in health care can objectively demonstrate measurable return on dollars spent-a true return on investment. Reduced catastrophic health incidents, improved work performance, and higher educational outcomes are a few of the benefits from eye and vision health maintained at the highest level.
As eye health providers (doctors and staff), I am not suggesting you need to “bang your own drum” or “blow your own horn”. At every opportunity we must exhort health care consumers to put the highest priority on taking care of their eyes throughout their entire lifetime. Eyes deserve that much respect.
• “Comprehensive Eye and Vision Examinations-A Path to Wellness”, KDD Health Solutions White Paper.
• “Impact of Eye Exams In Identifying Chronic Conditions”, United Health Care, 2013.
• The Patient Will See You Now by Eric Topol, M.D., 2015.
• “Think About Your Eyes”, American Optometric Association.
ECP Network Executive Director
ECP Network Strategic Alliances Director
Why is it an ATM card issued in Kansas can access cash in California, Canada, or even Cameroon yet it seems no electronic health systems can talk to one another?
Health care providers and hospitals historically have not been able to share electronic patient data to coordinate care for patients who have been treated in multiple healthcare settings. This lack of coordination is particularly problematic when patients have multiple chronic conditions. (Optometry knows this all too well with respect to communicating the yearly comprehensive diabetic eye examination.) Instead, health systems and hospitals could only communicate with their own staff, and perhaps, with a few other providers within their system. These limitations create yet another barrier for independent optometrists, which can lead to being excluded from networks and limiting your ability to serve patients.
The Hitech Act of 2009, passed to help address healthcare data interoperability, created data standards and Regional Extension Centers (RECs) across the country. They were created to serve as a support and resource center to assist providers in Electronic Health Record (EHR) implementation and Health IT needs. Members of ECP Network Leadership, including Executive Director Dr. Terri A. Gossard, Medical Director Dr. Rod Snow, Strategic Alliances Consultant Mr. Mark Ridenour, and Special Projects Consultant Mr. Rick Cornett met in January with The Ohio Health Information Partnership (OHIP) in Columbus, Ohio. OHIP is the REC whose mission is to assist physicians and other providers with the adoption and implementation of health information technology throughout Ohio, specifically in the adoption and use of electronic health records. OHIP is also responsible for the creation of a technological infrastructure, including the Health Information Exchange (HIE) Clinisync, that will allow Ohio physicians, hospitals, and health care professionals to electronically share patient health records across the state.
What should the goal be? A health exchange that allows everyone in the healthcare community to exchange patient health information, no matter where they’re located or what electronic health record platform they utilize. To be able to access the right data when and where the provider needs it. To get patient health information quickly, and coordinate care with other health professionals. And ultimately, improve the quality of care, reducing duplication, extending and saving lives.
CliniSync, Ohio’s state wide HIE, currently connects 149 hospitals and thousands of primary care physicians in 1,228 practices on a limited basis. CliniSync’s outreach now is focused on all physician practices, whether internal medicine, family physicians, specialists, and yes, optometrists. The ECP Network is conducting a pilot project in Lorain, Ohio, to facilitate communication between our network optometrists and the Mercy Health System using direct messaging via CliniSync to produce consumable data for the EPIC EHR system. The ECP Network strongly believes that implementing an electronic communication pathway that is automatic for the optometrist’s EHR and independent of vendor integration would be a game changer for our members.
The ECP Network is not alone in this belief. Major hospital systems recognize the value in expanding the relationships between primary care providers and other health care entities like optometrists. Online access to patient data across multiple care settings over time enables effective coordination that increases quality, efficiency, and access to care. These metrics will become ever more important in value based reimbursement strategies of the future. And this is the ECP Network’s focus: enhancing the independent optometrist's ability to compete in a rapidly changing healthcare marketplace by providing high quality, value-based eye health and vision care.
ECP Network Board of Directors
What is unity? Webster has several definitions, including:
• Quality of being “one”
• Totality of related parts
• Condition of wholeness
Does optometry have unity? I am not sure. Do we need unity? ABSOLUTELY!
Now, more than ever, optometry must stay organized and energized. In the past 30 years, we passed diagnostic and therapeutic licensure by being united. We have fought many legal and legislative issues by being united. We have promoted our profession and the importance of primary eyecare by being united.
We are now seeing many insurance and health care conglomerates beginning to shrink their panels. Their criteria may be based on quality metrics (PQRS, MACRA, MIPS), your licensure, or in some cases, simply your affiliations and relationships to other providers. Recently in northeastern Ohio, one of the largest hospital based systems began not allowing an optometrist on their panel unless there is a medical doctor or doctor of osteopathy also in the practice!
Some people think this will change with the new administration in Washington, D.C. Personally, I think there will be some modifications but many concepts will remain. Large systems like these changes and will want them to continue in some fashion. Smaller panels mean insurance companies can control fees, decrease overhead, be better able to track quality outcomes, and keep business within their own system. Certainly decreasing overhead and improving quality are worthy goals but this should not be at the expense of patient access to an entire profession – optometry!
The ECP Network is based on unity. It is irrelevant if you are independent or a member of any other group practice organization. You can still be with them and be with us! Our healthcare partnership goals are simple:
• Educate independent optometrists on upcoming changes that will affect profitability (MACRA and MIPS)
• Provide training to implement changes in your office
• Represent our members and the profession of optometry to health care entities
• Maintain our members’ present patient base and then expand it
• WORK WITH ALL OTHER NETWORKS WHO CAN’T WORK AS EFFECTIVELY IN THE HEALTHCARE ARENA
Sounds like “wholeness” and unity!
If you want/need specifics about ECP Network, please contact me at firstname.lastname@example.org
The new year is an opportune time to consider changes to your practice. ECP Network virtual try-on partner FittingBox allows you to upgrade your practice sales and marketing efforts by using cutting-edge virtual try-on technology to engage with your patients both online and in your office. Not only will you enhance your practice image, but you’ll gain the ability to work with your patients in new and exciting ways.
Virtual Try-On uses Augmented Reality technology to recognize and track the movements of a face while simultaneously placing a 3D model of a frame on that face. The patient looks into a screen, and an attached camera lets the patient see him/herself in real time. 3D models of the frames then appear on the face, resulting in an incredible “magic mirror” experience where it appears as if the patient is actually wearing glasses!
Adding virtual try-on to your website is an easy way to let your patients browse and try-on frames before they come in for their appointment. The patient can start getting a feel for the styles and colors they like while using an exciting digital tool that makes a big impact.
At the office, virtual try-on technology is very useful at helping a patient find the right frame by quickly and easily letting them try on different frame colors, styles and brands so that they can purchase with confidence.
FittingBox is the leading provider of virtual try-on solutions to the eyewear industry worldwide. They offer a best-in-class database of over 45,000 frame SKUs from over 420 individual brands all of which are available to their customers. You can learn more about FittingBox and its virtual try-on solutions at their website, www.fittingbox.com, or by contacting the ECP Network directly at email@example.com.
The Federal Trade Commission's (FTC) proposed Contact Lens Rule revisions add new prescription requirements that the AOA believes are imbalanced and do little to address patient safety concerns. These safety concerns are underscored by a 2015 consumer survey which found that among patients that ordered their lenses online:
- 1 in 4 reported receiving a different contact lens brand than prescribed by their doctor without advanced warning
- 1 in 3 reported an online retailer advised them to substitute a non-prescribed lens due to supply issues
- 1 in 3 reported they purchased contact lenses with an already expired prescription.
The new FTC proposal stipulates that prescribers must obtain a signed patient acknowledgement after releasing a contact lens prescription, and must keep it on file for at least 3 years. It did not include any of the suggested patient safety requirements and increased accountability measures for the internet contact lens sales industry which are key elements of the AOA’s bipartisan, bicameral bills to curb abuses of the online contact sales industry. These requirements and measures include:
- Holding sellers accountable for illegal sales tactics and false claims, and make increased enforcement to safeguard public health a priority for the Federal Trade Commission.
- Establish a live patient-safety hotline allowing doctors to provide sellers with patient health information and ensuring that the doctor-patient relationship is respected.
- Ban use by internet sellers of disruptive automated “robocalls” into doctors’ offices as the mechanism for verifying patient prescription information, and allowing doctors to choose live phone calls or emails from sellers instead.
- Ensure contact lenses must be dispensed exactly as the prescription is written by the doctor.
- Direct the Centers for Disease Control and Prevention to study the public health and health care cost impact of internet seller abuses.
- Increase fines to sellers to $40,000 per infraction.
The opportunity for doctors of optometry to speak out to the FTC and call for more patient protections exists through January 30, 2017. Click here to view the AOA’s Call To Action request, which includes links to respond directly to the FTC as well as sample language.
The ECP Network will continue to provide independent doctors of optometry tools to evaluate their practices in light of the ever-changing healthcare landscape. In other words, we aim to help keep your practice “in shape”. Take time to complete the practice score card first published in January this year. How are you and your practice doing?
Let’s get something out of the way right up front: the results of the Presidential election change nothing about the implementation of the Medicare Authorization & CHIP Reauthorization Act (MACRA). This legislation was passed with strong bi-partisan support to replace the Sustainable Growth Rate (SGR) and is independent of the Affordable Care Act (ACA). Under MACRA our reimbursement may now vary from your peers based on your performance on quality and performance measures. CMS has labeled the rules under MACRA as the Quality Payment Program (QPP) creating this website with numerous resources and detail.
While there are technically two tracks of participation within MACRA, since CMS estimates less than 1% of eligible optometrists will qualify for the Alternative Payment Models (APMs) track, this article will cover only the Merit-Based Incentive Payment Systems (MIPS) track.
MIPS will begin in 2017 as the initial Performance Year with special “Pick Your Pace” rules for the Payment Year of 2019. There will always be a two year lag from Performance Year to Payment Year to allow for the submission and evaluation of data. With minimal base fee schedule increases of 0.5% scheduled to end in 2019, succeeding in MIPS will be your only opportunity to provide yourself with a significant raise.
MIPS will combine the former Physician Quality Reporting System (PQRS), Value-Based Modifier, and Meaningful Use programs with a new Clinical Practice Improvement category. These measures will produce a weighted score which will ultimately increase or decrease your payment against a base fee schedule.
Actually, for 2107 CMS estimates two-thirds of optometrists will be excluded either because they are in their initial year of accepting Medicare, or they will not meet the low volume limits during the determination periods: less than 100 unique Medicare patients or less than $30,000 in Medicare charges. The initial determination period is 9/1/15-8/31/16, and CMS will also re-evaluate during a second determination period 9/1/16-8/31/17. Providers who fall below the low volume limits in either determination period will be excluded from MIPS for 2017.
These low volume limits are likely to change in subsequent years, so participating in 2017 could provide you with some valuable feedback on how you may perform in future years, plus if you are in a group practice you will have the option of submitting as a group, which may exceed the low volume limits. The opportunities for bonuses will never be as easy as they will be in 2017. Plus, while MACRA applies only to Medicare at this point, private payers often mimic CMS reimbursement formulas. The rest of the article will cover the options for those not excluded.
The result is very simple – not participating means you have elected to take a 4% cut in all your 2019 Medicare reimbursement and your score of 0 will be made available publicly. Your peers may thank you, because MIPS is a budget neutral formula, meaning every dollar rewarded as a bonus must be offset by a penalty dollar. The opportunity for increase/decrease is scheduled to widen to +/-9% by 2020 performance year.
CMS has deemed 2017 a transition year allowing providers to “Pick Your Pace” to gain familiarity with MACRA or the Quality Payment Program. You could submit just one clinical Quality measure or just one Clinical Practice Improvement Activity (CPIA) to escape the 4% penalty for 2019. This will earn you a score of 3 and result in no adjustment to the reimbursement schedule.
In 2017, yes. An option in Pick Your Pace is to submit data for a 90 day reporting period on more than one Quality measure or more than one CPIA. The more data you submit the higher your Performance Score which will exceed 3 on the 100 point scale. You will receive an increase above the base fee schedule, which will be calculated based on the performance of all other providers.
For 2017, 60% of the weight are on the Quality (formerly PQRS) measures. You need to select at least 6 measures with at least 1 of them an outcomes measure (if you cannot report an outcome measure you must report a “high priority” measure). There are 271 measures to choose from. You should select those where you expect to have more than 20 patients during the year. CMS will select your highest performing 6 measures. Below are examples:
• Diabetes: Eye Exam
• Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care*
• Closing the Referral Loop: Receipt of Specialist Report*
• Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema & Level of Severity of Retinopathy
• Documentation of Current Medications in the Medical Record*
• Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
• Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
• Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
• Age-Related Macular Degeneration (AMD): Dilated Macular Examination
• POAG: Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care*#
• Controlling High Blood Pressure*#
* high priority measure # outcomes measure
Clinical Practice Improvement Activities (CPIA) will carry 15% of the weight in 2017. This is a new category of reporting for providers. Providers in groups with 15 or fewer must select 1 high weighted or 2 medium weighted CPIAs. Those in practices with more than 15 providers select 2 high weighted, 1 high & 2 medium weighted, or 4 medium weighted CPIAs. There are 92 measures from which you can select. Below are examples:
• Provide 24/7 access to eligible clinicians or groups who have real-time access to patient's medical record*
• Care coordination agreements that promote improvements in patient tracking across settings
• Practice improvements for bilateral exchange of patient information
• Use of registry (AOA MORE) data for ongoing practice assessment and improvements
• Engagement of patients through implementation of improvements in patient portal
• Measurement and improvement at the practice and panel level
• Regular training in care coordination
• Practice improvements that engage community resources to support patient health goals
• Use of registry (AOA MORE) for feedback reports that incorporate population health*
Meaningful Use has been transformed into Advancing Care Information (ACI) within MACRA, which carries a 25% weight in 2017. Your ACI Score is composed of a Base and Performance Score, plus a Registry Bonus available to those who use AOA MORE. To achieve your Base Score, you must complete all of the following:
1.Perform a Security Risk Analysis
2.E-prescribe for at least one patient
3.At least one patient must access your portal
4.Create & electronically transmit a summary of care for referral or transition for at least 1 patient
5.(only for EHRs at Stage 3) request/accept at least one patient record
Performance Scores based on your quantity from the following:
• Patient (portal) access to view, download, & transmit information
• Use EHR to identify patient education materials & provide electronic access to those resources
• Send & receive messages to patients via secure messaging
• Send & receive summary of care
• Medication reconciliations after referral or transfer
You may elect to participate in MACRA as an individual via National Provider Identifier (NPI) or as a group via Tax Identification Number (TIN). Remember, participating in MIPS offers the opportunity to increase your future reimbursement, but also the risk of decreasing it. You can make this decision later in 2017. Also, while no details are offered yet by CMS, the Final Rule mentions “Virtual Groups” will be available in future years for groups of 10 or fewer. ECP Network will explore this option as an opportunity for or members who want to maximize their potential reimbursement.
Since there is no weight for the Cost category in 2017, each of the remaining weighted categories will be scored by CMS resulting in a Composite Performance Score on a scale of 0 to 100. This score will be used to calculate the increase/decrease variance from the base fee schedule. Since this is budget neutral, providers who pay penalties will fund those who earn incentives. The Composite Performance Score will be made available to the public via the Medicare Physician Compare website. As explained above, for 2017 scoring above 3 points will ensure no cut in reimbursement with the opportunity for increase up to 4%. (Exceptional performers can earn up to a 12% increase.) You will be notified of your results in early 2018.
ECP Network will monitor this and any clarifications on this Rule toward the benefit of our members. We will look to establish education and tools to help you comply and maximize your reimbursement opportunities. If you have any questions or concerns, ECP Network is here for you at firstname.lastname@example.org or 888-321-2020.
Mark Ridenour, ECP Network Consultant, Strategic Alliances, spoke on this topic at this year’s ECP Network National Meeting on June 12. His presentation entitled Yes, You Still Have to Worry About Your Grade Card, the New Merit-Based Incentive Program can be found here.
Contributor - Mark Ridenour,
Consultant - Strategic Alliances
This is the second in a series on market scorecard items, specifically addressing changes to the Medicare reimbursement formula. The first article in this series, Check Your Scorecard under the Merit-Based Incentive Program, can be found here.
This article will update you on the Medicare Authorization & CHIP Reauthorization Act (MACRA) now that the Final Rule has been released by the Center for Medicare & Medicaid Services (CMS). As a reminder, MACRA replaces the Medicare Part B (professional services) reimbursement under the Sustainable Growth Rate (SGR). This does not change the coding systems, however, your reimbursement may now vary from your peers based on your performance on quality and performance measures. CMS has labeled the rules under MACRA as the Quality Payment Program (QPP) creating this website with numerous resources and detail.
There are two tracks of participation within MACRA. Since CMS estimates less than 1% of eligible optometrists will qualify for the Alternative Payment Models (APMs) track, the focus of this article will be on the track impacting most optometrists, Merit-Based Incentive Payment Systems (MIPS).
The graphic below depicts the timeline and key components concerning the transition to MACRA. The Medicare reimbursement schedule was increased 0.5% in 2016, and will have a 0.5% increase in both 2017 and 2018. This reimbursement schedule becomes the “base schedule” in 2019 with an additional increase of 0.5%, plus an adjustment of up to +/- 4% based on each individual clinician’s 2017 performance.
There will always be a two-year delay from activity (performance or measurement period) to application (payment period). Therefore, your performance in 2017 will be reflected in reimbursement adjustments in 2019. The MIPS adjustment widens each year until reaching +/-9% in payment year 2022, where it will continue indefinitely. The base fee schedule will not be increased again until 2026
Low Volume Exclusion
Before diving into the mechanics of MIPS, it is important to evaluate whether you and your practice may be excluded in 2017 due to the low volume threshold. CMS will review each provider and group's volumes during a defined determination period. For the determination period, the low volume criteria are:
The initial determination period is 9/1/15-8/31/16, and CMS will also re-evaluate during a second determination period 9/1/16-8/31/17. Providers who fall below the low volume limits in either determination period will be excluded from MIPS for 2017. CMS estimates approximately two-thirds of the 36,385 eligible optometrists will be excluded from MIPS - 21,703 due to low volume and 2502 as newly enrolled providers. Providers in their first year of accepting Medicare are also excluded.
You may elect to participate in MACRA as an individual via National Provider Identifier (NPI), or as a group via Tax Identification Number (TIN). Remember, participating in MIPS offers the opportunity to increase your future reimbursement, but also the risk of decreasing it. No details are offered yet by CMS, but the Final Rule mentions “Virtual Groups” will be available in future years for groups of 10 or fewer. ECP Network will explore this option as an opportunity for or members who want to maximize their potential reimbursement.
MIPS will combine the former Meaningful Use, Physician Quality Reporting System (PQRS), and Value-Based Modifier programs with a new Clinical Practice Improvement category. These measures will produce a weighted score which will ultimately increase or decrease your payment against a base fee schedule. This formula is budget neutral, i.e., for every adjustment above the base fee schedule there must be equal adjustment below it. The weighting of these four factors can vary year to year. The Final Rule reveals the initial year weighting as shown in the graphic below:
In 2017, there will be no Cost measures evaluated for MIPS. Advancing Care Information is the transition of Meaningful Use measures dependent on your EHR. There are 271 Quality measures to select from, many similar to PQRS. The new category, Clinical Improvement Activities, has 93 to choose from, including “Provide 24/7 access to eligible clinicians or groups who have real-time access to patient's medical record” and “Care Coordination Agreements”. ECP Network is exploring ways to support your compliance, including establishing referral contracts, which would qualify as a Care Coordination Agreement. Reference this site to view your options for each category.
Pick your pace in MIPS: If you choose the MIPS track of the Quality Payment Program, you have three options.
The size of your payment adjustment will depend both on how much data you submit and your quality results. Unless you qualify for an exclusion, not participating in MIPS will result in your 2019 reimbursements being reduced by 4%. If you plan to submit data for the full year of 2017, you should be preparing now. CMS estimates 93.3% of optometrists who qualify for MIPS will receive a positive payment adjustment for 2019.
While this is a complicated rule, Medicare tends to serve as the standard mimicked by other payers in the market. ECP Network will monitor this and any clarifications on this Rule toward the benefit of our members. We will look to establish education and tools to help you comply and maximize your reimbursement opportunities. If you have any questions or concerns, ECP Network is here for you at email@example.com or 888-321-2020.
Mark Ridenour, ECP Network Consultant, Strategic Alliances, spoke on this topic at this year’s ECP Network National Meeting on June 12. His presentation entitled Yes, You Still Have to Worry About Your Grade Card, the New Merit-Based Incentive Program is available at www.ecpnetwork.com under Events/Meeting Notes.
Staff Training Tip – Grooved mountings use nylon cords to hold lenses securely in place. They are lightweight and attractive, however not every lens material or lens type is suitable for these mounting systems. For best results use Trivex or polycarbonate materials, otherwise edge chipping (and patient disappointment) may eventually occur. Chipping may be related to temperature changes and/or mechanical stress (e.g. rough handling, removing the frame with one hand, etc.).
Trivex gives better optical performance, especially if the lenses are not anti-reflective. Using a grooved frame for plus prescriptions will increase the center thickness. The minimum edge thickness for all lenses in a grooved mounting is about 2.2mm for best results. Your lab can give you guidance if thickness is a concern.
For a -5.00 lens in a 50 eyesize with 1.5mm decentration, using Trivex with a 1.5mm center thickness of would give an edge thickness of about 5.0mm, and poly would have a thickness of about 4.6mm. If the lens is a +5.00 in the same frame, Trivex with a 2.2mm minimum edge thickness would have a center thickness of 5.6mm, and poly with a 2.2mm minimum edge thickness of 5.2mm. For a helpful thickness calculator go to http://22.214.171.124/tools/thickness.php. Using this calculator will help you make decisions about whether a grooved mounting would work well for your patient. This calculator shows 1mm for the minimum edge thickness for plus lenses, which is a reasonable standard for non-grooved mountings, so 1.2mm must be added to the center thickness value for plus lenses when considering a grooved mounting. Increased center thickness adds weight and gives additional magnification for plus prescriptions. In every case Trivex will give a lighter plus lens than poly up to about a +10.00 power, even though the center thickness for Trivex will be slightly greater.
As with drill-mounts, polarizing lenses should not be used with grooved mountings for cosmetic reasons (this exposes the embedded polarizing film). Some polarizing lenses may also be prone to splitting if a grooved mounting is used.
We are all trying to find that ’trick’ or insight that gives us that extra edge in attracting new patients to our practice. Let’s face it, the competition is fierce and any little bit of extra effort may be all you need to win over the next prospective patient. Also know that this is a ‘momentum game’. The more new patient appointments you get, well, the more you get. Each new patient provides access to a new community – their immediate and extended family, their neighbors and friends, their colleagues at work. This is the classic ripple effect, so let’s start throwing some stones!
Your staff is an often overlooked asset resource for new patient acquisition. Make good use of them and not only will they bring in new patients, they will enjoy the challenge and be working for you for many years to come.
Dr. Terri Gossard
Executive Director of ECP Network
“Nowadays people know the price of
everything and the value of nothing,” Oscar Wilde. As with so much of what Wilde wrote or said, this quote is more than just a nice turn of phrase. Price, or the amount of money required to purchase something like a good or service, is very different than value, the usefulness or desirability of a good or service. How much do you need the service? What is it worth to me? Warren Buffett said it another way: “Price is what you pay. Value is what you get.”
The concept of value is incredibly relevant to our optometric practices today. Health care reform has seen a trend away from a “fee for service” payment model to ones that are “value based”. Value-based payment is payment methodology that rewards quality of care through payment incentives and transparency. The Physician Quality Reporting System (PQRS) and Meaningful Use Attestation are early examples of payment incentives. The idea is that value-based care will result from incentives created by value-based payments.
In recent years we’ve seen increasing numbers of examples of value-based payments and care – and while the results are mixed, it appears that both providers and payers are starting to recognize and invest in the coming shift. Hospitals and other providers (who bear significant risk in a move to value-based payments) are starting to change current business models in anticipation of more value-based payments. Moreover, the Affordable Care Act’s support of accountable care organizations and patient-centered medical homes puts even more pressure on providers to adapt.
If you’re like most optometrists and other health care providers, thinking about the future of our collective practices in light of health care reform is a frightening concept. As a private practitioner, what else is health care reform going to require of you? Will you be able to continue serving your patients at the high level of quality they are accustomed to? How will you keep up?
These very questions get to the heart of the ECP Network Mission statement: The ECP Network is a group practice organization dedicated to assisting independent eye care providers in providing high quality, value-based eye health care and vision care. The ECP Network strives to ensure efficiencies in eye care delivery as health care delivery models evolve. The ECP Network also provides a collective voice for our membership, and establishes opportunities for peer-to-peer collaboration. We negotiate discounted pricing and rebate programs to enhance profitability for our members, and we create pathways for maintaining the best clinical outcomes and highest levels of patient satisfaction. The ECP Network places a premium on giving its members representation for the challenges of tomorrow. Our leadership advocates for our members with accountable care organizations, patient-centered medical homes, and other provider collaboratives and delivery systems.
I personally feel that optometry has a unique opportunity to be part of the solution to some of our health care system’s challenges. In fact, the “Value-Based Proposition of Optometric Eye and Vision Care” is rather robust. Optometrists are a common, non-threatening entry point into the healthcare system. We are effective in getting those with chronic health conditions (e.g., high blood pressure) back into compliance with their primary care physician. As a component of preventive healthcare, optometric services create a positive return on investment. Lack of good vision is a barrier to education, which can result in a greater economic burden to our society. And of the five senses, individuals value vision the most.
In short, health care reform must not forget how to value things without a substantial price tag. When we consider what optometry provides — protection and enhancement of the gift of sight — well, that’s priceless.
Q: Can you tell our members a little about Google My Business?
Google My Business is a free program through Google that creates a pin on the Google search engine map (Google Maps) and connects it to your Google+ account. Once your business is verified, it improves your organic Google search ranking and gives your patients quick access to call, get directions, check your hours, and leave testimonials about your practice with the touch of a button. The Google Business Listing is aimed at helping businesses gain more exposure online, connect directly with their customers, and promote their business further as a whole. A convenient dashboard enables control all of Google’s business services in one place, including maps, Google+, and Google reviews.
Q: What's the best way to make the most of your Google Business Listing?
Adding a Google Virtual tour and a full gallery of images to your Google Business Listing allows potential patients to take a peek inside of your business and see what makes your office unique. It builds comfort and familiarity with your practice even before they have been there in person. It can also be used on your website and social media marketing.
Q: So how do you add a Virtual Tour?
A Google Certified Photographer is the only one certified to add a virtual tour of your practice. They are highly trained and have the equipment needed to produce a high quality tour. All of the images of your office taken during the photo shoot are provided for you to use as you wish. The one-time fee for the service goes a long way to reach potential patients. When you elect to have the Virtual Tour, the Google Certified Photographer will also verify your Google Business listing on your behalf, which is a big help.
Q: Once you have your listing, how do you know it will bring new patients to your office?
You will receive an email once per month to show how many viewers have seen your listing online. Also you can see metrics from your dashboard such as how many calls you received from the listing and how many users got directions to your practice from the listing. It is easy to measure your return on investment from these stats. Everyone I have worked with has benefitted from the listing.
Q: How does this help my practice obtain Google Reviews?
Google Reviews are the big difference from a good Google Listing to a great one. Having 10 or more positive reviews triggers the Google Search engine to show your listing more often and also highlights your listing when it is seen among other similar businesses. Once your listing is verified, all you have to do is share the review link with your patients, either on your website, in an email, via social media, or even in the office and you'll start generating patient reviews (hopefully good ones!).
Q: Why would a small optometric office want to use this service?
Small business owners love this service. Not only does it allow them to share their business online with patients and potential patients, they also receive beautiful architectural photography of their business at a fraction of the cost. It's a cost-effective way to tell your story to tech-savvy potential new patients.
Q: You've done hundreds of these tours for all different types of businesses. Are there any stories that stick with you about doing a Virtual Tour for someone?
One of my favorite stories was actually from an optometrist that I talked to recently. They had a patient who was going to bring in his young child in for an eye exam. The child was a little apprehensive about the visit since his last visit with a dentist did not go so well. The optometrist showed the parent the practice's Google Virtual tour, and the parent went home and showed his son the tour on their phone to demonstrate that the optometrist's office was not a scary place. He was even excited once he saw that there were games he could play in the waiting room. The Google Virtual Tour allowed the child to become comfortable with the office environment and made for a successful appointment.
To see a virtual tour, click here.
If you are interested in a Google Virtual Tour, or have more questions about ECP Network Google Photography member benefits, please contact Joseph Danzer at firstname.lastname@example.org or call the ECP Network at 1-888-321-2020.
Business Development & Client Relations | VueCare Media
Great eye care providers have always put a high value on educating their patients. Patient education is a tool of great importance in creating a healthier and more satisfied patient. You may already have your education “spiels” memorized from years of practice. Think about this: Is it possible that your population of increasingly tech-savvy patients expect their doctor to also utilize this technology? Patient education is a great place to start.
With the help of customized digital patient-centered education tools, you can spend less time on education and increase patient satisfaction. These tools can be utilized on televisions in the office, computer monitors in the exam rooms, or tablets/iPads in the dispensary. Each one can be customized for the patient’s situation. For example, in the exam room you can show the process of macular degeneration occurring with a “doctor view” and a “patient view”. Then you can prescribe UV protective eyewear, and your optical staff can demonstrate the advantage of this product to the patient directly on the computer screen.
With this level of sophistication in patient education, the patient is more informed and is satisfied with your expertise in managing their eye health. The more informed patient is healthier and more trusting of you and your office staff. This translates into increased optical sales and greater retention for eye exams. Patients love the simple, easy to follow diagrams and animations. They often come away with a profound “aha” moment in the exam room or dispensary.
Because the information is so clearly presented on the screen, the patient will more quickly understand their education. This allows you and your staff to spend less overall time with patient education. Reducing your chair time can improve your productivity or allow you more freedom to focus on other things that need attention.
The next time you are giving the same old boring PVD talk to a patient, ask yourself a few questions. Did the patient truly understand what I was telling them about their eye? Did they trust my explanation? How long did it take me to provide that education? Think about your dispensary also. How much could your sales improve if you had a more compelling way to demonstrate the necessity of anti-reflective lenses?
As technology changes, the way we use that technology changes with it. You and your patients have come to expect a high level of technology. I hope after reading this, you’ll consider taking a hard look at your patient education in the office and the dispensary.
VueCare Media delivers digital patient education and marketing tools that create a personalized experience for both patients and eye care providers. ECP Network Elite members will receive a 10% discount on the EyeChannel, VueSimulator, and VueLibrary monthly subscriptions. The one time setup fee will be discounted $200 for the EyeChannel TV, VueSimulator, and VueLibrary. Contact your representative for more information.
Training can be an important part of your staff meetings. It can improve morale, and it breaks the tedium of unscrambling problems. Following are a few thoughts and tips related to lensometry that you, or an experienced optician, can use to let the whole staff know a little more about the instrument that is really at the heart of your dispensary. The following preliminary exercise includes a how-to on adjusting the ocular of the lensometer for more accurate results.
Lensometer is a name commonly used for focimeters (fo-sim-iters). A focimeter is an instrument that determines the focusing power (i.e. prescription) of a lens. Lensometer is a registered trademark that originated with American Optical. B & L focimeters were trademarked decades ago as Vertometers®, but regardless of the name they all have the same function.
The anatomy of the instrument usually consists of: The power wheel, the axis wheel (not present on circle-of-dots targeted instruments, ocular/telescope, marking pens, ink reservoir, lens table, lens clamp, lens stop, collimating lens (hidden between the lens stop and the target lens), target lens/mires, and reticule (black rings seen through the telescope) and the often overlooked on/off switch. Pointing out the parts of the instrument helps avoid leaving your listener’s in confusion. Also show how to change the bulb and let everyone know where the spare bulbs are kept.
If you are going to let beginners practice with the instrument, show them how to safely pick the instrument up without spilling the ink.
The adjustment of the ocular is important in getting accurate results. For those under about 50 years of age, this adjustment may be needed several times a day due to accommodative fatigue or stress-related accommodative spasms. The over 50 set may be able to adjust one time, and use that ocular setting on a regular basis. To correctly make the setting:
a. Hold a piece of white paper in the light path of the instrument. It will serve as your viewing screen.
b. The room does should not be dark, but the instrument does not need to be on.
c. Look into the telescope, and view the black reticule rings.
d. Turn the ocular focusing ring (near to the viewing aperture) as far as it will go in a clockwise direction.
e. Next, slowly turn the focusing ring in a clockwise direction until the reticule rings are just in clear focus. If you turn too far, you will be inducing minus power, and the ring lines may seem to get thinner a little brighter. Using such a setting will tire you and possibly cause power errors in your findings.
f. Once the ocular set, remover the paper and turn the instrument on. Rotate the power wheel from the high plus power range until the mires just come into focus. If the instrument is in calibration, your power should be at plano. If it is not, try turning the ocular focus slightly clockwise or counterclockwise and retry coming out of the high plus power range. With repeated tries, you should find an ocular focus setting the consistently ends at plano. You should double check by coming out of the high minus powers. The same ocular focus setting should bring you to a good mire focus coming from either the high plus or the high minus range. If this cannot be achieved, you may be using an older instrument with some worn gears, and it should be serviced.
To complete this preliminary demo, use some spherical trial lenses and some prism lenses to allow your audience to see how the mires focus at different power settings, and how prism moves the mires. Time permitting, you can show how vertical mires focus at one setting and horizontal mire focus at another when a cylindrical lens is tested.
By using a penlight and playing light at an oblique angle on the ocular, you can show the lash smudges and occasional fingerprint on the ocular lens. This may encourage keeping the lens clean and sanitary. To clean the lens always use an AR cleaner soaked into a lint-free, grit-free tissue. Never soak the lens with excessive amount of cleaner. This prevents the detergent from working its way into the focusing mechanism of the telescope.
If the lighting in the area is darkened, you can turn the instrument on and using a piece of translucent waxed paper or stretched tissue as a screen, you can locate the exit pupil of the instrument. First stretch your “screen” over the lens to find a out-of-focus circle of light. Then move the screen away from the ocular to find a distance at which the circle of light is in focus. The in-focus circle is the exit pupil of the instrument. The distance from the lens to the in-focus circle is the “lash relief” that was designed into the instrument. The very best performance of your lensometer’s telescope will occur if your pupil (actually the entrance pupil of your eye’s optical system falls centered upon the exit pupil of the instrument, and if your pupil is the same diameter as that exit pupil. Older lensometers sometimes had a lash relief that was too short, and glasses had to be removed to get the viewer’s pupil on the instrument’s exit pupil. If you find that is the case with your instrument, be sure to adjust the ocular either with or without your glasses depending on the way you will be analyzing lenses (the settings will tend to be different sc or cc).
Watch for the September issue of Diversified’s Product News newsletter. It will contain a description how to give your lensometer a physical to be sure it not in need of service. It will be on the Diversified website (click on Library/Product News – no password needed) soon. If you have requested Product News in hard copy, it will be arriving around September15th.
The ECP Network is a group practice organization dedicated to assisting independent eye care providers in providing high quality, value-based eye health care and vision care.
· Ensure efficiencies in eye care delivery with evolving health care delivery models
· Provide a collective voice for our membership
· Establish opportunities for peer-to-peer collaboration
· Negotiate discounted pricing and rebate programs to enhance profitability
· Create pathways for maintaining the best clinical outcomes and highest levels of patients satisfaction