Tell Me Your Secrets: Let’s Get Down to Business
By Kareena Chawla, BS
Key Takeaways:
Building a successful practice requires careful planning, courage, and leveraging insights from industry experts to overcome common challenges and build a sustainable model.
Understanding the impact of private equity and turnover trends in ophthalmology is essential for making strategic, long-term career decisions.
Compliance in surgical co-management and effective appeals for claim denials are crucial for running a successful practice without legal or financial setbacks.
Building a practice from scratch, whether early in your career or at a later stage, is a significant endeavor that requires courage, determination, and meticulous planning. From the initial vision of a practice to navigating insurance protocols and managing workforce challenges, seeking advice from seasoned professionals who have successfully overcome similar obstacles can offer invaluable insights and help you craft your own path.
RWO’s Spring 2024 Virtual Meeting featured the session “Let’s Get Down to Business,” moderated by Dr. Hyelin You and Dr. Ravi Goel. Esteemed panelists Dr. Rudrani Banik, Dr. Ravi Parikh, Heather Dunn, and Matthew Baugh shared their personal insights and strategies for establishing and managing a thriving practice.
Building a Practice From Scratch
Dr. Rudrani Banik is a fellowship-trained neuro-ophthalmologist and Co-Director of the Neuro-Ophthalmology Service at New York Eye and Ear Infirmary of Mount Sinai. She is the Founder and Medical Director of EnVision Health NYC and also serves as an Associate Professor of Ophthalmology at Mount Sinai. As a functional medicine expert, she provides a personalized, holistic approach to eye care.
Dr. Banik left her full-time faculty position at New York Eye and Ear Infirmary seven years ago to open a private practice, taking a leap of faith despite her apprehension. She attributes her success to the “Right Time, Right Niche, and Right Place.”
Right Time: Had a large referral and patient base from her previous position. ● Right Niche: Integrated a functional approach to eye health, centered on a lifestyle- and nutrition-based care model.
Right Place: Opened her practice in a densely populated area of New York, yet distinguished it with a unique fee-per-service model.
Turnover in Ophthalmology, Private Equity, and Workforce Changes
Dr. Ravi Parikh is a surgical retina specialist and chairman at Manhattan Retina and Eye, and an associate professor at NYU School of Medicine. He also completed his Master of Public Health in Health Policy at Harvard.
The Corporatization of Ophthalmology
As private equity in ophthalmology rises, one may need to adapt to a private equity model depending on desired practice location. While higher upfront salaries are appealing, practices may be recapitalized within a few years. It’s essential to consider both short-term and long-term incentives to ensure alignment with your vision for practice growth.
Turnover in Ophthalmology
From 2014 to 2021, one in three ophthalmologists experienced workforce turnover. Although concerning, it’s crucial to recognize that turnover is common as physicians face burnout, transition to non-clinical roles, or pursue industry positions.
FTC Announces Rule Banning Noncompetes
Noncompetes are now illegal in for-profit entities, though this ruling does not apply to nonprofits.This ruling is significant for ophthalmologists because banning noncompete agreements in for-profit entities allows more flexibility for ophthalmologists to transition between practices, fostering competition and improving patient access to care.
Surgical Co-management Do’s and Don’ts
Heather Dunn serves as the Coding and Reimbursements Manager for the American Academy of Ophthalmic Executives (AAOE).
Surgical co-management issues can arise due to poor advice, inadequate compliance training, or insufficient practice management. Participating in ongoing compliance training is crucial for avoiding these pitfalls.
Do’s for Proper Co-Management
Review the Academy’s Comprehensive Guidelines for the Co-Management of Ophthalmic Postoperative Care. Find them at aao.org/codingtopics.
Determine if the Payer Allows Co-Management. Medicare permits co-management, though some payers do not.
Obtain Informed Consent for Co-Managed Surgical Care. Consult a liability carrier for legal considerations.
Calculate Appropriate Reimbursement. Use Modifier -54 for surgical care only and Modifier -55 for postoperative management only.
Don’ts for Co-Management
Avoid routine arrangements with referring providers for co-management; each case should be personalized.
Don’t split postoperative care when multiple procedures, like cataract and glaucoma surgery, are combined.
Avoid violating anti-kickback statutes by preventing financial exchanges between the surgeon and co-managing office.
Denied! Handling Appeals Effectively
Matthew Baugh also serves as the Coding and Reimbursement Manager for AAOE.
When dealing with denials although time consuming, prompt and effective appeals ensure the best possible outcome for your patients. Denials can be due to internal factors which are in your direct control, such as incorrect or missing modifiers, bundles services, registration errors, or unspecified ICD-10 codes. External factors range from coordination of benefits, credentialing issues, medical records requested, or claim processing errors or delays. Prevention of either factor is key by training staff, planning ahead such as verifying insurance information, and lastly by performing internal audits.
Conclusions
Building a practice and navigating the complexities of ophthalmology requires a combination of strategic planning, compliance, and adaptability to evolving industry trends. RWO’s expert panel underscored the value of learning from those who have successfully navigated similar challenges. By applying these insights on practice management, co-management compliance, and strategic career planning, ophthalmologists can establish sustainable practices that align with their long-term vision.
Join the RWO community of young ophthalmologists to connect with peers, learn from experts, and enhance your understanding of key topics in ophthalmology!
Kareena Chawla BS
Kareena joined the Social Media Education Team in Spring 2024, and now serves as the Team Lead. She is a second-year medical student at NSU Dr. Kiran C. Patel College of Allopathic Medicine in Fort Lauderdale and will be applying Ophthalmology in two years. She is also involved as an AMA Medical Student delegate for her campus chapter, and enjoys bridging her passion for healthcare advocacy with ophthalmology policies. In her free time, she enjoys dance, weight training, cooking, and experimenting with coffee and matcha recipes at home.