contact lens economics
Choosing a Corneal Topography Reimbursement Strategy
BY GARY GERBER, OD

There's little doubt that a corneal topographer provides more information than a manual keratometer. In addition to helping with specialized care such as orthokeratology or refractive surgery,  today's topographers can reveal subtle changes in the cornea that a keratometer may miss. Additionally, software can help us to follow and graph these trends over time.

Yet while nearly all of us have a phoropter in our offices, many of us (including active contact lens fitters) still don't have a topographer. Certainly cost is a major barrier, but I've met several doctors who've hesitated for other reasons -- the one I see most frequently and that we'll discuss this month is getting reimbursed. After all, there's no procedure code for topography. And if there's no code, then patients won't pay for it. Or will they?

Looking for the Light

As a practice-building consultant, I seek out the type of technology specifically described above -- namely, I help our clients find technology that's great for their patients and isn't covered by insurance. Because most insurance plans have a habit of sooner or later decimating professional fees (take the recent change in pachymetry fees for example: From about $100 to $11 in approximately one year), our company is constantly on the lookout for clinically relevant and superior technology that insurance plans won't pay for. That way, if the doctor charges a reasonable fee and successfully explains the importance of the test to the patient, then his practice has the ability to take better care of his patients and profit at the same time.

Include it or Charge Separately

So if you do buy a corneal topographer and get past the "no procedure code" speed bump (not having a code is too small to consider it a hurdle), how should you charge for it?

You have two choices:

1. Perform the test on every patient and build an incremental increase into your global professional fee

2. Perform the test on selective patients and only charge those patients for the test

(It either comes with the dinner or it's a la carte -- there's no other choice.)

Qualify Your Consequences

Which is better, one or two (familiar question)? Like most of you, I'll die not knowing the answer to this question. For some practices, a la carte makes more sense and for others the complete dinner makes more sense. Pick one, try it and move on. If it doesn't work for you, then try the other option. But don't hesitate to introduce great technology to your practice because of the trepidation about how to charge for it.

Jack Welch, the former CEO of General Electric, was quoted as saying, "A small business isn't a little big business." Inherent in this quote is the notion that one of the huge benefits that small business has is the ability to make mistakes without suffering major consequences. A pricing error on General Electric's behalf can cause stock prices to drop and upper level management to lose their jobs. Pricing corneal topography $3 too high, however, or as an "a la carte test" instead of as a "complete test," has nearly invisible consequences.

It's Good for You and Yours

Avail yourself of this great technology as well as many of the other technologies that are available. Learn how to use it, charge appropriately for it and take better care of your patients. It's not a case of, "If you build it they will come." Rather, "If you buy it, you and your patients will benefit."

Dr. Gerber is the president of the Power Practice ­ a company offering consulting, seminars and software solutions for optometrists. You can reach him at (800) 867-9303 or at DrGerber@PowerPractice.com.