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By Brian Chou, OD, FAAO

Investing in digital retinal imaging devices opens new treatment possibilities and generates returns right from the beginning. Below are insights on how to leverage this technology effectively.

Digital retinal imaging is rapidly becoming a standard practice in optometric clinics. Similar to the ubiquity of digital cameras, these devices allow instant viewing, editing, and sharing of images, all without the expenses associated with film. These advantages make investing in such equipment essential for your practice.

Understanding Revenue Generation Potential
Practices can impose additional fees for digital retinal imaging during routine exams, often charging between $30 to $60. Since these fees are typically not covered by third-party insurers, many patients may opt for this service; reports indicate that over 80 percent of patients accept the additional cost. To clarify value, you could explain, “Digital retinal imaging is my preferred method for assessing the interior of the eye due to its permanence. While I will review the images, it’s important to note that your vision plan does not cover the $XX fee, making you responsible for it.” ROB editor’s note: Always secure a signed ABN (Advance Beneficiary Notice) to protect yourself when charging for non-covered services.

Billing as Medical Eyecare
Ophthalmologists can claim medical insurance for digital retinal imaging when documentation is necessary and the proper ICD codes are utilized. Relevant CPT codes include those for fundus photography with interpretation, extended ophthalmoscopy, and subsequent extended ophthalmoscopy. It’s crucial that practitioners differentiate between screenings and medically necessary imaging within their software systems. The Optos units feature a screening function alongside a billing module named Optomap Plus, while the Synemed system with the Canon CR2 camera offers a similar software capability. ROB editor’s note: Payors may only reimburse for medical imaging if there’s a medical justification for the visit, so schedule patients again for medical photos when necessary.

Include in Routine Examinations without Additional Charges
One challenge with asking patients if they wish to undergo digital retinal imaging for an extra charge is that it may give them the impression of being pushed towards unnecessary services, resulting in inconsistent acceptance rates. To mitigate this issue, some practices, including mine, incorporate digital retinal imaging into standard examinations at no extra cost.

Opting not to charge for digital retinal imaging allows you to maintain the price of comprehensive exams. In my practice, the costs are balanced through:

1. Improved operational efficiency and a reduction in the need for dilation, enabling us to see more patients, many of whom are likely to purchase eyewear on the same visit.
2. Enhancing patient perception of our practice as cutting-edge, which encourages word-of-mouth referrals.

Enhancing Examination Value Perception
Most digital retinal cameras capture images covering a 45-degree field of view, except for Optos cameras, which can capture up to 200 degrees (approximately 78% of the retina). The advantages include permanent documentation for future reference and the ability to visualize the tissues while explaining findings to patients. Regularly incorporating digital retinal imaging into examinations increases the perceived value for patients, as they recognize its worth and appreciate receiving these measurements at no additional cost. This approach can still enable practices to bill for non-screening photography with appropriate retinal camera systems, such as those by Optos and Synemed. For instance, my office utilizes two Synemed Canon CR2 cameras, each costing $24,000.

Cost-Effective Options for Universal Screening
Broadening screening practices without additional charges is increasingly viable, especially with more affordable retinal camera options like the CenterVue DRS, priced around $14,000. However, models like the Optos can incur usage costs of nearly $20 per patient, making them less feasible for many practitioners who require screening imaging at no extra charge.

Affordable alternatives also exist. An innovative option is EyeQuick, set to be priced at $5,995. While primarily beneficial in primary care or veterinary contexts, some eye care practitioners may find it valuable as it is the lowest-cost digital retinal camera capable of medical billing. The OIS EyeScan, priced at about $20,000, offers portability and modular usage, although costs may vary based on additional equipment and services provided. Note that equipment costs can fluctuate based on included features like computers, software, and shipping. OIS has been recently acquired by Merge Healthcare.

ROB editor’s note: Your per-use fee structure may need adjustment with managed care patients who have set reimbursements; a per-use fee cannot be maintained if you are losing money.

Balancing Present and Future Value
When investing, prioritize current value over future promises. For instance, if you have two similar retinal imaging systems and one currently integrates with your electronic health record while the other promises future integration, clearly opt for the former. Maintenance contracts also vary significantly; some may cost around $10,000 annually due to factors like size requiring onsite technical support. Moreover, a lower-priced device may prove costly if it fails to meet your operational standards, as differences in image quality between systems can be substantial.

Ease of Use Considerations
Most new cameras are user-friendly, essential as image capture often falls to ancillary staff. For instance, the CenterVue DRS is straightforward enough for even a junior high student to operate easily. Other models might require additional training, but generally, the training needed for image capture is minimal. Physicians will also need to familiarize themselves with image analysis software.

Time Investment in Imaging
When integrated into routine exams, digital retinal imaging typically adds only two to five minutes to the preliminary assessment process, dependent on system efficiency and staff experience. The best systems integrate capture and review software with electronic medical records, minimizing duplicated data entry and ultimately saving doctors time by clarifying eye health without relying solely on dilation. While digital retinal imaging cannot entirely replace dilated fundus examinations, it can reduce their frequency, allowing patients to spend less time in-office. ROB editor’s note: A dilated fundus exam remains the gold standard for eye examinations; be mindful of legal implications if you opt to forgo this.

Enhancing Patient Eye Health through Additional Screening
Patients actively engage with their health when they can visually confirm their conditions through imaging. Digital retinal imaging has proven effective in bolstering patient adherence to treatments for conditions like diabetic retinopathy and macular degeneration. Today's consumers often perform their own research, building skepticism regarding medical advice—much like car owners often seek confirmation of mechanical issues. The visual evidence from retinal imaging reinforces the legitimacy of their eye health concerns, encouraging patients to follow through with recommendations.

Investing in digital retinal imaging not only aids in the swift detection of eye conditions but also underscores the worth of annual examinations for patients.

Resources for Digital Retinal Imaging

For further reading on Optomap and its relationship with dilation, refer to this article:
http://journals.lww.com/optvissci/fulltext///limitations_of_the_panoramic_200_optomap.7

If your primary use will be for medical billing, this analysis worksheet could be of assistance:
http://www.calcoastophthalmic.com/pdf/costanalysis.pdf.

Additional Resources

Our articles related to enhancing your practice's capabilities:
- EyeMed Vision Care Integrates Retinal Imaging Benefits
- Tools for Accurate Glaucoma Diagnosis
- Medical Eyecare Opportunities in Optometry

Brian Chou, OD, FAAO, is set to join EyeLux Optometry this coming fall, following an 11-year partnership at Carmel Mountain Vision Care in San Diego, California. You can reach him for inquiries.

Recent advancements in ocular testing tools allow primary care providers to effectively reduce severe vision loss, particularly due to conditions such as diabetic retinopathy or macular edema. By integrating powerful diagnostic eye care into non-specialty practices, these new retinal screening technologies enable early detection that’s both affordable and accessible for patients and providers alike. Additionally, these innovative devices enhance mobility and capabilities, aiding in their transportation to exam sites and offering handheld imaging options.

When it comes to selecting a retinal imaging camera for your practice, the choices can be daunting yet crucial for delivering quality care. Here are key factors to consider in finding the best fit for your unique needs:

Camera Types

Two prevalent types of retinal imaging equipment are tabletop and handheld cameras.

Tabletop Cameras

The term “tabletop” designates cameras stationed on medical instrument tables. These fully automated systems work collaboratively to optimize experiences for both operators and patients.

While generally more expensive than portable models, tabletop cameras consistently produce high-quality images. Their automated features contribute to their user-friendliness and elevated satisfaction rates among users. Recommended article:
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To learn more about advanced options, take a look at our site: Laser Retinal Imaging.

Handheld Cameras

Handheld cameras are smaller, portable devices powered by batteries, requiring no dedicated stands or tables. They suit practitioners needing mobility, such as those conducting fundus photography at patients' homes.

Handheld models have significantly evolved, typically costing less than tabletop options while making retinal imaging more accessible. They are utilized across various venues such as homes, mobile clinics, and health fairs, often shared between remote locations. Their compact size increases spatial flexibility for clinics.

Both handheld and tabletop cameras serve as effective tools for retinal imaging. However, the majority of handheld units operate manually, needing additional training for optimal image quality. This distinction does not diminish their value; it rather serves to highlight the necessity of selecting the right equipment based on patient demographics while ensuring personnel receive adequate training for proficient use.

In summary, handheld cameras cater best to organizations involved in health risk assessments, while tabletop units are more refined for healthcare settings that do not easily allow for transportation. Both options deliver comparable image quality, with the distinction mainly being the solution best suited to the organization’s demands. Join our latest webinar to learn how both camera types can extend care to underserved populations:

The Critical Nature of Fundus Image Quality

While cost remains a pertinent factor when selecting imaging equipment, achieving superior image quality is imperative. The ability to easily capture high-quality images is vital for effective program execution.

IRIS provides an innovative solution with proprietary image enhancement technology that optimizes gradability. Coupled with an impressive readability rate of roughly 95%, the likelihood of effective evaluations is high following imaging by licensed eye care professionals.

Staff training is essential in maintaining high image quality; seek service providers that facilitate training for your team, ensuring proficient use of your selected camera. IRIS emphasizes offering both on-site and virtual training for all camera types. Moreover, we strive for superior image quality across all cameras compatible with our software platform, with a dedicated training team available to support our clients as needed.

The IRIS Partnership with Health Risk Assessments

In an era where health risk assessment companies collaborate with payors and providers in value-based care settings, innovative solutions must address the comprehensive health needs of plan members. These organizations, referred to as HRAs, find IRIS technologies instrumental in enhancing patient care accessibility. The ease and reliability of IRIS solutions mean that preventative diabetic retinopathy tests can occur during at-home assessments. Fundus images are captured by healthcare workers using handheld cameras, uploaded to the IRIS platform, and subsequently enhanced for clarity before being reviewed by licensed eye care professionals.

Launching preventative diabetic retinopathy testing from a patient’s home drastically improves HRAs’ efforts to bridge care gaps with these essential screenings, providing an extra layer of service to health plan customers.

High-quality fundus images are crucial; neglecting this aspect may result in wasted resources. Therefore, prioritizing image quality when selecting a retinal imaging camera is vital to avoid financial losses.

Why User-Friendliness is Essential

Multiple personnel within your practice can utilize new retinal screening technologies; thus, minimizing the learning curve is vital for effective implementation. Choosing a user-friendly camera will ease frustrations among staff, allowing them to operate the tools confidently, leading to improved imaging quality and increasing early diagnoses of preventable blindness.

Tabletop models often boast greater ease of use than handheld counterparts as they tend to be fully automated, resulting in greater consistency in image capture. Conversely, handheld devices grant users increased control and mobility but may necessitate more effort, as alignment and focusing are manual processes, creating a steeper learning curve. With assistance from IRIS trainers, however, this learning curve can be significantly shortened.

Additionally, ensure that integrating software and hardware remains straightforward for your users. Staff proficiency enhances efficiency in implementing retinal screening within your practice, ultimately benefiting patient outcomes.

In conclusion, several elements must be evaluated when investing in a retinal camera, which will leave a lasting impact on both your organization and patients. Utilize these guidelines to make sound decisions regarding retinal screening tools for your practitioners and patients.

To explore which eye exam equipment best suits your practice, feel free to contact us for assistance!

If you wish to learn more about IRIS's innovations in diabetic retinal exams, check out our blog for updates!

Frequently Asked Questions About Retinal Imaging

How much do digital retinal cameras cost?

Prices for retinal (fundus) cameras can vary widely, influenced by factors such as field of view, size, and mobility. Assessing your practice’s specific requirements will help you choose a camera that aligns with your needs while fitting your budget. Our team is here to guide you in selecting the right camera tailored for your practice.

What conditions can retinal imaging uncover?

Currently, retinal imaging, conducted by eye care professionals, can identify numerous eye pathologies, including diabetic retinopathy, HIV retinopathy, hypertension, macular edema, epiretinal membranes, glaucoma, cataracts, wet/dry AMD, macular holes, and vein occlusions. Ongoing research aims at exploring the potential of retinal screenings to detect other conditions, such as Alzheimer’s disease.