The lure of new technology and gadgets is strong, and it is tempting to believe that buying the latest and greatest equipment is the key to providing patients the best care possible. As businesspeople, however, optometrists are also tasked with doing what is best for their practices from a financial standpoint. ODs seeking to balance their professional and business obligations may wish to weigh several factors before purchasing that great new device.
It important to weigh three major factors when considering a large business investment: cash flow, efficiency, and patient care. For questions you should ask yourself on these topics, we turn to Mick Kling, OD, of the leadership training and consulting firm Impact Leadership, for guidance. He said that before you buy, you should ask yourself three questions:
To determine whether a new technology will improve the cash flow of the practice, estimate the frequency with which you will use the new technology, and consider the upfront cost. Borrowing money rather than paying cash to purchase equipment means it will be more difficult to improve cash flow. The best technology in the world won’t benefit you, your practice, or your patients if it puts your clinic out of business.
How will the new technology influence your practice efficiency? One of the greatest things about a new technology is that it can allow us to do or see more with less effort. Any investment in a new technology should help improve your patient flow and facilitate faster and more accurate diagnoses. If a technology does not make you more efficient—or worse, if it makes you less efficient—then it is probably not right for your practice.
Among the most important considerations when purchasing new technology is how it will affect quality of care. Dr. Kling suggested that doctors should weigh the cost of purchase against the potential for a new technology to improve the care that they deliver. We are in the business of taking care of people. Any investment in a new technology should improve our ability to provide exceptional care to our patients. Often, however, we place too much emphasis on this criterion for making purchasing decisions without considering the other two factors: whether the investment will make us more efficient or improve our cash flow.
Optometric service networks of independent private practice owners (eg, Vision Source) provide ODs with trusted networks with which to share experiences and best practices. The strength and wisdom of these networks and their members can be tapped when a clinician is considering new equipment Ask your colleagues in these networks if they have the piece of equipment or technology in question, how often it is used in practice, how it affects cash flow, and whether patient care has been significantly improved.
Larger networks can negotiate lower purchase prices on behalf of their members. If you’re not affiliated with a network, alliance, or buying group, find a trusted colleague or two, and you can negotiate together.
Always negotiate the price of equipment plus add-on costs. Add-on costs include service agreements, equipment tables, and disposable pieces such as probes for the Icare tonometer (Icare USA) and activators for some vectored thermal pulsation platforms, (eg, LipiFlow, [Johnson & Johnson Vision]). Disposables costs add up quickly, and it’s best to ask detailed questions during the negotiation stage.
Understanding the onboarding process with new equipment is key to a successful purchase. Ensure that the company is committed to your success and that of your staff. This means providing adequate training, support, and suggestions on how to use your new equipment more efficiently. Arrange to have a trainer on site when first using the equipment on patients so that all team members are comfortable. Also, be sure to get trained in basic troubleshooting for when issues with the equipment arise.
When making equipment purchases, it is easy to fall into the trap of only considering the monthly payment of low-interest loans and leases when estimating affordability. What often gets lost is that we are adding crushing debt to our balance sheet, which can add enormous strain on the cash flow of the practice. Paying cash for equipment will always be healthier for your practice (Table).
Investing in your practice means making informed, researched decisions. Remember that we are in the business of health care, and taking financial care of our practice ensures that we can provide the best treatments for our patients.
With a rare disease, it can take a long time to get a diagnosis. Doctors may not recognize the symptoms of a neuromuscular disease they’ve never seen before. Symptoms may mimic those of more common diseases. Tests may come back inconclusive. Misdiagnosis is common.
The long diagnostic journey is frustrating for everyone involved — the individual living with a neuromuscular disease, their family, and even the doctors trying to find definitive answers. Is there anything you can do to make the journey go more smoothly?
While you can’t order diagnostic tests or make a diagnosis, knowing what questions to ask in healthcare settings could help your providers focus their efforts and get you more information about what’s going on in your body.
We asked a neurologist and a member of the neuromuscular disease community to share their experiences and advice on the most important questions to ask when you’re seeking a diagnosis.
Most diagnostic journeys start with a visit to a primary care provider. It’s important to give your doctor as much detail as you can about any muscular symptoms, such as loss of strength or reflexes, twitching or cramping, decreased sensation, or problems with walking. For a child, share any concerns about delayed developmental milestones, such as sitting or walking.
It’s also helpful to give your doctor a detailed family history. Before your appointment, ask relatives if they know of any family members who have had muscular issues or needed a walker or wheelchair at a young age. These facts will help the primary care provider determine what kind of specialist you might need to see. For neuromuscular issues, often, this is a neurologist.
“After getting a referral to a neurology or pediatric neuromuscular center, ask when you’re making the appointment if you’ll be seeing someone who specializes in muscle and nerve diseases,” says Jena Krueger, MD, a pediatric neurologist and medical director for the pediatric neuromuscular clinic and the pediatric neuromuscular treatment program at Corewell Health Helen DeVos Children’s Hospital in Michigan.
Even within a specialty such as neurology, doctors have different levels of training and experience with specific diseases. If the specialist you see seems unfamiliar with your symptoms, you can ask for a referral to a specialist who has experience with cases like yours.
When you visit a new clinic or specialist, this question will help you get a sense of the scope of what they can do. A multidisciplinary team brings together medical professionals with different areas of expertise. This can be especially beneficial in complex cases, such as diagnosing rare diseases.
“You also want to ask what resources are available in the clinic,” Dr. Krueger says. “For example, in our pediatric neuromuscular clinic, we have genetics, which plays a huge role in diagnosis and treatment, and it’s wonderful if you can have that available on the first visit.”
MDA Care Center teams may include a variety of providers, such as genetic counselors, physical and occupational therapists, dietitians, and social workers. These healthcare professionals work with doctors to guide individuals and families through the diagnostic process and — once a diagnosis is confirmed — help them explore options for treating and managing their condition.
There is an array of diagnostic tests out there, so you’ll need to know which ones your doctor thinks could provide answers for you.
You can ask how painful or invasive a test might be and how much time it will take. Also, insurance varies, and sometimes it isn’t feasible — financially or physically — to undergo multiple tests at once.
Common diagnostic tests for neuromuscular diseases include:
Genetic testing advances all the time, and your doctor may refer you to a geneticist or genetic counselor to help determine which genetic testing panel would be best for you. Even if you’ve had a genetic test before, your doctor might recommend testing again or trying a different testing panel.
Having genetic testing earlier would have helped MDA National Ambassador Amy Shinneman. Her diagnostic journey began as a baby and didn’t lead to an accurate diagnosis until she was in her 40s.
Over the years, Amy’s parents tried everything they could think of to reach a diagnosis, and she underwent a variety of diagnostic tests. It wasn’t until 2018, when her neurologist ordered a new genetic test, that she could finally put a name to her condition: Bethlem myopathy.
Some patients, like Amy, have a long journey toward a definite diagnosis. It’s OK, she says, to make sure that the doctor is confident they can help and to ask how long it might take.
“As I got older, I got better at saying, ‘Hey, I’ve been looking for this many years for a diagnosis, so please don’t say things to me that you don’t know for sure,’” she says.
A doctor who is honest with you, even if it’s to say, “I don’t know, but I’ll find out,” may be someone you want on your care team.
While going through numerous tests and doctor visits, it’s natural to try to figure things out on your own.
“I would go into that cautiously,” Amy warns. “When we’re desperate for answers, we can make ourselves believe we fit into certain categories.” She says that support groups can be a better source of information than the internet.
When you do search the internet, use reliable sources of information on neuromuscular diseases, treatments, and research, and discuss what you find with your healthcare team.
“I tell my patients it’s fine to Google, but use your physician as your backup and reference for the truth,” Dr. Krueger says. “The internet can be a valuable resource, but it’s really important that you use that as a jumping-off point for your questions and your discussion with your physician, and not your only source.”
Don’t be afraid to ask a lot of questions. Sometimes, we might fear that a question is foolish or that we’re annoying the doctor. Put those fears away and ask, ask, ask.
Rare diseases are complex, and even the experts are always learning. Make sure you know how to contact your healthcare providers and when is the best time to discuss any additional concerns.
Perhaps the most important thing for individuals and their families to remember while going through the diagnostic journey is simply to keep going. Keep searching and asking despite the setbacks and frustrations.
“My overall message is don’t give up and don’t lose hope,” Amy says. “I would say that 44 years is a very long time to search. But looking back, it was worth it to keep fighting for that answer.”
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