Friday, July 12, 2013

A time to splurge ... or a time to merge

When I joined an existing practice some thirty years ago, I was impressed with the technology my predecessor, Dr. A.E. “Buddy” Wascou, was using – he had 35mm fundal photography and an infrared autorefractor  (a Coherent Dioptron II)!  This latter instrument occupied a fair piece of real estate in his office and was introduced in the mid-seventies with a noteworthy price in the mid-twenties (1970s currency). Times have changed – we now have this technology of auto-refraction held in our hand, coupled with keratometry, to boot.

Through the eighties, the hot ticket items became biomicroscopy, Volk lenses, auto-perimetry and Polaroid fundal photography; soon followed by digital photography … just about the same time you had paid off your previous “goodies.”  As I recall, through the nineties most of our upper shelf clinical “toys” still remained in the mid-twenties price range (+/-).

Now, we have added a plethora of choices: OCTs (with or without anterior segment  assessment and auto-fluorescence), VEPs, the Optos Daytona, endothelial layer assessment, tear osmolarity, preferential hyperacuity perimetry, auto-phoropters, auto-screens, CSF testing, in office adeno-viral testing and AMD DNA testing. I’m sure I have just skimmed the surface and have not even mentioned that their integration into EHRs seems to need an air traffic controller at times.

To add to the neurosis, just about the time that I’ve befriended my OCT and humbled myself to its greater intelligence, I confront a new unit coming down from Canada which utilizes 12 LEDs (i.e., different wavelengths) to do an “en face” (layer by layer) portrayal of the retina through the RPE, auto-fluorescence, “fluorescent angiography” without the fluorescent dye … at about half the price of the present technology being unpacked. (This being the exception since now we are moving from the mid-twenties price range into the eighties to snag the top shelf stuff.)

Then, when I finally have time to stick my head outside my office to see what’s happening in the outside world, I no longer see any private medical practices in our county. I see surgical centers in which our MD colleagues have a vested interest. I see smaller practices merging into multi-specialty sites or at least larger groups.  I discover a new branch hospital that has displayed a disclosure sheet of all the doctors who have a vested interest in this new location.  Hmmm…

Reflecting back once again, in the late eighties, two of my classmates, Drs. Danny Kramer (NJ) and Scott Edmonds, had the foresight to initiate a movement of developing optometric referral centers – a site where a lot of our expensive “toys” could commune and become friends. (If my aging synapses still crackle, I believe the branded name was “CoCare.”)  Anyway, ODs would invest in these centers and subsequently refer patients for further evaluation instead of trying to squeeze additional instruments into their offices and create empty holes in their wallets.  

In our area, we had explored this possibility to the extent that one of our local hospitals had offered floor space for such a referral center; we had even started interviewing for an itinerant OMD as an employee to help staff our site, as required.  Once again, this was some twenty-five years ago … very progressive thinking for the time. Unfortunately, too progressive, and when dollars needed to be laid upon the table, it resembled a covey of quail.

Perhaps now with escalating third party plans, concurrent with the development of the home medical model, we should reevaluate our modus operandi. Perhaps we should pause, stick our heads outside of our private offices and observe how our medical colleagues are adjusting to this evolving environment.

I’m just saying….






Robert L. Owens, O.D., F.A.A.O.
President
Pennsylvania Optometric Association
http://www.poaeyes.org/