THE VALUE PROPOSITION: CLINICAL LAB TESTING IN OPTOMETRIC PRACTICE By John Rumpakis, OD, MBA, and Paul Karpecki, OD L ike doctors in almost ev-ery other sector of health care, today’s optometrists face signi fi cant challenges. For example, we are in-creasingly a ff ected by health care re-form, vertical integration, changes in patient bene fi t structure, third-party plan participation, increasing over-head costs, and more. All of these im-pact our traditional revenue streams. Yet even in the face of these hurdles, we strive to deliver improved clini-cal services. The evolution of point-of-care laboratory testing has been instrumental in our ability to do this. In many ways, point-of-care testing helps us to overcome fi scal challenges while simultaneously elevating the standard of care. As such, diagnostics like TearLab osmolarity testing, are quickly gaining traction in the average optometric practice and are weaving their way into daily clinical regimens. In part 3 of this series on how osmo-larity testing can bene fi t your contact lens practice, we will discuss how the clinical value of TearLab testing o ff ers a hidden revenue stream that extends far beyond direct reimbursement. CONSIDER THE CLINICAL VALUE The majority of the point-of-care testing that’s currently performed in eye care practice is related to the an-terior segment. Within this segment, the largest area of potential is ocular surface disease. Dry eye a ff ects nearly 30 million Americans, including 50% of all contact lens wearers. 1-5 Further-more, research suggests that if we were to rely on symptoms to diagnose dry eye, this would produce a missed or incorrect diagnosis more than 40% of the time. 6-8 Without question, there is an oppor-tunity here to improve care as well as quality of life for contact lens wearers. Despite a 20-year parade of contact lens improvements, dropout rates have not fallen. About 16% of contact lens wearers drop out every year. 9-11 As we discussed in the fi rst two install-ments of this series, osmolarity test-ing can be a catalyst for meaningful change in this regard. Osmolarity testing allows us to de-termine objectively and quantitatively the quality of the tear fi lm in dry eye and the severity level of the condition, o ff er appropriate treatment as needed, determine the likelihood of imminent contact lens dropout, and fi t patients in lenses based on clinical variables in-stead of monetary ones that are based on a patient’s knee-jerk decision to se-lect the least expensive available lens. This alternative, proactive approach sets the patient up for success and, in so doing, helps strengthen your practice. WHERE TO START Like many of the tests that are per-formed at the point of care, to perform and bill for TearLab osmolarity testing, your o ffi ce will need a CLIA waiver license. By de fi nition, CLIA stands for Clinical Lab Improvement Amend-ments. This means that your o ffi ce will need to be designated as a CLIA-ap-proved laboratory, and one of the doc-tors must be designated and approved as a clinical lab director. To begin this simple process, you’ll need to apply through CMS to get your CLIA certi-fi cation. 12 The cost is only $150 for two years. 13 You may have heard the argument that point-of-care testing isn’t worth-while because the reimbursements aren’t substantial. This is only half true. Indeed, point-of-care testing is rarely a huge pro fi t center from the myopic perspective of direct reimbursement, although reimbursement more than FIGURE 1 Number of annual patients Percent of patients who wear CLs Number of contact lens patients Average annual value of a contact lens patient Average contact lens dropout rate Average number of contact lens dropouts Annual economic value of your contact lens patients Lifetime economic potential of eliminating your contact lens dropouts 3,100 34% 1,054 $275 16% 169 $46,376 $2,086,920 22 REVIEW OF OPTOMETRY AUGUST 15, 2016

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