October 2, 2019
By Gary Gerber, OD
Co-Founder, Treehouse Eyes
We’ve all done it. Attend a CE event and hear about a new clinical technique or practice-building strategy. We take copious notes and return with grandiose visions of changing the world (why stop at just changing our practice?) with this new information. It can be a new glaucoma treatment paradigm, new dry eye device, new pricing strategy for sunglasses or a new way to order contact lenses. What it is can vary greatly and can, of course, include a desire to start and maintain a robust and comprehensive myopia management program. But what never varies is our struggle to execute and even more so, have the newly implemented item be sustained in our day to day practice routine.
My career as a consultant has brought our team into countless practices where we find the latest opto-techno-widget sitting in a room with a dust cover on it. The doctor tells us, “Yeah, it works really well. I just couldn’t get it to work in my practice.” From there we usually get one or both follow-up comments, “It takes too long” or “Patients don’t want to pay for it.”
Let’s deal with the second comment first, patients’ reluctance to pay. That’s obviously not the case as the doctor initially said, “It works really well.” Apparently at least ONE patient paid for it! Experience tells us the challenge here is usually how the fees are presented vs. the actual fee itself. After fees are dealt it leaves us with, “It takes too long.” Let’s address that in the context of myopia management in your practice.
Based on our experience at Treehouse Eyes, a company that only provides expert myopia management services to kids, I can unequivocally and respectfully state “It takes too long” is incorrect. It would be more accurate to say, “It takes longer than I thought it would and it takes longer than a kid receiving a primary care eye exam and a pair of glasses.” In fact, with more than three years of data, we now know it usually takes about seven times as long as a primary care examination.
Here’s a real-life example of where “it takes too long” originates and why it causes myopia management dabblers (MMDs) to sputter and eventually stop.
After attending a full-blown myopia management course, docs jump into their first case. Ninety-nine percent of the time this involves an orthokeratology design since most in our industry still incorrectly equate myopia management with orthokeratology (more on that later). These doctors are usually jumping in to these cases without the means to accurately and reproducibly measure axial length (and an A-Scan is not the answer here – a high-quality optical biometer is) [See https://reviewofmm.com/the-importance-of-measuring-axial-length-when-managing-childhood-myopia/ for more information]. They also commonly have not given their staff a deep dive into myopia management or prepped them for the FAQs that are sure to come up from parents. “What do you mean insurance won’t pay for this? Why haven’t I heard of this before? Why not just wear glasses and make the lenses stronger?” are just a few.
But even in the face of all the above, the doctor continues fitting more kids in orthokeratology lenses until one day a parent peppers him with a four-page print out of Dr. Google questions. Having the confidence of six previous cases under his belt the doctor carefully answers all the questions. Answering the questions turns that 30-minute appointment into a 50-minute one. While he’s answering the questions, the presbyope in the next room is looking at their watch and slowly getting agitated that the doctor has yet to come in to start their examination.
Eventually finishing with the parent of the myopic kid, the doctor quickly scurries into the next exam room and profusely apologizes to the presbyope for running late. Wrapping up the exam and changing the patients Rx, the delayed presbyope leaves the practice without buying eyeglasses since they are late picking up their kid from soccer practice.
Multiply the above by five myopia management consultations with three of them moving forward and five presbyopes buying glasses elsewhere.
Net, net, net… The practice lost money on a pure revenue generation model and created a capacity problem due to the extra time for follow up visits the myopia management kids needed that wasn’t planned for — they in effect generated about an additional 30 non-revenue appointment slots.
“Gary, that’s not my practice. I have plenty of open slots.” If you’re thinking that you’re missing the point. After 25 years of carefully examining appointment templates, I can guarantee you that kicking the appointment slot can down the road is costing you money.
The solution is straightforward.
- Recognize that you have the above problem in your office
- BEFORE you see your first myopia management case, get your office prepared. That means:
- Plan to see your first case a few MONTHS from now, not tomorrow
- Get your fees aligned to compensate for lost appointment slots
- Get your staff 100% aligned on what myopia management is, why it’s essential and why parents should get their kids treated. And remember – myopia management isn’t orthokeratology for the purpose of uncorrected VA. Take that approach, and you’ll fail.
- Buy the necessary equipment. At a minimum an optical biometer and standalone topographer.
- Work on your social media and marketing with an acute focus on myopia management, not orthokeratology for vision correction.
- And finally – adjust your appointment template NOW (to start in a few months) to accommodate myopia management cases.
Take the time to do all the above after you attend that course, but BEFORE you see your first case and you’re much more likely to have a sustainable myopia management program in your practice. If all the above seems overwhelming, just like you’re probably already doing with other specialty services like vision therapy, specialty contact lenses dry eye, etc., refer appropriate kids to a colleague who is not an MMD and collaborate on your patient’s care. Do what’s best for the patient and your practice and work with a trusted colleague. When you do, just like vision therapy, everyone always wins.
Gary Gerber, OD, co-founder of Treehouse Eyes