As our clinical team evolved its practice to incorporate interventional glaucoma (IG) principles, we found that we had to make some adjustments on the operational side to support that change. Namely, we had to adjust our patient scheduling, and we had to train our staff on how to introduce and discuss these procedures with patients. In the long run, however, this switch to an IG framework has generated gains in both time and money.

Staff Training: We quickly learned that staff alignment is crucial in helping the physicians practice with an IG focus. The entire staff­—everyone from the front desk to the call center to the technicians—needs to appreciate and share in the goal of preferring glaucoma procedures, especially early in the treatment journey, as opposed to topical drop therapy.

We facilitated this shift by giving our technicians scripts to use with patient candidates. We also screen patients when they check in for an appointment via a brief questionnaire that asks questions such as, “Do you struggle with your drops?” These small steps were easy to add, and the payoff has been notable. In fact, our entire operational team is now so well-versed in the IG mindset that our patients expect to hear about procedural options that might reduce their glaucoma drop burden when the doctor enters the room.

Short-Term Pain Yielded Long-Term Gain: I will caution that in the beginning of adopting this strategy, we lost some efficiency. Clinical visits took a little bit longer while everyone got used to a new way of doing things. However, that initial investment in time wound up yielding long-term benefits. For one, our practice is now realizing increased revenue from procedures, and our bottom line is healthier than when our physicians practiced with a medication-first mindset. Yet, the real gain our practice has recognized is in time savings.

The Time Impact of Complex Drop Regimens: There are several implications for the practice’s overall efficiency associated with topical medication use.

  • Four to five different staff members can be involved in a patient’s refill order, each with different responsibilities, such as reviewing prior authorizations, contacting the pharmacy, and ensuring the prescription is on the payer’s formulary.
  • In the office, both physicians and technicians are involved in educating patients on how and when to use the drops, as well as counseling them on the need for compliance with the protocol. Many patients ask additional questions about drop application at check-out, thereby creating an additional step in clarification.
  • Patients sometimes come in with a bag of drops, not knowing which ones are current or which ones they are taking. This can cause a bottleneck as technicians sort through the confusion and update the electronic health record appropriately.
  • Our operations team recently assessed 2 years’ worth of data on patients followed with a glaucoma diagnosis, comparing those who had received an interventional procedure and those followed on drops, to see what impact the IG model had on the schedule. Surprisingly, we found that we were losing a lot of patients on drops to no-show appointments, and that these were the same patients who were chronically noncompliant with their medications. Ultimately, our assessment showed that we were wasting a lot of time following up with lost patients.

Taken together, these micro-interruptions throughout a drop-managed patient’s journey through the clinic accumulate hidden costs. Conversely, we’ve determined that once drops go away, our practice recoups enough lost time that we can see more patients in a given day.

Understanding Payer Contracts: Knowing what procedures are covered for a given patient before having the discussion about procedural options is an important facet of IG integration. It is an unfortunate reality that insurance will sometimes dictate patient care, but if the doctor can enter the room with knowledge of what procedures are covered, he or she can at least steer the conversation appropriately.

Success Depends on Integration: While the IG model of care offers myriad benefits for the practice, success may hinge on how well the business side supports the clinical side. For instance, we had to change our marketing and communications with our referral network to encourage them to refer patients earlier in their glaucoma journey so that our physicians had a chance to implement procedures at the appropriate time.

As the physicians in our practice have migrated to an IG mindset, it has compelled the business side to re-examine the day-to-day operations. We have learned that when the entire team pulls together, we gain tremendous time savings, new revenue streams, and improved staff satisfaction. Our physicians often talk about how the IG model offers patients a better standard of care for their glaucoma. What we’ve also found is that the IG model has several positive ramifications for the health of the practice as a whole.