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New Jersey Ophthalmologist Stays Ahead of the Curve In Laser Correction

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Norden Laser Associates, a laser vision correction practice located in Ridgewood, is the first in the state to offer ReLEx SMILE minimally invasive laser vision correction. But Dr. Richard Norden, who has been in practice in Northern New Jersey since 1995, is not new to being first.

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A New Jersey ophthalmologist’s embrace of new procedures
establishes a clear point of differentiation.

Norden Laser Associates, a laser vision correction practice located in Ridgewood, is the first in the state to offer ReLEx SMILE minimally invasive laser vision correction. But Dr. Richard Norden, who has been in practice in Northern New Jersey since 1995, is not new to being first. He’s tried (and abandoned) many new technologies, always with an aim to offer his patients the best eyecare. 

“We’ve always been among the first in technology,” says Dr. Norden. “We were the first in North Jersey to do Lasik. We were the first to do LTK, a non-contact thermal laser, which worked great but the effect wore off, so we abandoned it. I suppose there we have the dubious distinction of being the first in New Jersey.” 

“I’ve also used other lasers, which I’ve not been happy with and returned,” he shares. “When this laser came out we thought we could do two things. One, it’s a very comfortable laser which is a small upgrade over the previous equipment. And two, we also wanted to introduce this SMILE procedure, which is widely used in Europe.” 

The laser he is referring to is the VisuMax femtosecond laser, which they acquired in December 2016 and is the only laser that can perform the ReLEx SMILE procedure. This is the newest, least invasive refractive laser vision correction technology currently available for treatment of myopia with minimal astigmatism in the U.S. Developed by ZEISS, the procedure uses the VisuMax femtosecond laser to create a lens-shaped layer just beneath the surface of the eye, which is removed through a tiny incision.

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In September 2016, it became the first new laser procedure cleared for use by the FDA in 20 years. However, despite close to one million procedures worldwide, SMILE is limited in the U.S. to myopes, only about 30 percent of laser patients. Treatment for myopes with astigmatism should be approved within the year. 

The procedure’s advantage is the small-incision lenticular extraction with no flap. “Because this laser technique is so minimally invasive, we’re able to treat patients who — because their jobs are physical — weren’t suited to earlier forms of laser correction,” says Norden. “Including firefighters, police officers, and contact-sport athletes — all of whom are likely to be struck in their eyes.”

 
How To: Add New Technology to Your Practice

Really think about it. Adding expensive new tech is not a decision to be made lightly, says Dr. Norden. It costs him $10,000 a month for the laser, maintenance and click fees … that’s $10,000 a month for 5-and-a-half years. “If this procedure catches on the risk becomes less as it gets adopted more widely.” 

Do the math. For what it costs Dr. Norden’s practice, he needs to do approximately two patients a month to break even. “We’ve done 17 patients so far, so it’s more than paying for itself very quickly but if there were more in my market I’m not sure we’d be seeing that adoption,” he explains.

Don’t forget tried and true. “In Europe, they promoted it as the new technology and it cannibalized Lasik. We don’t want to do that here,” says Dr. Norden. “We can’t treat all prescriptions, so we don’t speak ill of Lasik.”

Offer options. “We educate patients about their options. SMILE does offer some advantages over Lasik. Especially for people who are “afraid” of the idea of the flap [Norden estimates this at 5 percent]; that if they get hit its going to come loose. And the two are comparable in price so we don’t want people to gravitate towards one or the other based on cost but on an informed decision.”

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Get the word out. Dr. Norden isn’t big into marketing technology as a means of patient attraction, but his practice has come up with a clever way to bring attention to their new technology. A tagline: “Let us put a SMILE in your eye.”

 

This article originally appeared in the September 2017 edition of GO/OD.

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12 Tips to Make Your Contact Lens Business More Profitable

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1. LISTEN AND ASK THE RIGHT QUESTIONS

Clinicians often ask if patients are interested in contact lenses. Stop! This closed-ended question leaves little room for discussion. Dr. Stephen Cohen of Doctor My Eyes in Scottsdale, AZ, says: “I prefer to ask a patient, ‘In what situations would you like to be able to see without your glasses?’” Some people like the thought of not wearing glasses at social events, for example. This leads to a discussion about contacts, even for part-time use. “Many who started as occasional contact lens wearers become full-time wearers,” Dr. Cohen states. 

2. DISCUSS DAILY REPLACEMENTS

For patients wearing another modality, start discussing single-use contact lenses as an add-on for when they’re traveling so they don’t need to bring a case or solutions. Dr. Cohen says such patients often switch to daily lenses, having enjoyed the convenience, vision and health benefits. Dr. Raj Patel of Vancouver Vision Clinic in Vancouver, WA, says: “We believe strongly in the concept of one. Dispose your contacts every day or month. Compliance and recall are higher.”

3. OFFER AN ANNUAL SUPPLY

Tuli Santiago, office manager at Dr. Dawn Arnold’s practice in Union, NJ, says, “What’s working for us is to promote annual sales to patients. Our reps give us updates on rebates, sometimes as much as $200 off.” Teach patients how to redeem rebates; maybe even take the time to submit one on a patient’s behalf. If a patient buys a year’s supply, Santiago’s practice offers a discount on over-the-counter sunglasses. About 40 percent of patients take it. Dr. Cohen says he always presents the annual supply option. “Dispensing a year supply from inventory saves staff time,” he explains. It also reinforces the need for an annual exam.” 

4. MAKE IT EASY TO BUY

Dr. Patel believes you need to make it easy for patients to obtain contact lenses. Vancouver Vision Clinic has created a benefits card. One side shows the patient the lowest per box price (retail minus volume savings, insurance, rebate and shipping cost). The other explains what the practice will do for the patient (volume savings, rebates, emergency trials when a year supply is purchased, free shipping, exchange of unopened boxes for new power). “We call this the ‘giftwrap,’” Patel says. “What the patient is really buying is the relationship. If a patient walks in with their Rx, we simply staple our benefits card to the box so they know what they’re missing if they don’t buy from us.”

5. TRY DAILY MULTIFOCALS

“One of the largest areas of growth for our practice has been daily multifocals,” says Dr. Blake Hutto of Family Vision Care in Alma, GA. “I was finishing an exam with a patient and was one foot out the door when I happened to stop and ask, ‘Would you ever be interested in contact lenses?’ She leapt at the chance. Her prescription included about a diopter of astigmatism in both eyes, and she had low level dry eye syndrome. After completing a successful fit, she jumped up and gave me a bear hug. She was most impressed by the fact that, after she had told me ‘Dr. X said I would never be able to wear contacts,’ I saw that as a puzzle to solve, rather than as an excuse to jump to my next patient.”

6. FOCUS ON COMFORT 

“Comfort is what I target first,” says Dr. Hutto. “If a lens isn’t comfortable, who cares how fantastic the vision is? The fit will likely not be a success. Any patient who is over 45 and being fit with contacts, I assume some level of dryness. Dailies get patients the comfort they need by cancelling out chronic buildup of deposits which occur on monthly contact lenses, even when cared for meticulously. Soaking lenses leaves the patient exposed to preservatives, worsening dryness. Daily disposables eliminate these problems.”

7. SEE CHILDREN AS AN OPPORTUNITY

“We often neglect the opportunity with younger patients, particularly the 10- to 14-year-olds,” says Dr. Cohen. “I present contact lenses as an option, and say they are good candidates when mom and dad say it’s okay. I present CRT as an option to possibly slow or stop progressing myopia, and  UV-blocking contact lenses for kids who spend more time outdoors.” 

8. CHARGE A FITTING FEE

On average, contact lens wearers return every 15 months for an exam, spectacle wearers every 30 months. This points to hidden revenue and profit. Dr. Patel charges every contacts wearer a fitting fee. “If you want to fit more multifocals, do it and increase your fee,” he advises. “These patients are highly motivated to reduce the need for readers.”

9. OFFER A TRIAL

Dr. Hutto’s patients leave with the “Coke/Pepsi challenge of contacts.” They’re given trial packs of DAILIES Aqua Comfort Plus and DAILIES Total 1. The office checks after a few days to see which were more comfortable.

10. FIT SCLERAL LENSES

Dr. Patel’s partner, Dr. Derek McTyier, has built a following due to his ability to fit scleral lenses. It’s a growing part of their practice. Dr. Dawn Arnold has seen a 98 percent success rate fitting scleral lenses for keratoconus. “Scleral fits are doing wonderfully well,” says Santiago, who works at Dr. Arnold’s practice. They do Ortho-K fits too. The global fee covers the doctor’s time, lenses, solutions, office visits, and fitting. 

11. BE A TRUSTED SOURCE

“It’s our job to tell patient what’s new in materials, designs and solutions,” says Dr. Patel, adding: “They’ve come to expect it from us.”

12. SPEND MORE TIME WITH PATIENTS

Dr. Hutto says the key to a profitable practice is giving time to patients, not trying to see 50 a day. “This not only gives you a happy patient, it creates mobile advertising for your practice … advertising you don’t pay for, but one that pays you!” 


This article originally appeared in the September 2017 edition of GO/OD.

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17 Tips for Finding Meaningful Use in Your EHRs

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As of Jan. 1, 2014, medical professionals were required to adopt and demonstrate “meaningful use” of electronic medical records to keep their Medicaid and Medicare reimbursements. Meaningful use means the EHR must improve quality, safety and efficiency; reduce health disparities; engage patients and their families; improve care coordination and public health; and maintain security of patient information. 

Noble goals to be sure, but the transition to electronic is complicated and expensive for many small medical businesses. When weighing the cost and disruption of implementation to the penalties incurred, many doctors opt to just pay the fines. Nonetheless, few would argue that the adoption of EHR for all is only a matter of time. 

Whether you’ve already adopted it, tried and given up, or are holding out until the last possible moment, we asked folks who have run the EHR gauntlet and survived … if not necessarily victorious, certainly wiser, to share their tips, advice and workarounds for EHR implementation. 

BEFORE YOU COMMIT

1. RESEARCH! Explore the options. “Find a system that works for your office,” says Dr. Cynthia Sayers of EyeShop Optical Center in Lewis Center, OH. “Check demos and ask others. We are an all Mac practice, so our options five years ago were limited to software compatible with Mac. We chose MacPractice and have been very happy with it.” 

2. CUSTOMIZE. “Make sure your EHR system is customized to your business,” adds Michelle Wright of DePoe Eye Center in Sharpsburg, GA. “Exam pages can be customized with shortcuts to help the doctor be more efficient.” 

3. INVEST IN HARDWARE AND SOFTWARE. Wright also suggests investing in good scanners. “Everything will need to be scanned.” Additionally, “make sure your testing equipment is integrated with your EHR. For example, the OCT should go straight to the EHR system for doctor review. This saves valuable time,” Wright says. 

AFTER YOU CHOOSE

4. SET ASIDE TIME FOR TRAINING. “I have Revolution EHR and they have really informative videos to help you learn the system,” says Dr. Nytarsha Thomas of Visionelle Eyecare in Zionsville, IN. “I made it mandatory for every staff member to watch some of those videos.” 

5. SLOW DOWN. “Doctors tend underestimate how long it will take and how frustrating it will be so they operate business as usual during the transition. The schedules the first three to five days should be lightened and some additional technician staffing provided,” offers Jocelyn Mylott, of D’Ambrosio Eye Care in Central Massachusetts.

6. CONSULT OTHERS. “Get with another doctor to learn some tips of the system,” says Dr. Katie McElvaine of Springfield Family Vision in Springfield, MO. “The shortcuts and troubleshooting they have found can be very helpful.” Ask your vendor for other practices  who have had success.  

7.  CREATE SHORTCUTS. Like Dr. Rita Ellent of The Gardens Eye Care in Forest Hills, NY.  “To help document certain common findings I created a template that I keep on my desktop. This allows me to copy and paste common findings reducing typing time.”

8. PRACTICE ON TEST FILES. “Running patient scenarios on a test file in the EHR to practice keystrokes and where diagnoses are located has also helped in speeding up the transition,” Dr. Ellent adds. 

9. OUT WITH THE OLD. “Scan your old records into the EHR and shred,” advises D’Ambrosio’s Mylott. “You don’t want to be going back and forth.”

10. PICK A HARD STOP. Choose an end date after a transition period, suggests Dr. Thomas of Visionelle. “‘On Dec.19, 2016, paper records are dead to me!’ Have a meeting about it and stick to your guns,” she says. “It may be helpful to have a week or two transition period of paper in the exam room but each person has to finish entering records by the end of the day.”

STICK WITH IT BUT … 

11. HAVE AN EMERGENCY PLAN. “Electronic systems go down sometimes,” says Dr. Ellent. “It’s important to be able to switch gears and keep a supply of skeleton paper charts on hand.”

12. KEEP PATIENT COMFORT IN MIND. “It’s ok to still have some paper,” says Eyeshop’s Dr. Sayers. “Some patients aren’t comfortable with electronic forms, we give them paper and scan it. We jot notes on insurance info sheets to keep track of orders. Having a paper trail is still nice.” 

13. DESIGNATE AN EXPERT. “Someone internally should become fluent in the software to build screens and communicate with the vendor, along with creating workarounds. It saves time and you’ll have your own advocate,” says Mylott.

14. HIRE A SCRIBE. “It’s the best money I spent,” says Dr. Selina McGee of Precision Vision in Edmond, OK. “Even if you stick with paper, a good scribe makes you a better doctor.” Win win. 

USE BRIBES OR THREATS 

15. INCENTIVIZE. “Have a contest,” suggests Dr. Thomas. “An office I worked for had a contest for a gift card for whoever got the hang of it quickest. Or reward staff with a pizza party or something to thank them for their hard work.” 

16. BE TRANSPARENT. “There are people that will resist because it’s inconvenient and unimportant to them,” adds Dr. Thomas. “I tell them why it’s important to me. EHR can’t be lost. They’re safer and more secure. You can easily share them with other doctors. It takes no space; turn the records room into a staff lounge! It’s better for patients and the office. Don’t leave them in the dark.” 

17. PLAY HARDBALL. “If they’re still resistant, I pull the ‘this-is-so-important-it-may-cost-you-your-job’ card. They get on board after that,” she says.


This article originally appeared in the March 2017 edition of GO/OD.

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Ohio OD Follows the Family Medical Tradition

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Dr. Shimul Shah

Dr. Shimul Shah 
Marysville Family Vision, Marysville, OH

Dr. Shimul Shah’s No. 1 supporter is her dad, a 1970s entrepreneur. Both her parents are physicians and her sister is a dentist with a nearby practice. So, medicine was a natural for her. Shah fell into optometry when she took a year off after graduating from the University of Michigan with a degree in biology. “I was searching for a career path,” she says. “I took a peek at optometry at my mother’s suggestion. It seemed like a good fit.”

In 1999, she graduated from the Pennsylvania College of Optometry and her first job was at a LensCrafters. 

“I liked it for what it was,” she says. “I was a new grad, the systems were already in place, so I did eye exams and didn’t have to think about running a business.” 

She stayed for nine years until the frustration of having no control over what was being prescribed to patients forced her hand. 

Now, owning her own business, she employs three people — two full-time and one part-time — but she is the only optometrist and has the freedom to set her own hours: four days a week and one Saturday a month.

To get psyched for a day at work, I always …

Grab a cup of coffee before trying to work out. I need to take my time to ease into the day.

The most memorable point of my career was …

After practicing part-time at three locations I heard about a practice for sale 30 minutes from home. I went to see it. It was in a small town with a solid patient base. So, I took the plunge and four years ago I bought Marysville Family Vision. I’m officially my own boss, even though the thought of it still surprises me! Along the way, my family has been there to support me and my OD friends in Columbus have been exceptionally helpful.

The type of optical product I enjoy prescribing or selling most is …

Well, my sales technique is not about insurance but about choosing what will work best for my patients. So, selling whatever is best for my patient is my favorite. Now, I put more faith in my own experience and in giving them quality. I see about 10 to 15 patients a day and I’m involved not only in the frame buying, but in the selling to the patient.

My advice for ODs interested in opening their own practice is …

To understand the terms of your agreement ahead of time and don’t assume your patients will follow you from a retail setting to a private one.

My favorite type of patient is …

One who is loyal and actually listens to what I tell them!



This article originally appeared in the March 2017 edition of GO/OD.

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