March 2020


Adjusting to reimbursement cuts:
Plans to increase revenue and decrease costs

by Ellen Stodola Editorial Co-Director

With the 2020 cut to cataract surgery reimbursement, many practices around the country are considering their options for increasing revenue and decreasing costs. Administrators from three practices spoke to EyeWorld about how they plan to act.
Kimbel Hunter said one way their practice intends to increase revenue is by offering more premium lenses. Currently, the practice offers two options, but it plans to move to four different premium lenses. He added that many patients are asking for this technology. “Most patients want multifocals, and there are some huge improvements in options,” he said.
Additionally, the practice is looking to increase efficiency by purchasing a different platform for electronic health records (EHR). The new system confirms the coding requirements, provides documentation, and offers a fax or direct messaging option for referrals. “The system reduces training time and provides a consistent way to work up patients,” he said.
Piedmont Eye Center also plans to participate in additional clinical trials. “This helps to offset the reduction in reimbursements and keep our overhead low,” Mr. Hunter said.
Nicki Greenwell, COA, said her practice, led by Frank Burns, MD, put together a plan in December 2019 to address reimbursement cuts. They realized they had not raised their refraction fees in a long time. The practice reached out to other practices in the area and looked at online message boards to see what others in the area were charging. “We were one of the lowest prices,” she said, so they bumped it up.
They also increased the practice’s premium lens prices, which Ms. Greenwell said hadn’t happened since they first introduced the lenses. “We’ve also implemented ORA [Alcon], so we needed to increase them,” she said. The prices were increased by about $50 per case, and she said this will likely bring in quite a bit of revenue because the practice’s conversion rate is about 40–45%.
Ms. Greenwell said Dr. Burns, the sole ophthalmologist at the practice, plans to offer two new glaucoma procedures. Currently he offers iStent inject (Glaukos), but he plans to begin offering both the ABiC procedure (Ellex) and the Kahook Dual Blade (New World Medical). “We have patients who will benefit from these,” she said, explaining that Dr. Burns had held off on offering new glaucoma options because he was already performing the iStent, but these new technologies could help his pseudophakic glaucoma patients and patients who previously received an iStent but needed lower pressures.
The practice recently purchased a laser for the office. While this will cost more money upfront, Ms. Greenwell said it will make more sense in the long run. Previously, the practice rented a laser, which cost $50–75 per case. It also limited the days and number of uses since the laser was not owned by the practice.
The practice will be able to perform selective laser trabeculoplasty, YAG capsulotomy, and YAG iridotomy with this new purchase. Ms. Greenwell said being able to perform a YAG capsulotomy quickly in the office will likely help increase satisfaction in premium lens patients.
Finally, Ms. Greenwell said the practice is evaluating its marketing budget. They looked at what they were spending, what was working, and what wasn’t working. “We’re a very busy practice, so we still want to market to keep our name out there, but we didn’t need all of the magazine and newspaper ads that we were purchasing,” she said.
Eye Care Physicians & Surgeons, where Orval Gilmore, COE, serves as an administrator, is looking at numerous ways to adjust. He said they have talked about the cut in cataract surgery along with other carrier issues in the region. For example, Oregon instituted a Corporate Activity Tax, effective Jan. 1, 2020, which assesses a gross receipts tax. “This will be a significant tax for us with no revenue to offset,” Mr. Gilmore said.
One goal of the practice is to increase its premium lens percentage. “Our current premium lens percentage is collectively just over 8% of all cataracts,” Mr. Gilmore said. “We performed just under 4,200 cataracts last year, and 341 of those had premium lenses associated with them.” He added that the national average is 20–25%. “I know there are some clinics that are as high as 60–70%,” he said. “By increasing our percentage to 20%, we could increase our revenue approximately $250,000 for the year, with potential to do even more.”
Mr. Gilmore said that the practice also has a strong optical department, which will be an asset moving forward. “You can always increase the capture rate and sell more glasses,” he said. “We are also taking a hard look at our lens fees, as we have not increased them for quite some time.”
The practice also worked to get a better contract with its lab to decrease lens costs. “We want to make sure that we are not overpriced in the marketplace, but at the same time, we don’t want to be leaving money on the table if we could be charging more,” he said.
The practice is planning a $2 increase in refraction fees. “I had a consultant tell me you should increase them every year by $2,” Mr. Gilmore said, adding that the practice has not increased these fees in several years.
In terms of expenses, Mr. Gilmore said that the practice is looking very closely at its staff to ensure the practice is using them efficiently. “We have a couple of staff leaving, and we will take a hard look at whether or not we will replace them,” he said.
Finally, Mr. Gilmore said that practice is working with Brevium, a data mining system, because it is important that the schedule is full. “We have never had to do this in the past and have been fortunate that our schedules are typically full,” he said. “However, we have thousands of patients who have not been back to see us in the last 5 years. We are working at recapturing some of those patients.”

About the sources

Orval Gilmore, COE
Eye Care Physicians & Surgeons
Salem, Oregon

Nicki Greenwell, COA
Middletown Eye Care
Louisville, Kentucky

Kimbel Hunter
Piedmont Eye Center
Lynchburg, Virginia

Relevant disclosures

: None
Greenwell: None
Hunter: None



Adjusting to reimbursement cuts: Plans to increase revenue and decrease costs Adjusting to reimbursement cuts: Plans to increase revenue and decrease costs
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