Keeping up with Dr. Jones

Excerpted from page 38 of the March 2018 edition of AOA Focus.

Gilan Cockrell, O.D., chief executive officer of AOAExcel^®-endorsed business partner The Williams Group, has been known to spend three straight days wandering the aisles of an exhibit hall during an optometric trade show. As opposed to casually strolling past the booths, Dr. Cockrell and his business partner stop at practically every dazzling display—he concedes he has the luxury of time compared with many doctors of optometry and an insatiable curiosity about what's next.

Our heads spin with the innovative products out there that people dream up and how you can go back and implement those new technologies into your practice," says Dr. Cockrell, who practiced for 34 years, but now attends the shows as a practice management consultant, tracking the latest trends in optometry.

"There's no dearth of new technologies, innovative entrepreneurship and creativity out there," he adds. "The innovation in technology is allowing optometry the opportunity to participate in the overall health care of a patient in a way that has not been possible in the past."

The Alaska practice of Paul Barney, O.D., chair of the AOA's New Technologies Committee, recently upgraded its optical coherence tomography (OCT)-angiography so doctors could better assess the retinal vascular system.

"The vast majority of doctors of optometry look at new technology and consider whether the technology will allow them to provide better patient care," Dr. Barney says. "And if so, they would be motivated to get it. I also think there is a competitive aspect of purchasing equipment. As time passes, they see everyone else is using that new technology or they hear about it through continuing education—that it is becoming the standard of care. They start to feel the need to get on top of this.

"Doctors are constantly assessing things, such as how we are taking care of patients," he adds.

Yet, in the ever-evolving world of technology, how do doctors of optometry keep up and purchase practice-changing diagnostic equipment? Here's what the experts say doctors of optometry might consider when making a big purchase.

Create a value-added patient experience

Begin by considering why you want to make an investment in technology for your practice. Some doctors eagerly embrace cutting-edge technology, annually setting aside funds for making a big equipment purchase. Others might be thinking about adding a specialty that requires unique equipment. And still, others are mulling after reading or hearing about a technology that can detect, for example, age-related macular degeneration, at an earlier stage. Can they afford to buy it outright, secure a loan or lease it?

For Dr. Cockrell, the answer to "why" is patients.

When he practiced, Dr. Cockrell thought every day about how he could make that experience in his office better for patients, doctors and staff. He still does, as he consults daily at the practices of doctors of optometry across the country. He cites several pieces of equipment that not only save time but also reduce risk of missed pathology.

With this equipment, eye conditions could be caught before they become clinically significant, he adds.

"The net impact has to be an improvement in your patients' ability to perform in whatever area of life," says Dr. Cockrell, whose practice would put aside money annually for big purchases. "The technology has to bring value to the patient experience. A value that is palpable where the patients can feel it, see it. Then it's easy for them to say, 'Wow, this is a nice addition to my life.'"

Patients and doctors should share that sense of value added, which contributes to a culture of improvement and change in the practice. Staff, too.

"It's not always the doctor who performs the diagnostic tests," Dr. Cockrell says. "The technicians performing those have to be well-versed in what the instrument does, how it performs, what kind of value it's bringing."

Consequently, Dr. Cockrell suggests "testing the waters" prior to any purchase. He talks with patients and staff about the value a piece of technology can add to care.

"You're sampling the demand," he adds.

Go with the patient flow

Consider how the new technology will fit into your physical space but also sequentially in the continuum of care in your practice, as patients move smoothly and efficiently through check-in, pretest, exam room, dispensing and departure.

The goal is to avoid bottlenecks and unproductive wait times.

"One of the things I see now in this consulting world is doctors purchasing technology with the best of intentions, and then they struggle with implementation and the technology basically becomes a doorstop or a clothes hanger," Dr. Cockrell says. "Nobody wins in that scenario. I would put some thoughtful consideration into how you will implement the technology into your practice.

"The burgeoning advancement of technology also requires us to look at the workflow in our offices," he adds. "The workflow that was acceptable in an office even 10 or 15 years ago is not really conducive to practicing in this decade. The advent of all the different technologies just requires a different look at the workspace to help maintain fluid patient movement, as opposed to creating degradation of the patient experience. It must be about the patient. Creating the value and excitement about what it can do for the patient is still paramount."

That's not the only factor to reflect on as you look at flow.

Where exam rooms once were the center of the patient universe, their experience is now more expansive. Patient information and diagnostics can take place in other practice spaces, including at check-in/reception and pretest areas.

Richard Edlow, O.D., is a founding partner at Catonsville Eye Group outside of Baltimore. Dr. Edlow earned his bachelor's degree in economics and writes and lectures frequently on practice management as the self-proclaimed "Eyeconomist." He was chair of the former AOA Information & Data Committee for 15 years.

At a previous practice, Dr. Edlow says, they made an investment in customer-relations management software. Patients can make their appointments and pay their bills online. They are able to schedule appointments overnight. They can receive text messages from the practice. Patient registration is handled through a kiosk where they will out some initial demographic information, get their insurance eligibility verified and pay their copays.

Patients value their time, Dr. Edlow says.

"Technology in eye care and optometry today has so many facets to it," says Dr. Edlow, who wrote the article, "Leveraging Technology to Reduce Patient Transaction Costs," in a 2015 issue of The Journal of Medical Practice Management.

In the article, Dr. Edlow explained how his previous optometry/ophthalmology practice reduced the costs of communicating with patients—and no-show rates—by switching from automated patient visit confirmation phone calls (which can run about $395 a month) to live calls ($1.28 per four-minute call), and then to text messaging and emails (9 cents per patient).

At the time, his practice of 13 doctors of optometry and 13 ophthalmologists was seeing 600 patients per day. The costs added up.

"As an independent optometrist, I need to provide great patient care," Dr. Edlow says. "So, to provide great patient care, I need all the diagnostic equipment and the exam room equipment to 'wow' the patients. And at the same time, I need to run my practice efficiently and effectively, and I need to use technology to do that to make it cost-effective and to take advantage of some economies of scale.

"I also need to be relevant to the millennial patient, and to patients in general, by using social media or through a text or email," he says. "We're living in a great time in optometry, in eye care, in health care in general, whereby we can interact with a patient in a very cost-effective and meaningful way, and provide them with a great experience in the process."

Can you afford it? Can you afford not to?

On this, Drs. Cockrell and Edlow are on the same page. Their criteria for deciding whether to purchase a big-ticket piece of equipment are twofold, in this order:

• Does the technology enhance patient care and outcomes?
• Does it make economic sense?

"No. 1, is this going to allow me to provide better eye care services for my patients?" Dr. Edlow says. "No. 2, from a break-even analysis, am I going to make or lose money on this?

"If you meet both criteria, it's a no-brainer," he says. "You go ahead, and you purchase it."

Product salespeople are happy to help doctors of optometry calculate the possibilities financially. Still, Dr. Edlow does his own analysis. For instance, he asks how many tests on the equipment per month are needed to pay the lease or loan on it. Other considerations: How much time will be dedicated to educating staff on not only the value the equipment brings to patient care so they can communicate this to patients but also how and who will be trained to operate the equipment?

Another key consideration: How much can a practice write off by accelerated depreciation under Section 179 of the Internal Revenue Service Code (Publication 946)? Rather than depreciating property over several years, Section 179 allows taxpayers "to recover all or part of the cost of certain qualifying property, up to a limit, by deducting it in the year you place the property in service," according to the IRS.

Dr. Edlow also shops around. He goes to the equipment shows and conferences. He stays attuned to developments in clinical research, for technological innovations and care trends.

"The instruments have a goal of increasing the ability to predict, treat or prevent some pathological change," Dr. Edlow says. "So, an enhancement in technology improves not only the efficiency but also the precision and accuracy of the instruments. An OCT from a decade ago does not perform its functions at the same level that a new OCT does. I just read an article about OCT angiography, which decreases the risk of a catastrophic event and improves diagnostic accuracy."

Why technology matters

Drs. Edlow and Cockrell share a list of reasons why new technology can be an asset to a practice:

• Provides state-of-theart care for patients
• Enhances the value of a practice
• Keeps doctors' minds fresh and open to ideas
• Wows patients

Dr. Cockrell recalls a conversation he once had with a patient. The patient said, "We like coming here because every time we come, you've added new technology. We know you're trying to provide state-of-the-art care because you're not just taking all the money home. You're investing it back into our care."

Opportunity for optometry?

Dr. Edlow has compared the growth in the number of ophthalmologists completing residency programs in the U.S. versus the predictions on impairment and blindness brought on by the aging baby boomer generation. There is an imbalance, he says, presenting an opportunity for optometry. For example, a John Hopkins University study projected in the Nov. 2, 2017 edition of JAMA Ophthalmology, a twofold increase in vision impairment and blindness between 2017 and 2050 among Americans 45 years of age and older. Additionally, a U.S. Department of Health & Human Services health workforce analysis in December 2016 presented national and regional projections of the supply and demand for 10 surgical specialty practitioners between 2013 and 2025. Among the 10 surgical specialties featured in the report, ophthalmology demonstrated the "greatest" deficit, falling short by 6,180 full-time equivalents (FTE) based on supply (16,510 FTEs) versus projected demand (22,690 FTEs).

"Ophthalmology is not going to be able to accommodate the increased demand for services," Dr. Edlow says. "Who's going to provide it? The answer is optometry. As optometrists, we need to be prepared with the appropriate equipment to manage that care. To me, the message for our profession is keep doing what you're doing, but add medical eye care, and your practice will grow."