One question that I am asked most often is “How much do you charge for orthokeratology (ortho-k)?” A better question would be: “How do I determine the right fees for my office?” But that’s never asked, and here’s why.
Insurance reimbursements are based on what health plans deem “reasonable and customary.” Because most healthcare providers accept insurance for common services rendered, they may become conditioned to accept payment, even when it’s insufficient for the care actually provided. This is an unfortunate predicament in which healthcare providers find themselves, because many lack the knowledge to determine whether enrollment in a plan makes good fiscal sense for their practice. Others take on a herd mentality, accepting reimbursements because their colleagues are doing the same.
At least for the time being, most vision and health plans do not cover ortho-k as a traditional form of vision correction. Regardless, providers may feel compelled to establish fees based on what others are charging. Whatever the case, there is an intrinsic problem when we base our fees on what others are accepting, because ortho-k is a treatment, not a contact lens fit.
When it comes to ortho-k, my patient care philosophy is clear (Despotidis, 2020; Despotidis, 2021). My office goes beyond the fitting of the lens to ensure patient compliance and myopia stabilization. We also routinely discuss the role that screen time, lack of outdoor activities, posture, and ambient lighting may have on eyesight. And, we reward patients with snacks and thoughtful gifts throughout their treatment.
What you charge for ortho-k comes down to two questions:
- What is your commitment to myopia management? Have you invested in technology and education to optimize refractive stabilization?
- What is your style of care? Do you enjoy holding patients’ hands or do you mainly focus on the intricacies of fitting a lens, seeing patients only on a needed basis?
The cost involved with each philosophy varies greatly. When practitioners are capitated by insurance reimbursements or base their fees on what others are charging, their care may be compromised or their practices negatively affected financially.
To help my office navigate this delicate balance, we’ve opted out of vision plans and have limited which medical plans we accept. As a result, our fees properly reimburse us for the care that we provide. This was a gradual process aided by the use of different fee levels.
Levels of Care
Our staff has six levels to reference when presenting ortho-k to patients. Technicians select the level based on several factors, including a patient’s age, prescription, rate of myopia progression, corneal topography, sensitivity to contact lenses, and family history, among others. All of these factors play a role that is required both to fulfill the family’s expectations and to optimally and safely correct a patient’s refractive error.
As our experience grew, the levels selected became more representative of the actual care provided. Today, patients recommend our office for the care that we provide, not because we participate in their plan or because of the cost of our program.
What should you charge for ortho-k? The answer is simple but not easy. This process takes analysis and commitment, and it dares your practice to stand out. Your fees should be in alignment with the care that you provide at each and every visit. CLS
For references, please visit www.clspectrum.com/references and click on document #316.