A Dry Eye Center of Excellence: Does it Add Up for Your Practice?
By Marguerite McDonald, MD, FACS and Perry W. Fumuso, MBA
Last month, we began delving into the potential dollar-and-cents rewards of creating a dry eye center of excellence in your ophthalmology practice.
The American Academy of Ophthalmology tells us that 4.88 million Americans suffer the symptoms of chronic dry eye, and that as the population ages in coming years, that number is expected to grow. That means that establishing a dry eye center of excellence intuitively makes sense. So, as we did last month, we’ll now bolster that intuition with facts, examples, and calculations.
PROKERA® SLIM is a self-retaining biologic corneal bandage made of a cryopreserved amniotic membrane graft which is suspended across a large, thin plastic ring called an ophthalmic conformer. It’s the only cryopreserved amniotic membrane approved by the U.S. Food and Drug Administration for wound healing, and it is commonly used to heal and treat moderate to severe dry eye (as well as recurrent corneal erosions, filamentary keratitis, non-healing corneal ulcers, and a host of other conditions). The BioTissue preparation technique is the only way to preserve heavy chain hyaluronic acid and Pentraxin 3, which harness the power of regenerative healing; dehydrated amniotic membrane does not have these two agents. The PROKERA® SLIM bandage is worn for five to seven days, and the amniotic membrane dissolves as healing occurs.
Based on the estimated number of people walking around with dry eye, you can expect that more than 30 percent of the patients you see in a given month will have dry eye symptoms.
So, if you see 800 patients a month, it’s reasonable to assume that 33 percent of them will complain of dry eye symptoms. That works out to about 264 individuals. Of those, between 5 percent and 15 percent will be candidates for PROKERA®. If you take the low end of that range, you can expect that about 13 patients each month with moderate to severe dry eye will receive a PROKERA® insertion.
Based on the costs and reimbursement rates we currently experience, here is what you can expect from that in terms of revenue:
Assuming 13 PROKERA® patients each month, and that patients receive a sequential insertion in each eye (five to seven days apart, as the PROKERA® reduces vision by several Snellen lines), that means 312 insertions annually. It’s reasonable to expect that providing PROKERA® to dry eye patients could produce net revenue for your practice of $225,888 the first year.
Johnson & Johnson Tearscience LipiScan
Let’s assume that you personally see 100 patients a week in your practice; most of us see more, but this is an intentionally modest calculation. Of those, it’s reasonable to expect half will present with symptoms of Meibomian gland dysfunction (MGD).
Diagnostic imaging with LipiScan might be appropriate for at least 13 of those patients. Assuming only 25 percent of those patients return for an additional exam to determine the efficacy of the treatment regimen (once again, a modest projection), the following chart lays out the resulting expected weekly and monthly revenue:
Once diagnostic imaging is completed, a percentage of patients who have Meibomian gland dysfunction will go on to be treated with Johnson & Johnson’s LipiFlow, a 12-minute procedure. LipiFlow treatments, performed in the office, use thermal pulsation therapy to relieve MGD symptoms.
You can assume that anywhere from 20 percent to 60 percent of patients with MGD will have LipiFlow treatments, particularly after they see their Meibography images, which are extremely impactful. As these treatments are out-of-pocket expenses not covered by insurance, you can expect the following levels of revenue:
Of course, making LipiFLow treatment available in the office involves initial investment. Using current system costs and anticipated revenue, you can calculate how long it will take to realize a return on that investment, again based on the percentage of patients with Meibomian gland dysfunction who go on to be treated with LipiFlow.
In our practice, we have invested in the BlephEx® system, which allows us to perform a 10-minute in-office procedure to remove the biofilm on the lid margin, and to maintain eyelid hygiene. The system utilizes a soft sponge soaked in professional-grade eyelid cleanser which rotates at 2500 rpm. The procedure is comfortable, and we’ve found that regular cleaning with BlephEx® helps patients avoid recurring dry eye/blepharitis symptoms; for most patients, the optimum number of treatments is three per year.
This chart shows initial investment and expected return:
When you add the potential revenue from all those treatments together and calculate revenue from additional materials and treatments such as mechanical debridement of the lids with OCuSOFT Swabstix, and nutritional supplements, it’s likely that establishing a dry eye center of excellence could provide a bump in revenue of more than half a million dollars in the first year.
Of course, that’s just the first year. In our experience, revenue from dry eye related treatments has grown consistently, to the tune of 18 percent annually since we established our dry eye center of excellence.
Bottom line: providing care in a dry eye center of excellence is good medicine. The advanced diagnostic techniques and treatments available now mean that treating dry eye provides real benefit to patients. But it’s good business, too: treating a chronic condition allows you to expect steady revenue, and to build relationships with patients. And happy patients bring in referrals, and turn to you when more serious conditions arise. These patients will trust you, and your surgical volume will rise.
Marguerite McDonald, MD, FACS, with OCLI on Long Island, NY, is clinical professor of Ophthalmology at NYU Langone Medical Center, NY, and clinical professor of Ophthalmology at Tulane University Health Sciences Center, New Orleans, Louisiana.