The recent arrival of presbyopia therapeutics has created an entirely new category that holds both immense promise with regard to patients plus significant potential for practices. Many patients love the idea of using drops to treat their condition instead of relying on glasses or surgical intervention. Since these products entered the marketplace, leading methods have fielded appreciable interest—largely driven by word of mouth.
However, with great potential comes real challenges. Confusion around workflow and billing has led many eye care providers in order to relegate or even eschew these types of consultations in favor of established procedures and protocols. They’re missing an important opportunity, as effective integration benefits every stakeholder.
Practices gain access to a new revenue stream, individuals gain access to an in-demand treatment option, and the treatment group gains proof of concept, fueling momentum plus innovation.
Here, we will explore the key practice management imperatives required to make presbyopia drops an integrated part associated with a clinical armamentarium, including how to structure the model and important patient evaluation considerations.
Adapting a good established design
To start, there are important questions that practice managers must answer to facilitate a successful integration. How will I create a revenue stream close to this product, and what price point do I land on? How do I educate the patient on the particular value and importance of the treatment, as well as communicate the value of the consultation itself? What is the role of insurance, and what will (or won’t) they cover?
In the case of presbyopia drops, we can answer some of these questions right away, starting with revenue plus insurance.
Given the category’s nascency, insurance won’t cover consultation fees. That means we are looking at the fee-for-service model that is entirely cash pay. The particular form used to sign regarding fee intended for service is an Advance Beneficiary Notice (ABN). Now that we’ve defined our boundaries, we can make some useful comparisons to establish a clear direction.
In the world of contact and intraocular lenses (IOLs), we are usually experienced at consulting upon a range of therapy options, from “basic” (usually paid simply by insurance) to “premium” (usually paid within cash). This can serve as an useful starting point for creating a premium presbyopia discussion that a patient finds valuable and worth exploring.
When a patient comes in to get a vision or medical exam, vision or medical insurance coverage will cover their own basic costs, respectively. With those basic costs addressed, providers have an opportunity to inform sufferers about this new treatment category and present the particular respective appointment as a separate, premium offering.
Beyond covering our practice’s billing plus revenue needs, carving out space pertaining to a high quality consultation allows us to take the time we need to fully educate patients on a new therapy category: one that, as associated with today, is relatively lacking in ready-made patient education assets.
Educating and evaluating patients
Effectively educating patients starts with communicating the need for a dedicated assessment. It’s important to explain succinctly and directly that because this consultation is not covered by insurance, it will require an out-of-pocket payment.
From there, the patient should sign a form agreeing to a specialty pharmaceutical consultation. This is the time to explain the basic advantages and limitations of this treatment category, within line with the item literature.
Next, it will be crucial to perform comprehensive diagnostic evaluation of the patient. Patients receiving these types of eye falls must possess their entire retina assessed, including (and especially) the particular peripheral retina. Retinal holes, tears, or even any degree of degeneration necessitates more active monitoring after treatment is usually implemented, so these factors must be identified.
Further, effective assessment from the peripheral retina requires dilation; imaging modalities that will do not rely on dilation are not sufficient for this particular purpose. No screening technology available upon the market today may visualize all 4 quadrants in equal detail.
Fortunately, since dilation is definitely covered by vision and medical insurance, cost shouldn’t be a barrier. After dilation, a series of different image resolution technologies should be used. A fundamental approach would include direct ophthalmoscopy or fundus photography. More advanced modalities, which includes OCT or even widefield retinal imaging, can also play an essential role where and when available.
Once the education and evaluation steps are usually complete, treatment providers may answer some of the patient’s most important questions, including their daily dosing schedule (usually once or twice), eyes to be dosed, signs and symptoms associated along with complications or risk aspects, and restrictions around nighttime use or even use while driving. Go deep here and establish a robust dialogue.
These queries can become answered simply by a trained technician; however , since the category can be new, appropriate time and resources need to end up being invested up front in order to adequately train the technicians.
Taking the Initiative
Between the particular initial discussion, patient assessment, and deep dive schooling around therapy, risks, plus use parameters, it’s not very hard to justify the premium assessment fee.
Prescribing these types of medications correctly requires a high level of due diligence, and patients that are willing in order to pay for treatment directly generally want their particular care provider to take every step required to ensure their safety and wellbeing long-term.
Associated: Is presbyopia the newest subspecialty?
Implementing these protocols takes time plus effort, but the initiative is worth the reward. Too numerous patients today remain unaware of new or alternative treatment options because implementing something new creates distinct exercise management difficulties.
However , to provide the most comprehensive care possible and expand our practice possible, we should not only meet these problems, but exceed them. Fortunately, as this specific category continues to mature, we can expect industry partners in order to provide additional patient education and learning resources that greatly improve efficiency on the practice end.
For now, though, it is on us because care providers to understand the product literature, carve out a practice protocol that includes (and charges for) the because of diligence needed, and afford our patients the chance to pursue the presbyopia treatment path that works best for them.
Providing exceptional service takes time and effort but offers salient rewards for individuals and practices alike.