An elderly, impoverished woman sat in the preoperative area of The Eye Associates’ ASC, eagerly awaiting her second surgery for white cataracts. When the surgeon, Cathleen McCabe, MD, entered, the patient’s daughter, in tears, sprung to her feet and briefly pulled the doctor aside.
“You have no idea what a difference this is making!” the daughter told Dr. McCabe, an ophthalmologist at the seven-location, multi-specialty Florida practice. “I’m the single mom of a toddler, I work full time, and I’ve had to bathe, dress and feed my mother, along with my child, and place both in care during the day. Now, after one surgery, my mother can do these things herself, and she can watch my daughter while I’m at work!”
“It just reinforces why we [the practice] do what we do,” says Dr. McCabe.
The Eye Associates, comprised of nine ophthalmologists, six optometrists, and more than 200 allied health staff at its eight South Florida locations, is active in several eye care-related outreach initiatives, including the practice’s own SightMobile, a 25-foot bus used to offer free glaucoma and vision screenings in the community. (See also “Making a difference through outreach,” p. 14.) The 39-year-old practice’s fervor for altruism is in its DNA, as founder Harris Silverman, MD, now retired, started Southeastern Guide Dogs (www.guidedogs.org ).
Dr. McCabe encourages other practices to find ways of giving back, be it within or outside the practice or even outside of the country. “In addition to the satisfaction that comes with helping others, we find that it unites us [staff] in a common purpose, creating team building and team work that gives back to the practice itself at levels that exceed expectations.”
An example: Inspired by the practice’s outreach initiatives, Caasi Phillips, clinical service director, started a free in-office staff food bank, stocked by staff and physician donations, to help staff during times of need.
“Our practice is like a family,” she says. “When our family needs help, we help them the same way we help others who may be in need.”
Here, The Eye Associates’ staff explain why the practice has been successful in its eye-care outreach initiatives and the factors that other practices should consider if they want to give back.
A collective commitment
Everyone in the practice, particularly the practice owners and doctors who are the ultimate decision makers, agreed to commit to outreach initiatives and discussed specific staff involvement, says Dr. McCabe. This establishes buy-in with the staff and sets the foundation for continued success. “The last thing you want to do is initiate a relationship with an organization and then back out,” she says. “That’s really not fair to them.”
Upon complete staff buy-in for a particular initiative, The Eye Associates determines when to participate and the level of commitment of time and resources. Referred indigent surgical patients are scheduled in the next available appointment slots — the same as any other patient, says Dr. McCabe. “Typically, these patients have emergent needs, so we want to see them as soon as possible.”
Dr. McCabe adds that the practice assesses its capacity for indigent patients and communicates it with the respective outreach organizations. “Obviously, we can’t do 50% of our cases as free care, or we would not be able to continue the practice,” she says. “So, there’s a limit. But, at the same time, we’ve never turned anybody in need away.”
For example, Remote Area Medical (RAMusa.com ) offers free health care both nationally and abroad and has offered two-day free clinics near The Eye Associates’ Bradenton, FL location. Services, which include eye exams, and testing for glaucoma and diabetic retinopathy, are provided on a first-come, first-serve basis, so ticket distribution usually begins at 3 a.m. and patients are then served starting when clinic doors open around 6 a.m. The Eye Associates doctors and staff volunteer their expertise, and the practice has loaned a lot of its equipment to help provide better care, says Cindy Baxter, The Eye Associates’ director of marketing who oversees these efforts. Non-skilled volunteers also help in less demanding positions. RAM usually sends out emails and letters requesting help, and dates are scheduled months in advance with a call for volunteers needed over a weekend.
Also, Ms. Baxter organizes the SightMobile trips — a community service provided for any organization that requests it, she says. This includes mobile home parks, retirement centers, various health and wellness fairs, and school-related distance vision screenings. The SightMobile’s designated team provides distance vision and glaucoma screenings for free — no full paid exams, says Ms. Baxter. “This is especially important for identifying people that might have glaucoma. Since most people with glaucoma have no noticeable symptoms, it is important for people to have a pressure check. If we find someone with a higher pressure, we encourage them to see an eyecare provider for further testing.”
Mission trips typically take place over a week, with volunteer allied staff providing support to the one attending doctor, says Dr. McCabe. They participate in weeklong international missions several times per year, including trips to St. Vincent and the Grenadines, Kenya and Honduras.
The Eye Associates is rarely short on volunteers, says Terri Wilson, ophthalmic technologist. “I think this is because staff roles in these initiatives are directly related to their individual skill sets, and we enjoy using those skills to help others,” she explains. “Also, it is so rewarding seeing cataract patients at their post-op visits elated that they can see again.”
Staff gives up vacation time to participate, and the practice or individual doctors often support their expenses (airfare and lodging). Also, these missions allow for team building and bonding in a shared experience, Dr. McCabe says.
Choosing who to help
The practice researched local not-for-profit clinics and nationwide health organizations for indigent populations to determine which they could help with surgery and general eye care, says Dr. McCabe. “It really helps to be doctor to doctor, with the key members there to say, ‘Here’s where I think we can be helpful, and here’s where our limitations are,’” she explains. “This way, everyone is on the same page.”
Jill Grawe, The Eye Associates’ medical services director, recommends working with organizations that conduct patient financial background checks. The reason: Having practice staff do it can be time consuming and, thus, put a dent in its ability to help as many needy patients as possible.
Designating point people
Ms. Grawe manages the logistics of the practice’s surgical outreach initiatives to ensure all goes smoothly. The organizations notify Ms. Grawe of the patient’s financial status (some have insurance), the level of urgency for intervention and additional care needs, such as postop care or testing using equipment the referral practice may not have, she explains. “From there, I ask the doctors who wants to help, contact the anesthesia group we work with — they always wave that fee — and determine from the doctor exactly what he or she needs for the actual surgery, be it an IOL or specific medications.” Ms Grawe adds that they work with the organizations, such as Lighthouse of Manasota, to make sure all of the necessary supplies are covered.
Along with determining what instrumentation the doctor will prefer to use, Kathy Garro, RN, says she has learned to expect to have nothing available and to be able to adapt. It is important to include any instruments, such as intraocular scissors or favorites of the doctor, that are needed for the surgeries.
Dr. McCabe has found that giving the patients the postop medications/drops necessary following surgery is most beneficial. It increases compliance since many patients have difficulty returning for all postop visits. Most patients do not have access to these medications or simply cannot afford them.
The practice’s doctors coordinate the mission trips and tap volunteer allied health staff to ready the supplies — dilating drops, pain medications, handheld devices, such as tonometers and fundus cameras, among other supplies — and assist on the trips themselves. Ms. Wilson often attends these trips and calls ahead to see what equipment, materials, and medications the location already has available.
“Whenever I go, I try to make sure we have enough supplies — particularly dilating drops, because it’s so easy to run out,” she says.
MAKING A DIFFERENCE THROUGH OUTREACH
The Eye Associates altruistic efforts extend from southern Florida to across the globe and include:
- EyeCare America, which offers medical eye exams, often at no out-of-pocket cost (https://bit.ly/2h6hvvg )
- Lighthouse of Manasota, which educates and empowers those affected by vision loss (lighthouseofmanasota.org )
- Lions Recycle For Sight (https://bit.ly/2A0nVY1 )
- Remote Area Medical (https://bit.ly/2thRguo ), Manatee County Rural Health Services (https://bit.ly/2HLiLVD ), and Friendship Centers (https://bit.ly/2TP9gf0 ) in Sarasota, FL, which provide care to local underserved patients
- The practice’s SightMobile mobile clinic.
- Various cataract surgery mission trips
- Southeastern Guide Dogs (www.guidedogs.org )
Creating a caring environment
Upon deciding to help indigent patients, The Eye Associates created a patient care protocol to ensure these patients would not be made to feel any different than the practice’s paying patients, says Ms. Grawe.
“Many of these patients can be embarrassed by their situations — whatever they may be — and we never want them to feel that way,” explains Ms. Grawe. “To ensure they’re comfortable, we strive to make their interactions as seamless as possible by, for example, including an alert in the EHR that the patient doesn’t receive a bill. We don’t want these patients put in a situation where a front desk staff member mistakenly tells them they have a balance.”
Making an impact
Dedrix B. Daka, OD, of the Manatee County Rural Health Services, says The Eye Associates has been “phenomenal” in accepting the organization’s patients.
“Sometimes, they are the only practice that will work with the insurances our patients have, and even when patients don’t have the ability to pay, the practice will step in to help,” he says.
For Dr. McCabe and the rest of the practice’s staff, it all comes back to patients like the woman with bilateral white cataracts.
“I think when you see a situation where the patient’s quality of life is severely impacted by the inability to get care and you can provide that care — what a difference that makes!” she says. “Not only for the patient, but for the entire family.” OP