Introducing a new specialty, such as myopia control, into a practice can feel like a challenging task. From staff training, to obtaining the right equipment, properly filling out consent forms, and incorporating billing and coding, sometimes it seems as though it’s not even worth it. But I am here to tell you today that you CAN do it and it IS worth it! This article will provide the knowledge and tools to seamlessly transition your practice into a successful myopia control clinic.
1) Equip your office with the right tools
As long as you have an autorefractor, phoropter, SLE, and a topographer, setting up a myopia clinic is a piece of cake. It does not take a lot of equipment and/or resources to treat myopia. Furthermore, there are pharmacies available to dilute atropine to your specifications, such as Pine Pharmacy. You just call them, tell them the patients name and atropine strength and the pharmacy will reach out to your patients to determine insurance coverage, shipping etc.
For orthokeratology, the lab will create your patient’s lenses based on your autorefractor, Ks, taking out the guesswork for doctors still honing their skills. I use paragon CRT, but there are many companies out there who fit orthokeratology. All the lab consultants are extremely friendly and knowledgeable and can even help get your office set-up and walk you through the first few patients.
Even soft multifocal contact lenses, such as NaturalVue, can be ordered via trials, although the companies will give you trial set kits for free. Just call up customer service and they will set you up with everything you need to begin the process.
You may be thinking to yourself, well what about axial length measurements? There is an easy solution. You don’t need to own a special axial length instrument. Instead, you can refer your patients to a local ophthalmology office where they can use their A-scan technology to take an axial length measurement and send to your office. The axial length only needs to be done every 6 months to a year, so it is not a huge inconvenience for the patients to go to another office to have the measurement taken.
2) Train staff to handle myopia control patients
In order to have the staff understand a little about how and why we are offering myopia control, creating a small PowerPoint can be helpful. It should go over the main treatments involved, the cost of each procedure, the billing/coding (which is usually not covered by insurance). It will also make them more motivated to get more involved in the treatments since they are understanding the reason why we are treating myopia.
When it comes to the actual work-up of patients, the most tedious treatment is orthokeratology, which involves autorefractor, topography and vision. I write down a list of all the procedures I want done and have it stuck to the front desk. Also, for the first few patients it can help to work-up the patient along-side of them, so they begin to understand the necessary pretesting. I also have a designated technician who is the main myopia control manager who helps book follow-up appointments, create contact lens orders, etc. They can be a great resource for the patient and other technicians who may have to help on certain days.
3) Write and provide consent forms
It is important to have consent forms for each of the treatments since it is an out-of-pocket service and takes a certain level of commitment from the parent and patient to be successful. There are often many sample consent forms online which you can use as a template to create your own custom consent form that suits your practice. The consent form should go over what the treatment entails, the risks, the yearly price and what is included (lenses or drops), the number of follow-up visits per year, and a signature from the parent and doctor understanding all the terms and conditions.
The Review of Optometry provides a nice orthokeratology sample consent form.
4) Know billing and coding for myopia control
Luckily, since myopia control is not covered by insurance companies, there is no billing that needs to be submitted. That being said, it is still a good idea to have a procedure code, one for the initial visit (where the patient often has to pay the treatment cost) and follow-up visits (included), so that the staff and billing director know what is owed on that visit. Most practices charge the full amount for that year’s treatment on the initial visit while the follow-ups are included in the cost.
5) Properly educate parents about myopia treatments
In order to make myopia control successful in your clinic, it is important to educate parents about the positive impact this treatment can have on their child’s vision and ocular health. I often take at least 10-15 minutes to discuss the various options in office provide my opinion as to which option would be best for their child. There is a Myopia Calculator which is an easy way for doctors to show parents the likely calculate progression of their child’s myopia after a certain number of years.
I also send a PowerPoint to the parents reviewing all the treatment options and pier-reviewed studies and send them home with the consent forms so they can review benefits/risks, time, cost. There are also great websites with information and resources for parents such as Myopia Profile or Paragon Vision. This allows them to discuss it over with their partner at home and really absorb the information. I give them my email so they can reach out anytime with any questions or concerns.
6) Learn how to capturing new myopia control patients
There is also some marketing effort that goes into bringing a new specialty into a practice. However, there are many easy tools one can use to get their patients interested and asking questions. The first step is to leave out pamphlets near the waiting area so parents can already read about myopia control which could start a conversation in the exam room.
Furthermore, you can consider reaching out to a local news station about your new myopia control treatment who may consider airing a segment. Lastly, reaching out to your local PTA and school nurses could be a HUGE resource to spreading the word to parents. Pediatricians can also be a great referral resource, so take the time to introduce yourself to them in person and educate them on your myopia control treatments.
Conclusion
As doctors, we should always be striving to give our patients the best care possible.
Don’t be afraid to add a new specialty to your office. It may seem intimidating at first, but there are a lot of myopia management resources, including Eyes on Eyecare, that provide great guidance and tips.
Adding myopia management will not only allow you to grow your practice and stand out from the rest, but it will ensure you offer the best and latest treatments to our patients.
