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By Brian Chou, OD, FAAO

Investing in digital retinal imaging instruments offers entrée into new treatment areas&#;and pays dividends right from the start. Here are the numbers on making it work.

Digital retinal imaging is becoming commonplace in optometric offices. As with digital cameras that are now used everywhere, you can instantly view images, manipulate and transmit images, and take lots of images without the cost of film. These benefits make investing in one of these instruments something your practice should consider.

Synmed CR2 camera
courtesy Synemed, David Whalen

Calculating Revenue-Boosting Potential
The practice can charge an additional fee for digital retinal imaging performed for screening during routine examinations. Charges of $30 to $60 for screening retinal photography are common. These fees are not generally covered by third-party payers. I know of practices in which over 80 percent of patients agree to have digital retinal imaging despite the added cost. To explain to patients what they get in exchange for the added cost, you might say: &#;Digital retinal imaging is my preferred method for evaluating the inside of the eye because it&#;s a permanent record and I have it to compare against in the future. Although I&#;d like to review the images, you should know that your vision plan does not pay the $XX fee, so you&#;d be responsible for it.&#; ROB editors note: If you are a participating provider for a third party, protect yourself by having a signed ABN (Advance Beneficiary Notice) when charging patients for non-covered services or materials.

Code as Medical Eyecare
ODs can bill medical insurance for digital retinal imaging when there is necessity for documentation and an appropriate ICD code. The possible CPT codes for billing are (fundus photography with interpretation and report), (extended ophthalmoscopy), and (extended ophthalmoscopy, subsequent). However, if a practitioner is using the retinal camera for both screening purposes and medical billing, there should be some software function that differentiates the two. For example, the Optos units have a screening function, and also a billing function called Optomap Plus. The Synemed retinal imaging system using the Canon CR2 camera has an analogous software function. ROB editors note: Some third parties only pay for a medical photo if there is a medical reason for the office visit. In these cases, schedule the patient back for the medical photo.

CenterVue DRS

Incorporate With No Added Charge to Patient
When used for screening purposes, one drawback to asking each patient whether they would like digital retinal imaging and would accept an extra charge for the service is some patients may feel like they are being sold something extra and unnecessary and getting &#;nickeled and dimed.&#; The lack of consistent acceptance reduces procedural efficiency in the office. For that reason there are some practices (like mine) that incorporate digital retinal imaging into the routine examination at no additional cost to the patient.

If you choose to not charge the patient extra for digital retinal imaging, you do not need to raise the cost of your comprehensive examination. In my case, the cost of the retinal imaging is &#;financed&#; by:

1. Better operational efficiency of the practice and reduced frequency of dilation (yielding increased capacity to see more patients, and patients that are more likely to purchase eyeglasses the same day rather than come back when not dilated).

2. Patient perception that the practice is cutting edge by incorporation of the technology and word-of-mouth recommendation to friends and family.

Increase Perception of Examination Value
Most of the digital retinal cameras take a 45 degree field of view in the eye. The notable exception are the retinal cameras made by Optos, which can image up to 200 degrees of retina (about 78 percent of the retinal area). The benefits include photo-documentation for future comparison and the ability to examine the tissue while simultaneously showing the patient what&#;s evaluated. When you make digital retinal imaging a regular part of every comprehensive examination, patient perception and sense of value increases because they recognize that there is economic value to the retinal imaging and that they are getting the measurement done complimentarily, which encourages their return visits and recommendation to friends and family. A practice that takes this approach can still bill medical insurance for non-screening photography if they have the right retinal camera system&#;like Optos and Synemed. My office has two of the Synemed Canon CR2 cameras, which cost $24,000 each.

Economical Choices to Enable Universal Screening
Screening all patients with no additional charge is becoming more economically feasible, with low-cost retinal cameras, like the CenterVue DRS ($14,000). But I don&#;t think it is economically feasible with cameras such as the Optos unit for which some offices are paying close to a $20 use-fee per patient. Users can also purchase the Optos P200 units for about $80,000, which is too costly to allow most practitioners to absorb performing screening imaging at no additional fee.

There are several lower-cost options. A neat one is EyeQuick, which soon will be available for $5,995. EyeQuick may have more use for primary care settings and veterinary, but at least some eyecare practices will find it valuable because it is the lowest cost digital retinal camera which allows a practitioner to bill medical insurance. There is also the OIS EyeScan camera, which costs approximately $20,000.It offers a 35 degree field of view. One of its main features is portability and modular use. Note that the aforementioned costs cited for various imaging systems are approximate, since it varies depending on whether the system comes with a computer, software, an instrument table, shipping and handling, etc. OIS recently was acquired by Merge Healthcare.

ROB Editors note: Your strategy for a per-use fee may change with managed care patients who have fixed reimbursements. You cannot include a per-use fee test if you are losing $20 each time you perform it.

Present vs. Future Value
Make sure you are buying present value and not future promise. What I mean by that is if you have two comparable retinal imaging systems where one of them currently integrates with your electronic health record system but the other one does not but promises to do so, obviously the one that currently integrates is preferable. Second, don&#;t forget to consider the maintenance service agreement. One of the retinal cameras has a service agreement that costs $10,000 a year, partially because the camera is so large and bulky that it cannot be readily transported, thereby requiring trained service technicians to come on-site. Third, remember that low cost becomes too expensive if the instrument and system does not do what you want. There is a significant difference in image quality and function between some of the retinal camera systems.

Check for Ease-of-Use
Most of the new cameras are quite easy to operate, which is important because image capture is typically delegated to ancillary staff. In fact, the CenterVue DRS camera is so easy to operate, it is virtually self-administrable. I&#;ve seen a demo of it, and because the measurement is automated (autofocus, auto-alignment, auto-capture) a junior high school student could probably figure it out. Others require more learning but in all cases, the training for image capture is usually minimal. Doctors also have to learn how to use the image review software.

Minimal Time Investment
If digital retinal imaging is done as part of the routine exam, it probably takes staff between two and five additional minutes during preliminary measurements, depending on the system used and staff proficiency. The most efficient systems have capture and review software that integrates into the commonly used electronic medical records, saving the need for double entry. On the back-end, digital retinal imaging saves the doctor several minutes per patient, as it provides them with information about eye health more easily than relying solely on dilation. Digital retinal imaging during routine examination can reduce the frequency of dilated fundus examination, though it certainly does not replace it. The benefit of reduced frequency of dilation is that patients don&#;t have to spend as much time in the office. ROB editors note: The gold standard for an eye exam contains a dilated fundus exam. No matter what the marketing materials say, clearly understand your legal exposure if deciding to forgo a dilated fundus exam.

Improve Patient Eye Health With Additional Screening
Patients appreciate seeing their conditions or lack thereof in the photographs. I&#;ve found digital retinal imaging helpful for gaining patient adherence to treatment, particularly if they have signs of diabetic retinopathy, macular degeneration and other conditions. I think consumers are becoming more skeptical of their doctors&#; advice, relying more on their own online research. If a mechanic finds a problem with a car, many owners would want to know the problem really exists&#;and that the problem was not contrived to gain the sale of unnecessary work&#;before spending more money. The beauty of retinal imaging is that an imaged eye condition reinforces to the patient that the condition is real and that the doctor&#;s recommendation should be followed.

Investing in digital retinal imaging can serve your patients better by spotting eye health conditions faster and by reminding patients of the full value of their annual examination.

Digital Retinal Imaging Resources

A recent article by Dr. Chou on Optomap and dilation:
http://journals.lww.com/optvissci/fulltext///limitations_of_the_panoramic_200_optomap.7

For those who plan to use the instrument mainly for medical billing, this worksheet is helpful:
http://www.calcoastophthalmic.com/pdf/costanalysis.pdf.

Related ROB Articles

EyeMed Vision Care Adds Retinal Imaging Benefit

Do You Have the Tools Needed to Diagnose Glaucoma

Medical Eyecare Opportunity in Optometric Practice

Brian Chou, OD, FAAO, is joining EyeLux Optometry, which opens fall . He is a former partner of Carmel Mountain Vision Care in San Diego, Calif., where he practiced for 11 years. To contact him: .

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New advances in ocular testing equipment present an opportunity for primary care providers to reduce severe vision loss, especially those cases caused by diabetic retinopathy or macular edema. By bringing effective diagnostic eye care to non-eyecare specialists, the latest retinal screening tools make early detection affordable and accessible for both patients and providers. New, innovative eye exam equipment also offers more mobility and enriched capabilities for providers to leverage, including easier travel to retinal exam sites and handheld imaging. 

Choosing the best retinal imaging camera for your practice can be overwhelming, but it&#;s critical to effectively delivering quality care. Here are a few considerations to keep in mind as you select the best camera to fit your practice&#;s unique needs:

Types of Cameras

There are two common types of eye exam equipment used for retinal imaging: tabletop cameras and handheld cameras.

Tabletop Cameras

We use the term &#;tabletop&#; camera to describe cameras that sit on top of a medical instrument table. The two pieces of fully automated retinal exam equipment work hand in hand to deliver the best possible experience for both the camera operator and the patient.

Tabletop cameras tend to be more expensive than portable cameras. However, they do allow operators to take higher-quality images more consistently. Most tabletop cameras offer very high image quality and fully automatic image-capturing capabilities, contributing to ease of use and high user satisfaction.

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If you want to learn more, please visit our website Laser Retinal Imaging.

 

Handheld Cameras

A handheld camera is a smaller, more portable imaging device. This tool is battery-operated and does not need a stand or table to operate. It is best suited for customers who need to be more mobile with their camera to complete their exams successfully, such as those performing fundus photography in patient homes.

Handheld cameras have come a long way in recent years. This type of imaging equipment tends to be more affordable than tabletop cameras, and it allows you to make retinal imaging more accessible to your patients. Handheld cameras are used in homes, mobile clinics, and health fairs and are often shared between remote location

s. A handheld camera also requires a smaller footprint for your clinic, allowing for increased flexibility in space.

Both handheld and tabletop cameras have been proven to be effective eye exam tools for retinal imaging. Most handheld cameras are manual, which requires a bit more practice to achieve optimal image quality. This is not a reason to forgo handheld cameras; instead, it&#;s a reminder to select the right tool based on the needs of your patient population and to provide your personnel with the training they need to use either camera with accuracy and efficiency. 

 

 

In conclusion, handheld cameras are often best for health risk assessment companies or payors looking to provide more complete at-home care services, and tabletop cameras are better suited for healthcare provider offices, as they don&#;t travel well. We see comparable image quality from both solutions; the difference is the type of solution that best fits the needs of your organization. Here&#;s our latest webinar which teaches providers how to use both types of cameras to reach underserved patients:

 

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The Importance of Fundus Image Quality

While price is an important consideration for selecting any imaging equipment, image quality is paramount. Being able to easily capture a high-quality image using the right equipment is critical to the effectiveness of your program. 

IRIS offers a unique solution that includes proprietary image enhancement technology that helps optimize gradability. Couple this with IRIS&#; historic readability rates of approximately 95% and the chance of success is very high. Once the image is captured, a licensed eye care provider can then evaluate the health of a patient&#;s retinas.

Staff training is also critical to ensuring high image quality. Select a service provider that offers training for your staff to ensure that your team can effectively use the camera you choose. IRIS prides itself on providing both onsite and virtual training for all camera types. Not to mention, we know that superior image quality can be achieved with each camera compatible with our software platform. At IRIS, we have a team of training experts that are ready to assist our clients whenever they need it.

The IRIS Partnership with Health Risk Assessments

These days, more and more private organizations are partnering with payor and provider clients participating in value-based care programs that perform in-home health evaluations to evaluate whole-health needs of plan members. These organizations, commonly referred to as HRAs, or Health Risk Assessment companies, find IRIS technology to be useful in improving the accessibility of patient care. Because of the ease, reliability, and portability of the IRIS solution, preventative diabetic retinopathy testing can be done as a part of an at-home care check. The fundus image is taken by the healthcare worker with a handheld portable camera and is uploaded to the IRIS cloud technology platform. It is then automatically enhanced with our proprietary enhancement technology to create a more detailed view of the retinal image. It is then sent through the cloud to the IRIS Reading Center or other licensed eye care providers, and after examination, the results are made available to the HRA. 

Doing preventative testing for diabetic retinopathy straight from a patient&#;s home is a game changer for HRAs in their quest to close the care gap with these types of preventative screenings. It means an additional screening measure can be offered to the HRA&#;s health plan customers as part of the routine check an HRA provider already performs.

Furthermore, it is of paramount importance for these fundus images to have high image quality. If the images taken by a fundus camera are upgradeable, it wastes both time and money. Thus, in order for HRAs to avoid sunken costs, it is important to make image quality a priority in your quest to pick a retinal imaging camera.

Why Ease of Use is so Important

Multiple members of your staff can use new retinal screening tools, but it&#;s important to shorten the learning curve for them as much as possible to mitigate the go-to-market timeline. It is critically important to pick a camera that your staff will be comfortable using. Introducing a new tool can add frustration for your employees, which can ultimately counteract the effectiveness of your program. However, if they can use the tool(s) confidently, it will lead to high satisfaction and engagement in the program, quality retinal imaging, and an increase in early diagnoses of diseases that cause preventable blindness. 

Tabletop cameras are typically much easier to use than handheld devices because tabletop cameras generally are fully automatic, which usually leads to more consistent quality images. A handheld camera gives users more control and portability but requires more manual effort. Because the camera needs to be aligned and focused manually, there is a steeper learning curve. However, with the help of IRIS trainers, this learning curve is lowered drastically.

In addition to the actual camera itself, software and hardware integration must be easy for users. The more proficient your staff is, the more efficiently you can incorporate retinal screening into your practice and provide high-quality results to your patients. 

 

 

There are many factors to consider when choosing to invest in a retinal camera. Your selection will have a lasting impact on your organization and your patients. Leverage these considerations above to make confident decisions as you pick retinal screening tools for your camera operators and patients.

Want to learn more about what kind of eye exam equipment may fit best with your practice? Contact us to learn more!

Interested in learning more about how IRIS is innovating diabetic retinal exams? Check out our blog!

 

Retinal Imaging FAQs

How much are digital retinal cameras?

Retinal (fundus) cameras range dramatically in price depending on a variety of factors including field of visibility, size, and portability. Determining what your practice needs will be key in choosing a camera that meets your needs while remaining within your budget. Our team can help you choose the right camera that meets your practice&#;s needs &#; connect with us today to learn more. 

 

What can retinal imaging detect?

Currently, retinal imaging, done by an eye care professional, has the ability to detect a host of pathologies that affect the eye, such as diabetic retinopathy, HIV retinopathy, hypertension, macular edema, epiretinal, glaucoma, cataracts, wet/dry AMD, macular hole, vein occlusion, etc.  There is ongoing research exploring the possibility of using retinal screenings to detect other issues like Alzheimer&#;s disease.

 

 

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