There is always a drive to create a “center of excellence,” a “practice of distinction” or some other way to build your practice. However, added complexity in our practices rarely leads to better economics; perhaps it’s time to focus on what we have right in front of us. In the October 2013 Review, I published “The Economics of Apathy,” which focuses on how a few common disease states can impact our patients and our practices.

I recently lectured in Houston about ocular allergy, and in doing my research, I realized the top five areas in the country where pollen forecasts were consistently high were in southern Texas, and Houston in particular.¹ Even more surprising was how few of the audience members had a vibrant allergy or dry eye practice.

Table 1. Economic Impact of Treating Ocular Allergy2
Overall incidence of allergies	50%
Incidence of ocular allergies	83% of total allergy sufferers
Number of people in the United States with ocular allergies	134,875,000
Number of people in your practice with ocular allergies/year	1,453
Total number of office visits related to ocular allergy	2,905
Average reimbursement for an allergy-related visits	$73
Annual allergy-related revenue per patient	$146
Total potential revenue/year due to ocular allergy	$212,472
Lifetime economic potential	$9,561,227

Patients in Need

Ocular allergy and dry eye are fairly popular topics to discuss, and for good reason. The percentage of the US population that experiences symptoms of ocular allergy is in excess of 40%, and nearly 25% of the population experiences dry eye.¹ However, if you include lid margin disease, the population may be in excess of 60% to 70%.² With increased use of handheld devices, symptoms and clinical signs of dry eye are increasing daily. So why do we continually ignore these areas of patient care? Are we lazy, complacent or a combination of both?  

Let’s look at how taking care of your patients gives them a better quality of life and helps insulate your practice from market pressures. 

The average OD works 45 years, making roughly $150,000 per year.³ Even without the compounding of money factors, that puts the average OD’s lifetime earnings at roughly $6,750,000. While that may seem like a lot, inaction in our practices ends up costing us more than what our day-to-day practices provide. 

Table 2. Economic Impact of Treating Dry Eye2
Overall conservative incidence of dry eye (not including lid disease)		25%
Number of people in the United States with dry eye		81,250,000
Number of people in your practice with dry eye/year		875
Average reimbursement for dry eye-related visits		$73
Typical number of visits for nonpunctal occlusion patients per year		3
Typical revenue for Medicare punctal occlusion patient		$737.43
Typical revenue from non-Medicare punctal occlusion patient		$1,302.25
Percentage of patients undergoing punctal occlusion		3%
Percentage of Medicare patients	50%	$9,678.77
Percentage of non-Medicare patients	50%	$17,092.04
Incremental annual dry eye-related revenue		$213,003.54
Lifetime economic potential of diagnosing and treating dry eye		$9,585,159

Most of us believe a reasonable patient would tell us they suffer from ocular allergies or dry eye symptoms. However, average patients generally don’t keep up with our scope of practice, nor do they know our breadth of clinical knowledge; more importantly, they are often self-treating with over the counter products. 

The economic impact is staggering, and practicing to the highest level that our individual licenses allow is critical. We need to be proactive and ask the right questions, perform the right examination and provide the best treatment for efficient and effective outcomes. Health care reform and the eye care model are not mutually exclusive; elevate your business by simply elevating the level of care you provide.

Send questions and comments to ROcodingconnection@gmail.com.

1. www.pollen.com. 2. CMS national average figures as of October 2016.  3. Hepp R. 2015 income survey: love what you do. Rev Optom. 2015;152(11):30-4.