Should practices offer staff eye exams?

A look at the benefits and what’s involved in getting started.

If you consider that ancillary staff promote the importance of and have a key role in the ocular health assessment, it makes sense for ophthalmology practices to offer them annual comprehensive eye exams, says Martha C. Tello, BGS, COMT, OSC, an ophthalmic technologist and clinical research coordinator at Bascom Palmer Eye Institute in Miami.

“We tell patients that getting their eyes checked annually is very important, yet how many of us actually do this?” she asks. “It’s a glaring disconnect that should be rectified to show patients we practice what we preach.”

A comprehensive eye exam for staff is the same as it is for patients, say those interviewed for this article. Specifically, it’s comprised of the patient’s medical history (including positive family history), medication history, visual acuity, lensometry (if the patient wears glasses), retinoscopy (if the patient doesn’t wear glasses), slit lamp, and tonometry. Dilation is also an important component of the assessment.

Here, the employees of three ophthalmology offices that offer free annual comprehensive eye exams to their ancillary staff members discuss the additional reasons to consider these exams and what’s involved in doing so.

Martha C. Tello, BGS, COMT, OSC (left) discusses the findings of her eye exam with Kendall E. Donaldson, MD, MS, associate professor of ophthalmology and medical director of Bascom Palmer Eye Institute in Plantation, FL.

The reasons

Those interviewed offered the following reasons to contemplate offering free annual comprehensive eye exams to staff:

  • Staff education. “Undergoing annual comprehensive eye exams enhances an employee’s clinical acumen, not only enabling him or her to identify possible red flags for the ophthalmologists to further assess, but it also allows the staff member to answer patient questions,” says Nancy Baker, administrator at Summit Eye Associates, in Hermitage, TN.
  • Stellar customer service. Once staff undergo a comprehensive eye exam, they understand what it’s like, which translates to patient empathy, Ms. Baker says.
    Ms. Tello agrees. “Before I had an eye exam, I had no idea why patients complained about dilation, and I would just reply, ‘I’m sorry; it must be done.’ Now, I instill a numbing drop in all patients to lessen the burning, and I also have patients bring drivers to their exams, so they don’t have to worry about their light sensitivity. Those little things mean so much to patients, but I never thought of them until I, personally, experienced what they did.”
    Of note: Expressing clinical empathy to patients can increase their satisfaction of care, lower malpractice complaints, and motivate them to become compliant with their treatments, according to the Canadian Medical Association Journal.
  • Foster staff understanding/respect. When front desk and billing staff undergo comprehensive eye exams, they gain an understanding of what happens in pretesting and in the exam room and, therefore, why it takes as long as it does, explains Mary Becka, practice administrator for Fairview Eye Center, in Fairview Park, OH. “This lessens the ‘us’ vs. ‘them’ mentality that often exists in medical practices.”

Getting started

Before offering staff members free annual comprehensive eye exams, take the following steps:

  • Gauge staff interest. “Believe it or not, not everyone wants to get their eyes checked, so field interest first,” explains Ms. Tello. “If there is a reason that the employee refuses, there should be an acceptable reason. Expectations should be spelled out early.”
  • Review legal issues. Consider three factors:
    1. The HIPAA Privacy Rule. Given that the eye exams are offered in the potential hire’s place of employment, those offering the exams should be mindful of the HIPAA Privacy Rule ( ), so they can protect the employee-patient’s health information and the practice from liability, says Steven L. Simas, a health-care and employment law attorney at California-based Simas & Associates.
      “Try to define staff roles, try to have policies and procedures, and treat the employees who opt for the free annual comprehensive eye exam as much like patients as possible,” he says. “Also, create a mechanism for an employee to express concern, and reduce and restrict the access to the employee-patient’s health record. A practice can’t totally prevent liability, but it’s more liable if it doesn’t have policies and procedures in place.”
      Ms. Becka says that at Fairview Eye Center, they make all staff members aware that designated staff will see their medical information, should they choose to undergo the exam. She adds that they tell all new hires and current employees annually about the HIPAA Privacy Rule. Also, they educate employees who have access to employee-patient medical records on the practice’s policy to never discuss an employee-patient’s medical information.
      Alternatively, Ms. Tello says she bypasses clinical staff and goes directly to the doctor for her full comprehensive exam to prevent potential violations of privacy. “In any business, there’s always gossiping co-workers, so I feel more comfortable seeing the doctor alone. That said, this may not be an option at other practices.”
    2. The federal Stark law. Named for former Congressman Pete Stark, who sponsored the bill, this prevents the physician from referring patients to medical facilities in which he or she has financial interest, whether it’s outright ownership, investment, or a structured compensation agreement. Translation: It prevents kick-backs.
      Before referring staff members to the optical after their exams, practices need to be aware of this law and its exceptions.
    3. Employer responsibility. Before installing a staff exam program, determine whether doing so will incur unwanted obligations by obtaining and possessing employees’ medical information, Mr. Simas says.
      “If the ophthalmologist diagnoses a condition that impacts the employee’s ability to do his or her job, he or she may be obligated to terminate that staff member’s employment — that doesn’t make for a great patient-doctor relationship — or purchase, for example, a blue-light filter for the employee who performs computer work and was found by the ophthalmologist to have computer vision syndrome,” he says. “The bottom line here is that the practice should hire an attorney in the state the practice is located to review the possible pitfalls of such a program.”
  • Determine when and how to perform the exams. The office manager and the practice owner/doctor need to identify the ideal time for the eye exams and whether one or more doctors are going to perform them, Ms. Baker says.
    “Remember, staff members undergo dilation and are going to be away from their stations for certain amounts of time, and you don’t want these exams to interfere with seeing patients. One ‘how’ policy we’ve implemented is that staff clock out during their exams.” Other practices may schedule the employee’s exam at the end of the day so the visual effects of dilation do not interfere with that person’s ability to complete his or her responsibilities.
    Fairview Eye Center staff members undergo annual comprehensive eye exams “slowly over time” in order of seniority, with fellow staff members covering their duties at the time of the exams, Ms. Becka says.

Calling all staff!

To instill the importance of practicing what is preached, Ms. Tello says the following was printed in the Bascom Palmer Eye Institute newsletter:

“When was your last eye exam? So much of our time is spent on emphasizing routine care, preventative maintenance, early screening and diagnosis of eye disease for our patients. . . To raise awareness, the Plantation team at Bascom Palmer have taken the lead in providing free eye exams to faculty and staff. Join the initiative, and make an appointment at any Bascom Palmer location. Protect your vision, while setting an example for your patients.”

It won’t take long for staff to understand the true value in these comprehensive eye exams. OP