Episode Transcript
Speaker 0 00:00:00 Welcome to the dry eye coach podcast series. Click on dry eye. Your insider passed to the most exclusive dry eye topic. The series will raise awareness about the current and future state of ocular surface disease. The podcast will focus on a variety of topic before we get to our next episode. Here's a quick word from our sponsor.
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Speaker 0 00:00:53 In today's episode, we're excited to have our friends and colleague Jake Lang from associate eye care to talk about how to increase your dry eye service. Welcome Jake.
Speaker 2 00:01:03 Hey everyone. How we doing?
Speaker 3 00:01:05 Hey buddy,
Speaker 0 00:01:06 What type of modality that are you in? Let us let our listeners know about who you are.
Speaker 2 00:01:11 Yeah, so I'm Jake Lang. Uh, I work in a OD MD integrated care practice called associated eyecare. Uh, we're located on the east side of the twin cities Metro area, so that, um, Minnesota and Western Wisconsin, for those that don't understand the flyover states. Um, so we're yeah, on the east side there. And, uh, we have, um, six clinics now, a couple of satellite offices in and some, uh, hospital settings. And, um, we're currently 10 MD and seven ODS, including our, uh, resident. We do everything. Um, our model is, uh, vision for a lifetime. Um, so we have pediatric team glaucoma team retina team cornea, dry eye. Of course. I don't know if you've heard of it, but we have a dry eye team for which I am the medical director. Um, and, uh, yeah, we try and do a little bit of everything, but yeah, my niche and end of the world is cornea and dry eye services.
Speaker 3 00:02:15 Hey, you said pediatrics, what is that?
Speaker 2 00:02:17 <laugh> I just, that's the shorter, uh, people with the smaller eyes. Oh,
Speaker 3 00:02:23 Don't worry. I'd refer my kids to you as well. Hey, before we get started, I got a question you just said you had 10 MDs, you have seven ODS, including your resident. So tell me, and of those 17, how many are passionate about dry eye and love dry eye?
Speaker 2 00:02:38 Um, I'm gonna say, uh, two.
Speaker 3 00:02:41 Okay. Okay. Well, no, the reason why I wanna set that is as we're talking about how to increase your dry eye services, how do you get the other people engaged? And so that's why we, we wanted to, to, to hear about that. And so, so tell us, why are you so passionate about dry eye?
Speaker 2 00:02:57 Well, I, I, I, you know, I've done cornea and contact lens for some time and, um, always found that the front of the eye is kind of where it's at, uh, what's happening now. Um, the amount of technology, the amount of, uh, evolution of care that we've had, whether you're talking about LASIK or refractive surgeries to medications and therapeutics, it's just been exponential. And I enjoy that really kind of cutting edge, new, great stuff. And, and the front of the eye has been there's other regions, but, um, in my opinion, uh, just the technology and excitement there continues to build and grow. It's also something that's easy access, easily accessed se, um, so drops, which I think we're all familiar with prescribing really can hit home and make, uh, make, make a change and, and get to our patient's problems. Um, so I've found that you don't have to be as evasive as, um, maybe some other specialties, um, to help all our patients. Um, and, uh, it's just an unmet need that I think, you know, there's job security here for sure. Um, that <laugh>
Speaker 4 00:04:10 Go ahead
Speaker 3 00:04:10 To follow up on. Go ahead, Tracy.
Speaker 0 00:04:13 Oh, I think we have the same question because you're, you're, you're exciting. You're talking about your little technology, which I know that you and I both share. Um, can you, uh, tell me like what types of dry services that you currently have or types of technology that you have at your offices?
Speaker 2 00:04:27 Yeah, so for, um, diagnosis, uh, clinical stuff, we do a lot of tear lab, a lot of inflamma dry, um, lip of view two is, um, our, um, our main thing we use gall topographers, um, which is kind of an integr integrated, uh, topographer so Shug and, uh, placebo discs. Um, so it's a little different, but gives us a lot of great info, um, as well. Um, from a diagnostic standpoint, that's kind of the, the hallmarks there of toys and tech, um, from therapy op options. You know, we do a lot of pharmacologics and, and, um, treatment options there. Um, we also, uh, have been, uh, long time lip Aflo, uh, users. Um, we were part of the FDA trials for lip Aflo. So we were very early, uh, adopters for thermal pulsation, um, and have continued, uh, with that lip flow since the FDA trials and, and FDA approval and, and so on and so forth.
Speaker 2 00:05:30 We've kind of had a little stall with some of that though. We were looking at changing a lot of things. Um, and then there was this thing called COVID that kind of swooped in kind of at the same time, there was a lot of, uh, science being really least about, you know, other devices and, uh, uh, you know, intense pulse light, which I know Tracy, uh, are an expert at. Um, so we've kind of, uh, had to go into a stall mode as we kind of figure out what the new world order's gonna be, um, with our clinic flow, with our, um, you know, utilization of dollars and, and so forth. So we've kind of had, uh, we've kind of been now watching to see which way the wind blows and some of that has to do with, um, reimbursement too. I think there's some, you know, changes on the wind with regard to thermal pulsation that we're kind of trying to predict the future. And if you guys can help me with that, we could all, uh, play the lottery a lot better.
Speaker 3 00:06:28 <laugh> Hey, so you mentioned all these different dry eye services that you have. And so how do you tell the other providers within your pro practice, how do you get them engaged and get them referring to you? I mean, how do your parents or not parents, maybe your parents will have dry. They want your help too, but how do your patients learn about all the technology as well as your referring providers? Cause I know you have a large network as well. Yep.
Speaker 2 00:06:52 Yep, exactly. Um, so yeah, like we had said, you know, only a couple of us being really, you know, a driving forces between ocular surface disease care. Um, how do you get the other providers of the 17 involved? And a lot of it is just, um, reminders, um, and, uh, constant, uh, contact, you know, walking around and saying, Hey, did you see that letter? I sent you about Mrs. X, Y, Z. Um, she is doing great. We've done this therapy and look how much better she's doing. Um, I think, uh, some of the excitements really grown lately, uh, uh, with regards to, um, us being more engaged with social media and, um, uh, accessing our patients too with, um, just blasts elast and, um, surveys saying, Hey, we are offering dry services and, you know, and some of our, the greatest source I have is patients from other clinicians that just haven't even known.
Speaker 2 00:07:51 We have these options. Um, and once they hear about it and it hasn't been, you know, talked about or adequately treat did maybe because these patients had, you know, other things on their plate, whether it be, you know, macular degeneration or, or severe glaucoma, um, that may be tying up a lot of their time with their provider. Um, once they see that we have that option, they, they seek it out themselves. They come in, they're excited that we're offering, you know, new things and, and better things for 'em. Because one of the benefits I find is, uh, of, of dry eye is patients are symptomatic. And so, um, they'll usually tell you when something's wrong and they, and they feel it. So they, they wanna do something about it as opposed to our glaucoma colleagues that have to deal with this, uh, silent, blinding disease is,
Speaker 3 00:08:41 You know, but it's not just feeling it, they see it, that fluctuating vision. Is it blurred all the time or does it fluctuate most of the time it's gonna be fluctuating vision and that's what we have to follow up on. And so my other question into all those drive services and, and procedures you have, how do you offer that to patients? And do you have any pearls on that? Is it, you know, do you go, Hey, you need this treatment, or do you have packages where maybe you get micro bluff exfoliation with an I P with the thermal pulsation, what do y'all do there?
Speaker 2 00:09:10 We don't do much for packages. Um, we really try and do tailored approach, uh, for the patient's specific, uh, wants needs and, and ocular disease. Um, so, you know, I give the patient my best recommendation. Biggest thing I'm doing is kind of sorting through the levels of their ocular surface disease and trying to hit the big offenders first. Um, most of the time we're gonna hit the biggest fish first and then move on to other things if we haven't got to where we need to get yet. Um, so that might be, you know, a lip flow or thermal pulsation for a, a patient with a lot of M G D it might be plugs with a patient with, uh, severe SHOs and just not volume there. So it really depends on the patient. Um, and we do a step step wide as approach, but not a package. Like I'm gonna see if for 90 days, or this is gonna include X, Y, Z, you know, it's all, um, uh, all a cart, I guess you'd call it.
Speaker 0 00:10:06 So you mentioned that one of your biggest fish is M G D. Um, what other big fish are you tending to focus on in your practice? Things that you're trying to bring patients in first specific therapies?
Speaker 2 00:10:18 Yeah, I think that's a huge one. Um, we see, I see a lot of, uh, secondary ocular surface disease too from, um, you know, neurological damage from multiple surgeries, stem cell efficiencies from, um, multiple surgeries. So, um, there's a lot of these other kind of M or core co corneal conditions, um, that I, I see a lot of that, uh, kind of get off the beaten normal path for dry, which I, I find exciting and, and really fun because it keeps you on your toes.
Speaker 0 00:10:52 Do you find that other, um, optometrists or other ODS are, um, seeking out your home management skills? Uh, I think there's a rumor out there that ODS don't like to refer to other ODS. And I think we should speak to that because I haven't found that to be the case personally. What about you?
Speaker 2 00:11:09 I, I think it's changing. Um, I think that a lot of the younger ODS are, um, embracing the inter collegiality. Um, and so I, I feel like there is more and more of that. Um, I still think it's a problem, um, in all avenues. And I, you know, I don't know if that's, you know, time, uh, or just, I don't wanna deal with this, but, um, hopefully now with, you know, more social media and advertising and things like that, we're gonna tell these patients, our stories and tell them all the great things we can do, and then they can find us,
Speaker 3 00:11:45 Tracy, I know you do this, Jake. I know you do this as well. And we do within our practice is that optometric co-management when it comes to the various dry eye treatments. And I think one of the biggest things is gonna be the communication. And you mentioned that earlier, Jake is talking to the providers within your practice, but get out in the community as well. And so if you have a spot in the day that you go out and meet some of the doctors in the area, give them some of the information, introduce yourself, and that's one way that you're gonna help build your dry eye services. So whether it's dry eye, whether you do specially contact lenses, whether you love to do glaucoma, I mean, this is one of the ways that we could be a resource for each other, but it's all gonna be about communication and having the patient understand that as well. So I'm, I'm glad you brought that up there, Tracy.
Speaker 0 00:12:31 Well, I find that some of my biggest refers aren't actually people that are in eye care themselves. I talk with a lot of women's physicians tend to be big fans of referring patients to me, um, as well as I've actually got a couple of dermatologists who like the fact that I am able to do certain procedures on the eyelids that they won't touch. So I think it's gonna become more and more important that we're coming with other, um, medical specialists in our areas to get the patients the help they need.
Speaker 3 00:12:58 Definitely. So, so Jake, you know, we're, we're talking about being stuck in a rut, you know, not, or we're trying to find ways to increase our services. What are some other pearls? Do you utilize questionnaires or surveys or, or there testing that you do on every single patient? Like for me, we do, we do, uh, myography on every patient. That's the vital sign or visual acuity of dry eye. What are your thoughts?
Speaker 2 00:13:21 Yeah, we do. Um, we do a survey on pretty much everyone that comes in, um, a lot of the dry eye consults I'm having, they're getting the full workup, right. And so we're at a level where, um, I'm not screening the patient as much. Uh, I'm letting my colleagues do that. Um, so at that higher level, we don't do as much like, um, capture, um, I'm letting other people do the capturing, I guess. But, um, yeah, I agree with you networking. Lots of letters sending out, um, is a, is a huge thing and phone calls, too. Something I wanted mention on your comments there at Walt is, you know, I think there's something to be said about picking up the phone still and calling, uh, Dr. X, Y, and Z and say, Hey, I saw your patient today really interesting case. Um, this is our plan. And, and that personal touch of that phone call goes a long way is
Speaker 3 00:14:11 Yeah, actually many times they don't know what, what you do. And so they're like, oh, oh, you, what do you like to focus on at the practice? And you say dry eye. And they're like, oh, well, I had a patient. I'll send it to you because oftentimes, and they, we all have that one patient that, uh, that, that we know has, has dry eye disease. Tracy, did you have another question for Jake on that?
Speaker 0 00:14:33 Um, no. I like the comments about phone calls. I know we're all being a little bit more careful, so, so that, you know, dropping by the office, isn't something that I'm able to do as much anymore, or physically dropping off even up, uh, welcome buckets. It's not quite, um, not always able to do right now. So I think the phone call absolutely is a great idea, um, for trying to get those other referral bases, uh, in also love the idea of a survey. Um, I think that's fantastic. Our main screening in our network of the three clinics that I'm a part of is if the patient's chief complaint is dry eye, that should automatically kick a, Hey, have you met Dr. Doll conversation to start happening? So you complained, never underestimate the power of what the patient actually is there for in your primary care services.
Speaker 3 00:15:20 So Jake, what survey, what are you all using?
Speaker 2 00:15:22 Yeah, we use speed. Um, that's, that's the hallmark of it in our, uh, surgical stuff. We'll do that, uh, a S C R S speed form, but that's, that's our end of the spectrum. Yeah.
Speaker 3 00:15:33 What's the threshold on that? What's that number,
Speaker 2 00:15:37 Uh, for referring someone out with?
Speaker 3 00:15:40 Yeah, I mean, is it for me? I use seven, you know, if it's anything over six, I'm bringing 'em back or treating them more aggressively. What about you
Speaker 2 00:15:48 Exactly above six is kind of what we use as a, as a landmark in our clinic,
Speaker 3 00:15:53 Tracy.
Speaker 0 00:15:55 Um, maybe I'm a little bit more picky. Um, I tend to see, um, cases that are a little bit worse, but, um, 8, 7, 8, if it's O it's, if it's over seven. So I guess if it's eight, I'm seeing people
Speaker 3 00:16:05 Uhhuh. Yeah. So, so Jake, do you have any pearls in regards to, uh, actually I filled in at a, uh, uh, OD office once actually for two days. And so I, for one, got to see first hand the vision in vision insurance, and then they have dry eye, you know, any pearls or comments you can help us with on that, on how to get that patient in for the dry eye services.
Speaker 2 00:16:29 Yeah. I think if you're really talking about the vision, uh, patient here is I'm here for my routine exam, doc don't bill, anything medical, I just want my, you know, my vision plan filled. Um, I think, you know, it warrants a little bit of time to discuss, you know, the symptoms that they're having or signs that you're seeing. Like, you know, I'm seeing a lot of signs of dryness. You have something going, you know, that is bothering you. And a lot of times that'll open the floodgates. Um, and then you sometimes have to reign them back in and say, Hey, I know we're here for the vision exam, but let me tell you what your options are and letting patients know, like there's a lot of stuff we can do for dry now, um, is huge. And, and I think once people see that value in, Hey, there's something that could, John there's special testing that can evaluate my disease state. They're much more likely to seek further care. Um, and so I think that's a big part is just an introduction that, Hey, that I have options. I have a disease condition that I can do something about, and I probably should, am I gonna do it today? Maybe, but you know, there's options out there for me that I can make my world better. If I take it upon myself to go see the doctor a little bit more often,
Speaker 3 00:17:45 We, we know what a huge role our technicians play. How could they help us in regards to increasing our dry services? What are some of the things that you do within your practice?
Speaker 2 00:17:55 They're huge, aren't they? I mean, they really are a huge part of what we do every day and, um, our patient education and our patients experience. So, um, I agree with you all like such an integral part of what we do. Um, they're the ones that usually are, are diagnosed in the dry eye before I see the patient, right? I mean, they understand, like this was a difficult, uh, refraction or this patient has, you know, red eyes or their vision is fluctuating throughout the testing. Um, I always tell, uh, you know, our technicians, if you have to reach for that bottle of artificial tears next to the topographer to get a good topography, there's a reason for that, that they have dry eyes. And so some of those times when they're saying, oh, we had to put some tear drops in to get this measurement or that measurement, um, or the patient was all over the boards with their visual acuity. Um, they should, they start to realize like, oh, that's, what's going on. Once we educate our patient or our staff about how, uh, dry eye impacts, not only our, uh, health of our eyes, but also our vision, like you had said earlier,
Speaker 0 00:19:04 I agree. And your staff can be some of your biggest advocates because these are not one and done type of, um, visits John, really to get dry under control. It's a series and it's fun for the techs. And the people are supporting us to see the patients coming in with improvements, their, um, demeanor change and getting more positive as they start to feel better. So sometimes our techs can be our, um, our big advocates as they talk to new patients about the things that they have seen us do with other people.
Speaker 2 00:19:32 Yeah. And, and some of our best patients. Right. I know I have, uh, several techs that are, that are great dry eye patients that are, you know, singing our praises when we do well. And, oh, I did this and it worked great for me. And you should, you should give it a try or, oh, you should ask Dr. Lang about this. Uh, I love it. And I'm doing great. So, um, they're also some of our happiest patients and happy patients, you know, that word of mouth is, is so important.
Speaker 3 00:19:57 Jake, do you have a dry eye counselor or a guru or a whisperer or whatever, or a Louie that we have in our practice?
Speaker 2 00:20:04 Yeah. Yep. We're, uh, that's, uh, in the works as well. I, I can definitely see that, but I have a clinical assistant ascribe if you will. That is kind of the, the dry eye whisperer. Um, so she is a huge advocate and huge help with going over things with my patients, you know, after they, after my portion of the exam is done. Um, and more so all the phone calls. So if patient gets home and forgets or has questions, or, you know, a caregiver has questions, um, there's such a great resource.
Speaker 0 00:20:38 I have a concierge we call, um, we call, um, my assistant crystal. Um, she's also an office manager. We call her our dry concierge. I think it's really important to have a consistent person that, um, the patients can talk to, especially when you're considering, you know, the potential for outof pocket costs. And the fact that a lot of this is in newer science. You been around since about 2007 from dues one, there's a lot of questions sometimes that, um, need to be answered. And so I think having a go-to person is really helpful for patients. I know it's really, um, makes my patients take that next step to feel a lot more cared about.
Speaker 2 00:21:13 Yeah, definitely having a name that they can call and in a big clinic like ours saying, you know, Hey, I need to talk to Marie. Um, and not Dr. Lang, you know, they don't wanna talk to me. They want to talk to Marie she's, she's better than me, most times, so,
Speaker 3 00:21:29 Oh, Dr. Lang. So as we wrap this up, you know, for, for our listeners, what are three takeaway pearls, can you give, when it comes to increasing your dry services? And we talked about a lot, we talked about technicians, we talked about the whisperers. We talked about the surveys. I mean, did I just steal your thunder or I'll let you go.
Speaker 2 00:21:50 I think that's great. I think, yeah. All those things are great. Um, three things I think you could do is, you know, uh, communicate, uh, communication is key, whether it be with your staff, with your, uh, providers in your clinic and, um, the providers outside your clinic, whether it be ophthalmologists or primary care or rheumatology, um, communication is key. So, um, let, let everyone know how much advancement there's been in this, uh, section of eyecare and, uh, options you can provide to your patients. Um, second one would be education of the patients, um, letting 'em know there's options, um, whether that be for a routine exam or a medical exam, whether it a glaucoma check where you're seeing a degradation, the ocular surface from the glaucoma therapies, or, uh, you know, I'm here for only my vision plan. Um, but doc, my eyes burn so bad. Um, so I know we see those patients all day. Um, and thirdly is yes, utilization of staff. Um, I think having, uh, P people that are singing your same story, um, working together, raising all ti or high tides, raising all the boats is, is so important.
Speaker 0 00:23:01 Those were an amazing three takeaway points. So, um, I heard staff education and communication, which I think are things that all of us can always to, to work on. So thank you so much, Jake, for all your time and expertise.
Speaker 2 00:23:18 Thank you guys for having me. It's a great pleasure to be here with dry eye coach and, and to see you guys, or at least chat with you guys anytime.
Speaker 3 00:23:25 Thanks, Jake.
