3 steps to get started with dry eye treatment
DOs follow 3 steps to add dry eye care to their practices: create an initial plan, ensure consistency of messages and patient materials, and screen all patients every time.
OOne of the biggest barriers to expanding dry eye care into the average optometric practice is confusion about where to start.
These 3 steps will allow DOs to intentionally add treatment for ocular surface disease to their patient services.
1. Make a plan of 30,000 feet
There are many great resources out there now, but that too can be overwhelming and confusing at times. I challenge DOs to explore and use the resources available from providers, education programs and dry eye leaders. These resources are available when DOs know this is an area of expansion they want to pursue in the fastest and most painless manner.
DOs who only test the waters do not need to plan all the details. They need a starting plan that addresses the flow, planning, and education of staff and patients.
Related: Why Patient Occupancy Matters In Dry Eye Disease
When it comes to flow and scheduling, my best advice is to start scheduling dry eye assessments only in the last time slot before lunch and the last before the end of the day. This will give you presence of mind without wondering how many people are waiting or who else is on the schedule. It also allows the DO to take extra minutes if needed to further educate the patient.
At the onset of OD, their exams can take a long time. Don’t be fooled by the number of minutes spent on this visit or the dollar amount spent by patients. This will be the foundation of the whole relationship and their loyalty to the DO and the treatment plan. Although DOs may need to schedule a little more time for dry eye assessments, follow-ups should fit directly into the normal planning model.
Start thinking about space and flow. This won’t be a concern at first, but it could be as the word about dry eye services spreads. It’s important, even now, to position diagnostic devices in the smartest way possible to limit patient recoil and keep staff on board.
Related: Dry Eye in the Digital Age
2. Educate now
For the plan to have bite, a cohesive message must start at the top and spread to every station in the office. Now, before we really get started, it’s time to educate staff on the need to increase the diagnosis of dry eye and improve outcomes. It is important to talk about their roles in this new mission. Their roles are essential in order to uniformly screen patients, to advise patients correctly regarding visits and dry eye protocols and to supervise patients in their treatments.
Consistent messaging can be accomplished by creating a simple one-page protocol for screening, scheduling, and billing, as well as a summary page for each of the DO benchmark treatments. Try to spend at least an hour explaining to all staff the expectations for each role in the plan and pointing out the distinctions for each product prescribed or sold.
This is also the time to collect patient education materials. When I first started I used pre-filled folders containing any brochures I might want to give to the patient. That way, instead of looking for a specific brochure, I just deleted the ones I didn’t need for that patient. This technique saved me a considerable amount of time and assured me that the patient left well educated. How DOs educate their patients is critical, but many doctors find dry eye visits take too long, so the little things that save time are valuable.
Related: Experts Offer Advice to DOs Starting Dry Eye Subspecialty
Patients with dry eye often arrive frustrated due to the length of their illness and confusion over why it occurs and what treatment options are available. Excellent patient education is a unique service that carries a significant weight in differentiating practice in dry eye care.
It is important to educate patients early on. While it’s certainly more helpful to create an extra one-page checklist with instructions for patients, at least collect the brochures of recommended products and treatments so they don’t come away empty-handed.
As for the means of a great education, if the ODs are sure they want to delve into dry eye care, I suggest buying an anterior segment camera. For dry eye care, it’s best to choose one with a built-in patient education platform and printable patient report (I use the Oculus 5M keratograph and Crystal Tear report). The reason I say do it now is because it can be a big help in building buy-in from staff and patients, which can avoid the initial struggles and disappointments. It also serves as a clear investment and visible tool to delineate the practice’s intention to implement a new service and protocol.
Related: Lactoferrin Levels May Diagnose Dry Eye
3. Make some rules
First, screen each patient each time. That’s right, everyone, every time. This is where it all begins. Screening reveals the need and creates the responsibility to do something about it. Ideally, I have found it even better when screening is based on structural issues rather than symptoms.
Here’s why: While surveys can be useful in documenting what the patient is feeling, the patient may take the perspective that DO recommendations are made based on those symptoms. At this point, the patient may make an uneducated decision that she does not “need” to do everything the doctor recommends. Other times, the patient may get off to a good start with home treatments, but stop as soon as she starts to feel better because she thinks she is treating because of the symptoms.
Instead, try incorporating screening that shows patients their clinical presentations in a way that is both clear and motivating. I print a report for patients that shows red flags and why I’m asking them to come back for a dry eye assessment or specific treatment. This visual will help inspire adherence and longevity of treatment more than allowing patients to base their decisions solely on symptom control.
Related: Why ODs Should Treat Dry Eye Disease
Universal screening should be the first hard rule. As part of this, write down what the screening will be, who will perform it and interpret the results, when it will occur in the exam and where, and the conversion criteria that brings the patient back for a dry eye assessment and the scripts needed to do so.
Second, never do a dry eye assessment on the same day as the current exam or follow-up visit. It is too important not to give the dry eye assessment its own space and time. Dry eye must seem important to the DO before it seems important to the patient.
Consider the patient’s point of view: he had to be concerned about the insurance of eyesight, refraction, dilation and glasses. The ocular surface disease is too complex and critical to be thrown over or squeezed in the middle. In my office, we tell the patient that we want to get to the bottom of the concerns and make lasting change. But to achieve this, we will need time to perform the necessary diagnostic tests.
DOs that plan to charge a reimbursable fee for this service should ensure they have the equipment to justify the fee. They should also make sure that they do not charge both the patient and the insurance company for this extra time or this test when assessing for dry eye. This is when an anterior segment camera with analysis and reporting functions comes in handy, because with it the DO is more than 92285. Always make sure that patients first sign a advanced beneficiary notice (ABN).
Related: Proper Documentation Helps Guarantee Prior Authorizations
Ultimately, ODs interested in adding a treatment for dry eye and ocular surface disease don’t need all the details. Remember that progress is more important than perfection, so waiting to start until everything is figured out will be the biggest shortfall.
Write a rough draft of these key pages with bullet points to guide the first steps:
– A one-page protocol on planning and fees
– An educational summary page for each treatment and essential product
– A one-page guide to what is part of a dry eye screening, who will run it and interpret the results, when it will occur in the exam, and the conversion criteria that brings the patient back for a dry eye assessment and script for this discussion
– A one-page processing guide showing when to use what. I list a good, better and best option for each category of ocular surface disease to give me a clear picture in the exam room
More by Dr. Brimer: How Blinking Affects Contact Lens Wearing