It is essential that ‘ownership’ of the OCT lies with the practice as a whole and not just the optometrist. It is equally essential to avoid the feeling by front-of-house staff that it’s another ‘new toy’ in the consulting room.
At our practice in Hove we addressed this issue early on by making sure that all of our staff were enthusiastic about the benefits of the test. This was achieved by appropriate training, in simple and easy-to-learn terminology.
Newer members of staff have a crib sheet which they can refer to. In the case of our Retina Scan Duo, because it is an automated piece of equipment, each full-time member of staff has been trained to use it and their results have been explained in simple terms. To keep interest up I have found that presenting short two-minute case studies are always well received by everyone.
[CaptionComponent="2572"]We experimented with the options of an optical assistant running a pre-programmed test versus an optometrist. We found that although the scan results did not vary significantly where there was a need for either an additional test or a repeat test, the patient would have to leave the ECP and return to have the additional scans.
Also, in the case of complex scans such as a patient with a cataract or a patient with a previously undiagnosed pathology, an experienced ECP was far better placed to be able to obtain the relevant information.
Additionally, as the results were explained by the optometrist we decided that they would take all scans rather than an optometric assistant. Each practice will have different requirements and so it is important that this is investigated and tested to see which suits best.
Charges
The biggest elephant in the room still seems to be charging for OCT examinations. It is widely accepted that an OCT scan is an additional service and as such it should carry a fee. Typically, fees can range from an additional £20 to £100.
However, the author is aware that there are some practices that do not charge extra and do not have this built into some form of direct-debit based fee plan. There may be convincing arguments as to why an extra fee is not levied. However, one simple fact must be true in such cases – the cost of OCT must be subsidised by sale of product. Finance companies (like Performance Finance) have excellent illustrations which show the time taken to pay for the OCT based on different levels of charging. These are typically based on how many patients are scanned per week.
At our practice we set our fee at £45 as an additional cost on a menu-driven examination – ie it was in addition to the cost of a routine examination. Others have incorporated it into plans and others have worked it into a standard, advanced and premium format.
[CaptionComponent="2573"]Whichever method is chosen, the simple fact remains that if it costs £35 per day to lease the OCT and your practice performs six examinations at £45 each daily then not only will the OCT be paid for sooner; in the long-term it will prove highly profitable, generating additional revenue for the practice.
Scope
Many OCTs are not just restricted to retinal imaging. Several have anterior segment modules, either as part of the package purchased or as an additional (buy-in) module. As a practitioner who fits complex contact lenses such as sclerals (see Figure 1), I regularly use my OCT as an anterior segment imaging device.
It allows valuable information to be obtained across the profile of the lens and together with fluorescein patterns optimises decision-making when fitting such lenses. In essence it makes fitting complex contact lenses easier. As a result of using anterior segment OCT in such fittings we have been able to raise fitting fees considerably, thus bringing in additional revenue.
It is also prudent to mention that many practitioners who have OCTs have benefited from joining CCG-driven wet AMD pathways and have benefited from the extra revenue this has bought.
Final thoughts
In conclusion, purchasing an OCT is a considerable investment perhaps second only to a practice refit (Figure 2).
With the current estimation of penetration of OCTs in the market being very low at less than 10% there exists a real opportunity to differentiate from the rest. The clinical arguments for OCT are well established but with a thought out business approach, from start to execution, an OCT can prove viable and profitable.
Read more
OCT: The business considerations - part one
Dr Sandip Doshi works in independent practice in Hove