The Value-Driven Eye Care Game: A Player's Survival Guide

By Alistair L. Jackson M.ED F.A.A.O. and Larry J. Alexander O.D F.A.A.O.

With the establishment of optometry as the primary eye care profession, and significant reforms under way in health care, the opportunity exists now to add value to an independent eye care practice for both the doctor and the patient. The favorable geographic distribution of optometrists in rural and urban locations lends well to the evolving trends of health care in America. Ease of access to care without having to travel long distances lends well to the economics for patients.

The difficulty for the independent practice is the paradigm shift required on several levels: from paper records to electronic; from an optical focus to medical, from individual and episodic care to team-based and coordinated care. Add to this the concomitant increase in the complexity of billing and coding and we have a whole new game on our hands, a survival game. The exact strategy to make this shift adeptly does not exist.

Vision without execution is hallucination. This guide will serve as a basis for applying some organizational sense to the adventure of creating a new medical model for forward-thinking optometric practices.

• Language: English
• Publisher: AuthorHouse
• Release date: Nov 6, 2013
• ISBN: 9781491824641

Alistair L. Jackson M.ED F.A.A.O.

Larry J. Alexander, OD, FAAO, author of the “New Medical Model” chapters is no stranger to the optometry profession. Well known for his authorship of Primary Care of the Posterior Segment, a text used by most schools and colleges of optometry as well as by eye-care practitioners, Dr. Alexander speaks out now on the value-driven eye-care game from an illustrative academic career as a clinical professor of ocular disease at the University of Alabama Birmingham Medical Center School of Optometry. In early 2013, Larry launched Eye Lessons, a website dedicated to providing educational lessons, articles, slides, and white papers for the betterment of optometry and ophthalmology. Larry lives with his wife, Lynn, near Dallas, Texas. Alistair L. Jackson, M.Ed, FAAO brings to the optometry profession much-needed insight about health care reform. In his reform-focused chapters, Mr. Jackson shares the wisdom of his many years of researching, writing, and speaking to doctors about electronic health records, certified EHR technology, and the implications of health care reform for independent eye care. Given his extensive study, writing and expertise on this topic, Alistair has attained FAAO status in the Special Category for non-clinician contributors. In early 2013, Alistair launched Eye Care Advice, a consultancy dedicated to curating health care reform for forward-thinking eye doctors. Alistair lives with his wife, Ruth, near Vancouver, Canada.

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© 2013 Larry J. Alexander, OD, FAAO and Alistair L. Jackson, MEd.. All Rights Reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 10/30/2013

ISBN: 978-1-4918-2465-8 (sc)

978-1-4918-2464-1 (e)

Library of Congress Control Number: 2013918025

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Table of Contents

Foreword

Prologue

Chapter 1. We Belong

Chapter 2. From Eye Wear to Eye Care

Chapter 3. Paradigm Shifts and Culture Changes

Chapter 4. From Eye Care Island to Grand Central Station

Chapter 5. To Play or Not To Play: Analyze Your Current Situation

Chapter 6. Old Plays, New Twists: The Reform-Style Medical Model

Chapter 7. From Statewide Communications to Nationwide

Chapter 8. A Pre-Emptive Strike: Eye Wellness

Chapter 9. A Logical First Move: Anterior Segment

Chapter 10. The Epidemic: Diabetes/ Diabetic Eye Disease

Chapter 11. Losing Sight: Glaucoma

Chapter 12. Baby-Boomer Disease: Age-Related Macular Degeneration

Chapter 13. Ocular Effects of Pharmaceuticals and Systemic Disease

Chapter 14. Money Madness

Chapter 15. Diagnostic Technologies and Practice Management

Chapter 16. Certification: Field Goals for EHRs

Chapter 17. Get in the Game!

Conclusion

Appendix 1: Glossary of Health Care Reform Terms and Acronyms

Foreword

The Value-Driven Eye Care Game – A Player’s Survival Guide is the first of its kind that offers a roadmap for eye care providers who want to understand and implement the type of transformation necessary to take advantage of the emerging opportunities in health care reform. The authors have very effectively applied the broad principles of health care reform to eye care, with excellent examples of how the implementation of these principles should look within our specialty.

While many in the profession hope for health care reform to go away, or are still hoping it will not affect their businesses, the authors have taken the realistic approach that health care reform is here to stay and that those providers engaged now in learning the new rules of the survival game are the ones best positioned for success.

If you want to join the growing number of eye care providers who are positioning their practices for success, this guide is for you. It will give you a broad understanding of the basic principles of health care reform necessary for you to make the right decisions for your practice. Herein, you will find specific examples of how you need to re-define your role in health care. The guide will help you appreciate the power in the emerging system to position your practice in ways never before available to eye care providers. The principles laid out here will empower you to recognize new and exciting opportunities made available through health care reform.

Health care reform is not something you incorporate into your practice, rather a new era that requires every health care provider to re-think the basis of care delivery. We are moving from a practitioner-centric system to one that is patient-centric. Best patient outcomes at the lowest cost is the new golden rule we must live by in every clinical decision. Reform will look different in every state, community, and practice. Successful providers will engage in extensive analysis of every aspect of clinical practice. This guide will lead you on your journey not only to survive, but also to help shape the emerging system in your community in a way that is beneficial to your practice and assures your business success.

James E. Grue, O.D.

Prologue

With the establishment of optometry as the primary eye care profession, and significant reforms under way in health care, the opportunity exists now to add value to an independent eye care practice for both the doctor and the patient. The favorable geographic distribution of optometrists in rural and urban locations lends well to the evolving trends of health care in America. Ease of access to care without having to travel long distances lends well to the economics for patients.

The difficulty for the independent practice is the paradigm shift required on several levels: from paper records to electronic; from an optical focus to medical, from individual and episodic care to team-based and coordinated care. Add to this the concomitant increase in the complexity of billing and coding and we have a whole new game on our hands, a survival game. The exact strategy to make this shift adeptly does not exist.

Vision without execution is hallucination. This guide will serve as a basis for applying some organizational sense to the adventure of creating a new medical model for forward-thinking optometric practices.

The authors acknowledge incomplete knowledge of health care reform and value-driven eye care, topics that are subject to constant change. Evolving legislation and new research in medicine are only two of many factors that may affect the accuracy of the statements made herein.

Larry J. Alexander, OD, FAAO, author of the new medical model chapters that follow, is no stranger to the optometry profession. Well known for his authorship of Primary Care of the Posterior Segment, a text used by most Schools and Colleges of Optometry as well as by eye care practitioners, Dr. Alexander speaks out now on the value-driven eye care game from an illustrative academic career as a clinical professor of Ocular Disease at the University of Alabama Birmingham Medical Center School of Optometry. In early 2013, Larry launched Eye Lessons, (see www.eyelessons.com), a website dedicated to providing educational lessons, articles, slides and white papers for the betterment of optometry and ophthalmology.

Alistair L. Jackson, MEd, FAAO brings to the optometry profession much needed insight about health care reform. In his reform-focused chapters, Mr. Jackson shares the wisdom of his many years of researching, writing and speaking to doctors about electronic health records, certified EHR technology and the implications of health care reform for independent eye care. Given his extensive study, writing and expertise on this topic, Alistair has attained FAAO status in the Special Category for non-clinician contributors. In early 2013, Alistair launched Eye Care Advice (see www.eyecareadvice.net), a consultancy dedicated to curating health care reform for forward-thinking eye doctors.

Chapter 1

We Belong

We are not alone

We begin our analysis of where eye care is going in the health care reform world with the fact that eye care belongs. We belong! I wonder sometimes, though, if others believe that more than we do. Is there a remnant pre-parity mindset that still says we do not belong or that we are not integral to real health care, which happens in hospitals and physician offices but not in ours? I know we know better than that but what I cannot explain is the pervasive assumption that health care reform is not really going to affect me.

Medicare parity

The stroke of a pen made all optometrists Eligible Providers under Medicare. Optometry instantly belonged to the mainstream of health care. State associations and individual providers did not need to take further action, other than to begin claiming the benefits of the AOA’s win. I am sure that many of us who have been around long enough to remember the day still, and will always, remember it as one of the most significant days in the history of optometry.

Eye care inclusion

Health care reform is not like Medicare parity. Even though we now clearly belong and are counted among the Medicare Physicians, when it comes to health care reform, we must help ourselves. On parity day, the AOA did it for you. Now, you must help yourself. So, what does that mean?

Health care reform is a new game with new rules. More than a single piece of legislation, it is now about the introduction and implementation of new technologies, new standards and guidelines, new rules and new laws galore. It is a game of connected care and it must be played out practice-by-practice, facility-by-facility, provider-by-provider.

The needed adaptations, of course, put you in control of your destiny. You must engage to learn the new game even as you continue playing by some of the old rules. The transition is neither easy nor instantaneous. Fortunately, you are not alone. Your professional associations and groups are there to help. Indeed, the purpose of this guide is to give you a game strategy and, hopefully, simplify your task.

Chapter 2

From Eye Wear to Eye Care

Reframing the essentials

You are no stranger to the uniqueness of eye care among almost all other health care verticals. Where else can we find such a predominant point-of-sale component? For many of us, it is this very uniqueness that defines us, so much so that we may consider ourselves to be in the eye wear business not in the practice of eye care.

There is a saying in the world of big business that goes like this: retail has lost its stickiness. What does that mean? First, it is reflective of the advent and growth of online shopping. We know that, while health care is transforming, the whole world is changing too. We are seeing commerce revolutionized before our eyes. Rightly or wrongly, people are buying contact lenses and eye wear online like never before, and that is threatening the viability of retail eye wear stores, and likewise the dispensaries in your practice.

What about stickiness? Stickiness is essentially loyalty. What keeps customers and patients coming back? If they can buy their glasses online more conveniently, or find them cheaper at the big-box outlet across town, why should they buy from you? The answer is stickiness. More precisely, the answer is that doctors restore stickiness.

When you started your practice, you may have heard it said that businesses compete on three dimensions – quality, service and price – but that you can only pick two. If you try to compete on all three levels, your business will implode. So pick two … and just make sure they do not include price!

That leaves you winning on quality and service. It also leaves you with the principle that people will buy their eye wear where they get their eye care. I believe that sincerely. I believe it is the secret sauce for independent eye care providers amidst all the craziness of both commerce and health care. Doctor, you are the difference.

Now let us take that to the next level. Do you, doctor, make the difference as a salesperson, as a discounter, as a frame advisor? Do you restore stickiness by doing more of what your very capable staff already do so well? No. Your patients come back and buy glasses in your dispensary because they cannot get you online. They cannot get eye care online. They cannot get your advice or your team acting on your recommendations. You, more than anyone else in your practice, make your patients feel cared for. And that is how you restore stickiness.

It means clearly that you must