Tips4EyeDocs Daily – 01/06/2012 – No.19 – Alternative Practice Revenue?


Reviewing your 2011 performance figures can be sobering for some independent private practice OD’s (IPPOD) and heartening for others. As the new year jumps off, revenue levels can be predicted. Based upon 2011 figures, are there changes in practice strategy that might change the financial outcome for 2012?

High technology has always been a potential alternative revenue stream that many vendors pitch to practice owners. For some, this seems logical, easy, and even exciting. For others, they scratch their head whether it makes sense to spend that kind of money on something that might work. Who knows!

Doctors have a plethora of options to explore. Upgrading to a retinal camera or new retinal imaging is much talked about. The vendors have been beating the drums that it’s the easiest way to add revenue. However, with reimbursement levels being sensitive to regulatory action, the durability of that revenue stream remains problematic.

But a newer kid on the block, preventative care may be an easier strategy to deploy. Because preventative care isn’t a straightforward reimbursement, many doctors have incorporated this technology as an out-of-pocket expense rather than a reimbursable claim. Even at a mere $50-125 per test, the revenue gained is not dependent upon excessive staff or doctor time to process. In fact, in comparison to a same-dollar procedure, the out-of-pocket gains in bottom line net income.

Two kinds of technology are promising. The first, cardiovascular ultrasonagraphy (HeartSmart Technologies) and the second, macular pigment density measurement (Macuscope) can be suitable avenues for alternative revenue streams. With an aging patient population, both of these instruments coincide with optometry’s interest in overall health care and are usually an out-of-pocket expense.

Of course, technology alone cannot drive revenue if the other parts of a practice are faltering. But if the practice is like most others, healthy and still looking for opportunities, consider cardiovascular ultrasonography or macular pigment density measurement.


  1. A startling fact to me is how many patients in general will even pick up their prescriptions. In the UK, up to a third of patients don’t even pick up their prescribed medications at all. Spotted on Twitter” via @StopFakeDrugs
  2. Doctors who have blogs open their posts to reader’s comments. On the traditional web page this isn’t possible. But with today’s blog structures, it’s possible to let readers post comments to your own posts. There are advantages and disadvantages to permitting readers to post their comments. The Pros and Cons of having Comments on your Blog. Spotted on Twitter via — jowyang (@jowyang)


My overview: Antibiotic resistance is a concern to almost all eye care professionals. The more resistant and durable microorganisms can cause significant morbidity and even permanent vision loss. This article reports the use of Targocil as a replacement for vancomycin in methicillin-resistant Staphylococcus aureus. If further studies support this early finding the eye are profession will have an enhanced tool to fight major eye infections.

Citation:Suzuki T. A new target for Staphylococcus aureus associated with keratitis. Cornea. 2011 Oct;30 Suppl 1:S34-40.

Abstrac Staphylococcus aureus is a leading cause of keratitis, with an increased number of isolates exhibiting antibiotic resistance. Therefore, we need to understand the present situation regarding drug-resistant S. aureus in the ocular site. It has been shown that 35% of S. aureus isolates from ocular sites are methicillin-resistant Staphylococcus aureus (MRSA). MRSA isolates from ocular sites have a high rate of multiple mutations and high levels of resistance against fluoroquinolones. Wall teichoic acids (WTAs) are major polyanionic polymers in the cell wall of S. aureus and are likely to be important in the pathogenesis of eye infection. A new compound, targocil, was recently shown to function as a bacteriostatic inhibitor of WTA biosynthesis in S. aureus. The minimum inhibitory concentration (MIC) at which 90% of the keratitis isolates are inhibited (MIC90) by targocil was 2 μg/mL for both MRSA and methicillin-sensitive Staphylococcus aureus. Targocil exhibited little toxicity at concentrations near the MIC, with increased toxicity at higher concentrations and longer exposure times. Targocil inhibited intracellular bacteria in the presence of human corneal epithelial cells to a greater extent than vancomycin. Targocil-resistant strains exhibited a significantly reduced ability to adhere to human corneal epithelial cells (P < 0.001). The WTA biosynthesis pathway of S. aureus appears to be a viable target for preventing keratitis caused by strains of this bacterium.

PMID: 21912228 [PubMed – indexed for MEDLINE]

For a reference to this post, use this URL

About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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