Eyeworld

22 Ophthalmology Business • December 2016 Patti Barkey, COE, is chief executive officer for Bowden Eye & Associates, Bowden Eye Services Manage- ment Organization and Eye Surgery Center of North Florida. She has financial interests with Allergan, TearScience, Bio-Tissue, Bausch + Lomb (Bridgewater, New Jersey), and ScienceBased Health (Houston). Ms. Barkey can be contacted at Pattibarkey@hotmail.com. patient. But the use of dry eye coun- selors is about so much more than building greater efficiency and more voluminous patient traffic. Thanks to recent breakthroughs in the science and the availability of so much tech- nology, the dry eye space has become much more complex. It would be easy to overwhelm patients with information overload, and expecting our medical staff to provide all the education in a condensed patient encounter might be equally stressful to them. Cash pay services: Worth the investment? Our practice philosophy when it comes to dry eye disease is that every patient is worthy of evaluation. We constantly see patients with dry eye who are suffering considerably from their symptoms. Yet there are good diagnostics that can help the pro- vider understand the problem, and there are equally good and effective therapeutic strategies to treat the underlying problem. One aspect of dry eye that I see many practices struggle with is that there may be discomfort in asking patients to pay out of pocket for cer- tain services. Our response is that we are never selling services to patients; we are providing them opportunities to select additional services that will help us understand the nature of their problem and how to treat it. This is much more than a semantic shift because the reasonable person who took the time to come into the office for an appointment is interest- ed in how to solve their problems. This last principle sums up our approach to dry eye disease in our practice: We start by standardizing a high standard of care because medical necessity should trump all other concerns. We engage patients in meaningful conversation to con- vey benefits, but we do so under the premise of presenting options and have a truer sense of the response to treatment over time. For example, as our doctors treat the inflamma- tory component, patients should see reduced inflammation on repeat InflammaDry testing and osmolarity should normalize. This fact points to the value of the objective data gained from these tools as valuable for pa- tients' education. Advanced diagnostics also help our doctors to direct treatment to the underlying cause. We have learned that inflammation is an important factor in causing and exacerbating dry eye disease. Therefore, treatments like Restasis (cyclosporine, Allergan, Dublin) can be important for treating patients who present with signs of dry eye but will only be effective if dry eye is in fact present, thus high- lighting the need to rule out mas- querade and look-alike syndromes. It may seem obvious, but it is amazing how often the need for a positive diagnosis is overlooked in the midst of busy clinic operations. At the same time, advanced diagnos- tics might alert our physicians to the fact that other elements beyond the inflammation require treatment. Elevating the standard of care If constant training and education and an emphasis on advanced diag- nostics serve as the backbone to our dry eye capabilities, the addition of educational adjuncts help comple- ment our goal of providing patients high quality results in an efficient and effective manner that benefits all sides. One example is that we rely on specially trained counselors to help educate patients about their various options. It is something we learned the value of from the premium IOL market, where consultations with a highly trained expert help start the patient off on the right foot; our physicians' valuable time is reserved for a meaningful encounter with the providing needed education. Some- times that conversation is the final step in working with a patient with dry eye disease, but often we will make recommendations for how we think we can make the patient feel better. Depending on the patient's financial comfort with additional ser- vices, we will suggest them as needed and as appropriate. The dry eye market has grav- itated in a similar direction to the premium cataract surgery market, where the practice builds on core capabilities by adding services that meet the interest level in providing quality care. Some patients will be comfortable paying extra and some will not. But the major difference is that unlike a premium IOL offering, the patient with dry eye disease is dealing with a disease process and will continue to do so if the disease is not properly diagnosed and treated. On a larger level, we are building a relationship with patients who are having trouble with their vision to let them know that we are able to help and intervene. Our core ser- vices will provide a fully appropriate recommendation for fixing their problem, and because we are serious about the dry eye problem, we have the capability to add additional ser- vices that may enhance the experi- ence and the outcome. OB continued from page 21

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