Blueprint For Success
Building low vision and profit into your practice
BY ERINN MORGAN

Six out of 10 optometrists still refer out. Don't be like them. And, don't forget that low vision can, indeed, help increase not just patient care, but your practice's profitability as well.

Following are some of the steps taken by a few of your peers who made the decision to keep patients in the practice by adding low vision services to their existing operations.

Johnson City Eye Clinic, a Johnson City, Tenn., ophthalmology practice in business since 1942, did the math and decided to try low vision. "We had enough people to justify a low vision center," explains Peter Lemkin, OD. "I saw a need. I do it to help the patients we see in the practice and just to make it a better practice."

Incorporating a low vision center can be profitable for a number of reasons. One is that it helps keep patients in the practice. "We have two MDs, a retinal specialist, a pediatric specialist, and an OD on staff," says Susan Fried, OD, of Flemington Eye and Refractive Surgery Center in Flemington, N.J. Prior to Fried's arrival at the center, however, there was no one to handle the low vision patient flow. "They had doctors saying, 'There is nothing else we can do for you,' to patients. And, they didn't like saying that," she notes. "Now they get a lot of very positive feedback from the patients. In the beginning, the people at the front desk would get all choked up and teary eyed because there were some people that had serious vision problems for 10 years who could now be helped."

There are many scenarios in which a low vision addition can get started. Some practitioners see the need in their existing practice and launch it from there.

Others pinpoint a multi- disciplinary practice that appears to require low vision services and approaches them. "I looked for a place that had a retinal specialist," says Dr. Fried, "and I went to them and told them I wanted to start low vision."

Others get involved by expanding a small existing low vision service. "We had a small low vision department," explains Jeffrey Sonsino, OD, of Vanderbilt Ophthalmology (with 15 ophthalmologists and three optometrists in the medical center at Vanderbilt University in Nashville). "I have expanded that since I got here."

Others are hired solely to start a low vision specialty from scratch. "I was specifically brought in to start up the low vision clinic," says Scott Hearing, OD, of the Stuart Eye Institute, which has locations with low vision clinics in Jupiter and Stuart, Fla. "I had a small private practice prior to joining the Institute. As a multi-specialty OD and MD practice, they wanted to expand into low vision."

Regardless of how you get started in low vision--or why--it can be both fulfilling and a smart business decision. Experts and statisticians agree that as the baby boom ages, the low vision category will explode.

To get started, experienced practitioners recommend a few simple steps.

1. Research

Learn what you are getting into. There are many ways to research low vision, including reading up on the subject, reviewing low vision Websites, speaking with low vision company sales reps, contacting consultants and other doctors with experience in the discipline, and taking a class.

"Do some reading in order to understand the basic things you need to know," says Dr. Lemkin, who also spoke with company reps and a recognized low vision specialist in his area.

Hearing stresses the importance of education. Some low vision companies and industry organizations offer continuing education about low vision.

2. Make a Plan

To get her low vision clinic rolling at Flemington Eye and Refractive Surgery Center, Dr. Fried began by putting together a booklet on budgets, devices needed, etc. "First, I wrote a list of devices I needed," she says. "And I put together a booklet that showed why I needed so many devices and what their functionality was. I also gave [the practice] the approximate cost of startup, which was about $10,000."

Other points include deciding the office location for low vision work. "I use their exam rooms, and they scheduled me on a day that the retinal specialist was not there so we could juggle," says Dr. Fried. "I go in three times a month. I set up an hour time slot for new patients and a half hour slot for follow-up patients."

Another consideration is deciding how many days a week you plan to practice. Some start off with a minimal amount of time. "I see patients one half day a week, but I could probably do it two full days a week," says Dr. Lemkin.

3. Start Simple

Though sources agree startup costs for a clinic can range up to $10,000, it is also possible to start with a smaller investment.

"We started with a hand-held magnifier," says Dr.Lemkin. "There are also things to help patients--like writing with bold markers and getting big-print checks from the bank. Patient counseling is important." 4. Add an Assistant

When a LV patient flow has begun, one addition you can make is an occupational therapist or low vision technician. "The greatest thing I added to this clinic was an occupational therapist," says Dr. Sonsino. "She trains our patients how to use the devices."

Why? "All the research shows that if you prescribe things and don't properly train patients how to use them, you are throwing rocks at the wall," explains Dr. Sonsino. "But, if you do train them, you greatly enhance their quality of life."

It's all about a team approach. Unlike many areas you can add to your practice, low vision makes room for all the Os. Dr. Sonsino observes, "It is great to have input from the MD, the OD, and the occupational therapist or technician."