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Building a Low Vision Practice
Lou Lipschultz, OD
Private Practice
Olympia Fields, IL
For a copy of the handout:
Goals for Today
■ Provide strategies for developing “primary
low vision care” in an Optometric practice
■ Present cases
■ Provide a strategy for managing a practice
in startup or challenging times
visit www.llipschultz.com and visit the LECTURES link
Corporate Affiliations:
Lou Lipschultz
■ United Webcast, LLC
■ OcuSource.com, LLC
■ LetsGoExpo, Inc.
■ OneSuiteNetwork, LLC
■ Vision Rehab, Inc.
Experience
■ 1986: ICO Graduate
■ 1994: Founded Sight Systems
■ 1986: Purchased practice
■ 1997: Founded Vision Rehab, Inc.
■ 1987-93: Acquired 7 local
practices
■ 2000: CEO HumanWare
■ 1999: Consolidated into 3
locations
■ 1986-1991: Peds/VT focus
■ 1990-1997: CL focus
■ 2004: Founded OcuSource.com,
LLC
■ 2006: Founded LetsGoExpo, Inc.
■ 2010: Founded United Webcast,
LLC
■ 1992-1998
Board of
Advisors – Bausch & Lomb
■ 1993-2000: LV focus
Before we Begin…
Challenging Questions
■ Have you set your personal goals?
− Personal?
− Professional?
− Financial?
■ What is your timeline to “exit”?
■ How much do you want to make along the way?
■ What will it take to achieve your goal?
− Will it be more patients?
− Higher fees?
− Side business?
How to Plan Your Path
■ Break down each goal into steps
■ Create a business plan
− Personal
− Business
■ Study other businesses
− Basic accounting
− Real estate
■ Strategize to work smart!
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Money Talk – Primary Care
Money Talk – Low Vision
Target income = $100k
Still $100k Target Income
■ Exam fee = $100
■ 4 LV exams per day
■ Average sale = $140 ($240 total)
■ Average net of practice = 25%
■ Average net per patient =$60
■ LV exam fee = $250
− $250 x 4= $1,000 exam fees
■ Average purchases per case
− $400 = 4 x $400 = $1600
■ $100,000 / $60 = 1666 patients
■ Total revenue = $2600 for the ½ day
■ 5 days per week 48 weeks = 240 days
■ 40 weeks (NOT 48) = $104,000 per year
− 7 exams per day are required to meet target income
■ If net = 25% = $26k
− Over 25% of $100k goal from ½ DAY per week (10% of time)
Developing Low Vision Practice
Video Magnifiers (CCTV’s)
1. Equipment
■ Deciding on product(s)
2. Forms
■ Financial relationship
3. Marketing
■ Their role in the office
4. Training
Recommended Equipment
■
Exam equipment $200
■
Hand magnifier trials - $500
■
Telescopic trials - $800
− Hand-held charts, fields
− 3x, 5x, 7x, 10x
− 2.2x, 3x, 3x spiral (Designs for Vision)
− 7x binocular (Beecher)
■
Filters - $100
■
ADL’s - $200
■
CCTV - $2,000
− Brown, orange, yellow
− Check guide, writing guide, talking watches, large print phone
− Color table top version
TOTAL - $3,800
Forms
■ “Delegate whenever possible”
■ Send prior to exam
− LV history form
► Establish
goals
− Medicare Payment Policies
− Payment Policies
− Return policies (get it signed)
− Directions
− File request from Retina/Ophth/referrer
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Marketing Low Vision
Marketing Your Service
■ AWARENESS is the key!
■ Network
− Retinal Specialists
− Diabetic/primary care doctors
■ Brochure/referral packs to referrers
■ Your current database – educate your patients
(parents and grandparents)
■ Public presentations
− With a retinal MD
Ramping Up LV
Your OT Relationship
■ Take MD’s out to lunch
■ Finding the OT
− Share your plan
− Bring referral kits
− Offer in-service for their staff
− Visit at least 3 times per year
− Advertise locally for position
− Local rehab facilities
− Don’t count on finding an OT trained in vision
■ The Relationship
− Hired (My preference)
− Referred
Things You’ll Need to Know
■ Today’s patients are LESS techno-phobic
■ Patients increasingly accept or EXPECT advanced technology
− Scanning hardware and software
− Magnification software
− Video magnification
■ Get to know your local Department of Rehab.
■ Daily living devices a must
− Talking watches and clocks
− Writing guides
− Large print phones
− Accessible telephones
− GPS
■ Create referral relationship for advanced cases
Most Common Cases
■ Macular Degeneration
− Non-exudative (dry) ARMD
− Exudative (wet) ARMD
■ Diabetic Retinopathy
− Non-proliferative
− Proliferative
■ Glaucoma
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AMD “Vocabulary”
Devices
“Retina Rot”
“Macularia”
“Max Degenerate”
“Immaculate Direction”
Where to Begin
Example
■ Quick estimate of required magnification
■ 20/400 with goal of 20/40 = 400/40 = 10X
1. Distance magnification from Distance Acuity
2. Near add from Distance Acuity
3. Rule of thumb
■ So magnification required = 10X
■ Equivalent Power
− 10 x 2.5 = +25 Diopters
Dry ARMD:
Common LV treatment
Wet – LV Treatment Options
■ High add (+3 to +10)
■ Greater than expected
magnification
■ Low power telescopes
■ Excellent driving candidates
■ Lighting
■ Contrast enhancing filters
− brown or orange
− Improves with eccentric
viewing training
■ Eccentric viewing training
■ Results vary dramatically
based scotoma
− Size
− Location
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Cases
Tonya D.
■ Think “out of the box”
■ Remember… you’re not CURING low
vision…. You’re empowering the patient
with tools, skills and knowledge
■ 31 Y.O. WF ad agency executive
■ Dx: Albinism/nystagmus
■ BVA - 20/200 OD, OS
■ CLET
■ Primary Complaints
T. D.
T. D. - Tx
■ Proceed in steps
− Can not see audience during presentations
− Can’t see laptop while presenting
− Cosmesis
■ 1991
− 2.2x Spiral Telescope (OD) at Null Point
Direction
− Zoomtext for Notebook Computer
− +6.00 add
■ 1999
− 3.0x Fixed Scope - Down Gaze for CRT Work
− 80% Grey Polarized
T. D. - Tx
■ 2003
− Requests any new solutions?
■ Fit with Telescopic Contact Lens
− Over Minus by -12.00
− Over-refraction in spectacles
− Net = @1.2-1.5x (20/80 BVA)
− Added bioptic into system (20/30 BVA)
■ 2008
− Happily wearing CL telescopes and using other
devices
D. K. Hx
■ 3 years prior
− WET ARMD
− Post focal laser OD
− BVA
► OD:
► OS
10/150
2/200
− Stable 6 months
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D. K. Tx
D.K. Tx
■ Returning visit (3 years later)
■ Goals
− Excellent disposition
■ Spouse deceased
− “Voracious reader - dearly misses reading”
■ Va same (10/150)
− Does not leave house much: Caregiver for husband
■ CCTV re-dispensed
■ Tx
− Video magnifier dispensed
► Only
device that provided fluent reading
− “Abusive spouse” – returned device in 3 days
■ 6-month follow-up
− VA same
− CCTV excellent for all near activities
− “New person”
H. M. Hx
H. M. Tx
■ Albinism
■ Blue Solid Tint 60% Toric SCL
■ 20/200 OD/OS
■ 7x Monocular Loupe
■ +4.00 - 2.00 X 180 OD, OS
■ 3x Binocular TS in Primary Gaze
■ CPF Brown
■ Goals
− Decrease glare
− “Normal eye color”
H. M.
H. M.
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J. B.
“I wonder if…”
■ 1997
− Bva - 10/400 od, os
− 20 inch CCTV barely helped
− Implant surgery went bad!
− Retina not visible even upon dilation
J. B.
Practice Managent
■ Post-op BVA - 20/80
■ TX
− +5.00 Add RORX With Prism
− Renting CCTV for Reading Bible
Suggested Philosophy
Focus on Specialties
■ “Manage your practice as if you were
selling it tomorrow”
■ Pediatrics
− Books always clean
− Minimal chance for surprises
− It could happen!
► Illness,
disability, death
► Bringing in a partner
► Planning for retirement
■ Geriatrics & Low Vision
■ Referral Services
− Emergency services
− Glaucoma
− Diabetic retinal monitoring
7
Maximizing Marketing Dollars:
“Mine” Your Database & Recall
■ Your patient database (list) is your
GOLD! Mine it!
− Recall at-risk patients (diabetes)
− Past-due recall
− Year-end opportunities
► Flexible
spending
► Benefits changing/ending
Maximizing Insurances:
Medicare & Others
■ Invest in Medicare billing training
■ Learn the “allowable”
− Return visits
− Modifiers
− Special testing
Recommended Books
Summary:
Low Vision in Practice
■ Anthony Robbins
■ Very low cost to initiate – high ROI
− Series of personal growth books
■ Real Estate: no money down
■ 4-Hour Work Week
− Timothy Ferris
− Less than $5k
■ Fantastic specialty
− Creates nice diversion
− Technically challenging
− Emotionally challenging
− You’ll see lots of disease!
■ Tremendously rewarding
− Internally
− Financially
Today We Have….
Discussions/Questions?
■ Reviewed implementing LV into practice
■ Reviewed Cases
■ Reviewed Growth Strategies
THANK YOU!
Lou Lipschultz
[email protected]
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