Efficiency in dry eye service

Anticipate challenges to offer the best patient experience.

Figure 1: Expected and unexpected challenges affect the success of dry eye services in your practice.

The focus in many of our practices today is the “patient experience.” More than ever, patients expect things to happen quickly and at their convenience.

As practices add the care of dry eye disease (DED) to their service listing there are some expected and some unexpected challenges to be anticipated.


When we first got “real” with dry eye, I called the project the “beast.” There were so many patients to care for, and they were within each segment of the practice: cataracts, contact lenses, glaucoma, refractive, aesthetics, and even pediatric patients.

Prepare for what you are going to find when you start caring for and listening to this group of patients, beginning with the patients you already see. As a way to cope with this onslaught, I highly suggest you don’t start a marketing campaign right away, but wait until after you have taken care of your patient base.

Based on SPEED scores at Bowden Eye, I estimate that six out of 10 patients who walk through our door have symptoms of DED. Another one to two of that 10 may be asymptomatic. Due to the volume, create scheduling processes that allow your practice to identify the patients and then systematically diagnose and treat. (They all will need follow-up care as well.) I am not a huge fan of block scheduling for these patients because they show up in so many different areas of your care. Instead, I recommend having a dry eye technician to perform tasks such as diagnostics and product training.

Another schedule management technique: Patients who are identified but don’t have time the same day for additional diagnostics can start a basic treatment regimen and schedule a follow-up appointment for additional tests and to see your provider.

When you have treated your active patient base, you can use datamining software to identify previous or inactive patients who may need dry eye care. You can also educate your outside referral sources by letting them know about your new practice offering.

Figure 2: Weigh each of these factors when pricing new services.


In our practice, we creating efficiencies by modifying the SPEED form to include specific components for the triggering of our standards of care. For example, a positive response to symptoms for allergies will trigger allergy testing. The triggers make it easier for the technician and provider to be prompted for diagnostics, products, therapies, prescriptions, etc. It saves time and gives the physician more information to make treatment decisions.

Education can create efficiencies. When patient education takes place, you will move more efficiently and your patients can make smarter decisions about their care. Examples at Bowden Eye include patient education software (RENDIA), a patient engagement platform (CheckedUp), brochures, posters, and videos by industry partners. Simple laminated images in the exam rooms that the providers can refer to are super helpful.

Consider sending emails to patients ahead of the appointment with educational links. When scheduling appointments, remind them to visit your website to learn more about options. Finally, if you use counselors (which I highly recommend), have a counselor reach out to the patient ahead of the appointment to remind them to bring a family member and to review the offerings.

Staff education, which also increases efficiency by allowing your staff to move quicker, can include: Dry Eye University, Dry Eye Access, industry partners, articles, and BSM educational modules. Expect your staff to know what you’re offering and why you’re offering it.

Staff buy-in

Consider treating staff members who are symptomatic for DED. Treating your staff helps them relate to the patient and will make them advocates for a higher level of patient care. Include all staff members in this (reception, optical, front desk, and billers) to establish a support system in this area.

Maintain a consistent treatment approach as much as possible. Publish your approach to diagnosis and management, and make it available practice wide. Also, inform the staff of any changes. This will help hold the staff accountable, but also help your team to execute by minimizing confusion.

Billing and overhead

Approach dry eye diagnostics and services in the same way you would approach all other practice services. Some areas are covered by insurance, and others are strictly cash. To identify how services are covered, send up a trial balloon to your contracted carriers. Additionally, investigate coding and utilization for those procedures that exist.

For self-pay treatments, products, devices, etc., consider a financing or credit card option. I train my staff to offer credit options first. I don’t want a patient to have to ask if we have an option other than check or cash. Try to remove “judging” from how patients are approached, and create scripts for staff to use for all patients who need cash-based services and products.

Other considerations when setting pricing:

  • Branding. Consider how you have branded your practice. Is it recognized as a clinic or like a high-end patient experience? If you have “bells and whistles” that patients have become accustomed to, then build on that trend.
  • Competition. Price shop your area competition. There is nothing wrong with being the highest priced if you deliver the service and meet patient expectations. If you set fees low, consider that patients who jump from provider-to-provider may be more difficult to satisfy.
  • Bundling. Consider bundling DED services to make it easier for your billing department and your counselors as they present options to the patients. Additionally, bundling items makes it less likely that the patient will pick and choose from the treatments your provider orders. We have bundled products together to create a “starting bundle.” The bundle might include an ocular supplement, a mask, and lid and/or lash cleanser.
  • Return/Refund Policy. For services that are already performed, you and your staff invested time and overhead costs to perform the services so I would not recommend offering a refund. Instead, manage patient expectations up front. Refunds for products should simply follow the manufacturer guidelines.

When calculating prices, consider your overhead. An important factor in setting fees is to consider who is performing the service. It costs more for a doctor to perform a procedure than it does for a technician. At Bowden Eye, our techs do diagnostics but not procedures. The patients pay cash for most services and deserve the provider involvement.

Most practices do not have to add staff — you can cross-train refractive or cataract counselors or your surgery coordinators. If you must add staff, they will more than pay for themselves in facilitating the patient experience.

Meet patient needs

Dry eye patients are in your office, and they want their experience to be valuable. They don’t want to leave without their problems being addressed. Their eye problems should be “owned” by you and your team. If not, they will go elsewhere. Adding dry eye services brings opportunity for you and your patients to build stronger relationships, and that is a win-win for both sides. OP

Questionnaire triggers

When offering dry eye questionnaires, create internal practices so that certain answers to your chosen questionnaire drive subsequent testing or prescribing. For example:

  1. Score: Certain questionnaire scores should trigger testing, such as osmolarity, MMP-9, and other diagnostics.
  2. Allergy: Positive symptoms for allergies can trigger allergy testing.
  3. Sjögren’s testing: Positive answers to the questionnaire can prompt the ordering of Sjögren’s testing.

Avoid the “center of excellence”

Let’s all try to get away from calling the care of dry eye disease a dry eye center of excellence.

Dry eye disease is a chronic issue for the patients involved, and there isn’t a cure. It’s best to simply have the care as another service offered by your practice. Also, I think the term “center of excellence” creates somewhat of an obstacle for practices that don’t think they can achieve “excellent” status. At this stage of the game where there is still a lot to learn about the disease, all practices should treat the patients and their eye conditions or send them to a specialist who can.