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Perspective Retinal Imaging
The Impact of Ultra-widefield Retinal Imaging
on Practice Efficiency
Paul E Tornambe
Retina Consultants, San Diego, California, US, and San Diego Retina Research Foundation, San Diego, California, US
I n the current cost- and resource-constrained healthcare environment in the United States, characterized by declining government
reimbursement and increased utilization scrutiny by managed care plans, providers are challenged to continue delivering quality care to
more patients while also more effectively managing practice economics. Employing technology to improve practice efficiency is one of the
most promising solutions to this dilemma. We have demonstrated that the integration of ultra-widefield (UWF) retinal imaging in our practice is
cost-effective. It has allowed us to increase the number of patient encounters while simultaneously raising the quality of care, and increasing
Keywords Ultra-widefield retinal imaging, UWF, practice
efficiency, patient volume, cost-effectiveness,
quality care, retinal periphery, patient satisfaction
Disclosure: Paul E Tornambe is a consultant to Optos.
Acknowledgements: Editorial assistance
was provided by BioComm Network, Inc.
Compliance with Ethics: This study is based
on data collected within the practice over a three
year period as well as a review of the literature
and did not involve any studies with human or
animal subjects performed by the author.
Authorship:: The named author meets the International
Committee of Medical Journal Editors (ICMJE) criteria
for authorship of this manuscript, takes responsibility
for the integrity of the work as a whole, and has given
final approval to the version to be published.
Open Access: This article is published under the
Creative Commons Attribution Noncommercial License,
which permits any noncommercial use, distribution,
adaptation, and reproduction provided the original
author(s) and source are given appropriate credit.
Received: February 6, 2017
Accepted: March 10, 2017
Citation: US Ophthalmic Review, 2017;10(1):27–30
Corresponding Author: Paul E Tornambe, 12630 Monte
Vista Rd, Poway, CA 92064, US. E:email@example.com
Support: The publication of this article was supported
by Optos. The views and opinions expressed are those of
the author and do not necessarily reflect those of Optos.
Ophthalmic medical practices in the United States are under unprecedented pressure to care for a
rapidly growing population of patients, even as Medicare reimbursement levels continue to decline
and payers are implementing payment programs based on cost and quality metrics. The Centers
for Medicare and Medicaid Services (CMS) has continued to enact significant cuts to payment
rates for a range of ophthalmic procedures, from glaucoma surgery to retinal detachment repair
and various diagnostic imaging procedures. These are only the latest changes to the economics of
care delivery to which ophthalmologists must rapidly adjust. More than ever, the financial viability
of the ophthalmology practice depends on its ability to deliver efficient care – integrating cost, quality,
outcomes, and patient satisfaction – within an ever-changing landscape of medical innovation,
government regulation, payer intervention, and patient expectation.
Several years ago, we formally evaluated the relative efficiency of academic hospital center and
small group practices by applying activity-based cost analysis to both settings. 1 We found that the
small group practice outperformed the academic medical center on nearly all markers of efficiency.
In the latter setting, only four service lines – non-laser surgery (e.g., pneumatic retinopexy, pars
plana vitrectomy, scleral buckling surgery), laser surgery (e.g., pan-retinal photocoagulation, retinal
tear repair), non-optical coherence tomography (OCT) diagnostics (e.g., other forms of multi-modal
imaging such as color, red free, autofluorescence, fluorescein angiography [FA], ultrasound), and
injections – were profitable, with profit margins ranging from 62% for non-laser surgery to 1% for
intravitreal injections. The largest negative profit contributions were generated by office visits and
OCT imaging. The continued reduction of reimbursement rates for both diagnostic services and
therapeutic injections in the intervening years has made conditions even more challenging for both
types of practice and has increased the critical importance of evaluating and improving efficiency.
Various models for measuring and comparing practicing efficiency are in development. For example,
an efficiency index, calculated as a function of cost, number of patients receiving care, and the quality
of care, has been proposed to measure the care delivery process for a given intervention within the
ophthalmic practice. 2 As such models are expanded to include outcome measures and are validated
in larger inter-practice comparisons they may be useful in efforts to improve both the quality and
efficiency of care.
Regardless of how efficiency is measured, it is increasingly clear that one key to the challenge of
simultaneously improving practice efficiency and quality of care amid relentless financial pressure
is the use of advanced technology – diagnostic and treatment systems that provide more useful
clinical information, more rapidly, and with greater comfort or convenience for patients. An example
along these lines is the positive impact on efficiency and quality of care in cataract and refractive
practices produced by the integration of wavefront technology. The impact of this technology for
digital refraction and optical path diagnostics was recently described, with the authors noting that the
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