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Power Hour Optometry
Seeing Fewer Patients and Earning More: Inside a Smarter Optometry Workflow with Dr. Janelle Davison
00:54:13
You don’t need more patients — you need more from each visit. That’s the lesson Dr. Janelle Davison learned after transforming her practice into a lean, high-performing operation that runs on technology and trust. She didn’t scale by...
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Transcript53 lines
- [00:00]
Dr. Janelle Davison
Foreign.
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Eugene Schottzman
Welcome to the Power Hour. I'm Eugene Schottzman, your host of optometry's biggest and longest running show. And today's episode takes us inside a model of care that blends innovation with efficiency and does it in a pretty practical way. My guest is Dr. Janelle Davison, and in this episode we talk about how she's designed her practice to run leaner and smarter. So she sees fewer patients a day, but she increases her revenue per patient. One of the ways that she does it that was kind of different is that she gives patients the option to opt in for all these additional things upfront before they even walk into practice. Things like retinal photos, dry imaging, dilation reversal, and also something unique that I hadn't heard of before, which is her anti aging bundle. So you learn about that. It's 89 bucks. And all of this is baked into the virtual paperwork that the patients fill out right before they walk in the door. We also talk about her decision to create a standalone dry eye center and why separating it from her main office actually improved patient understanding, reduced billing confusion, and increased her treatment acceptance rates. So interesting things to consider. Also, towards the end of the episode, when Janelle brought up the presbyopia drop, I reached out to Orasis and asked them to create a short 90 second segment to explain what the product is and how it works, just in case you or your patients want to learn more. The segment runs in the middle of the show in case you want to learn more. As always, if you've got episode ideas, feedback, or questions, reach out@Eugene Schottzman.com or through the Power Hour website. And don't forget to subscribe on Apple, Spotify, or YouTube, so you never miss an episode. Now let's go to the show. All right. Dr. Janelle Davison, welcome to the Power Hour.
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Dr. Janelle Davison
Hi. Good to be here. Happy Friday.
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Eugene Schottzman
Yeah, that's right. So I. We have a lot to talk about, and I know you do a couple of things in your practice that are rather unique that I want to jump into. Before that, though, I do want you to give the audience a little bit of background on yourself, on your practice, and certainly kind of help people understand what you've discovered in your practice over the last few years that has helped you stand out.
- [02:20]
Dr. Janelle Davison
Yeah. So thanks for having me again. I've been practicing now a total of 19 years, 15 those in private practice that I started cold in 2010. And so I've learned a lot along the way. I have to make a lot of Modifications and adjustments just to be able to still be here. I say there's some practices that started, but they're no longer with us. And so one thing that I do, I really stay on top of innovation. I try to make sure that I'm kind of aware of where the industry is going and I'm not afraid to think outside the box. I don't typically do what everybody else is doing. I never really been that type of person. So I'm not that type of provider or type of business owner. I do what I think is going to be best to propel my business to the next level and to keep us profitable. And so I have a primary care scope practice. And within that practice, about 2015, I started really diving into ocular surface disease and it really built out. Dry eye bought in and was one of the first to have a dry eye Spa in 2018, where I actually partnered with an esthetician, offered a lot of additional services within the practice. And then Covid hit. So this is interesting. This is March 2025. So we're five years from COVID 19. And so this time five years ago, our offices were closed down, many of us. And so I had to kind of rebrand and restrategize at that time. Right around that time, my lease was ending in the location that I was at. That location wasn't really growing that much. The environment around me, they weren't building anything. There weren't any new businesses coming into that plaza. And so a more modern, younger demographic, mixed use plaza was like 20 minutes in, closer to the city, opened up, had a space available. So I actually kind of relocated right during COVID and that was the perfect time for me to rebrand. I really thought out how I wanted my office to be. We kind of scaled down, became more of a boutique. I have two kids who are 16 and 13, so I really want to manage my time, meaning not see as many patients. I'm not leaving the clinic tired and exhausted because I have a part three job when I leave the office, work with my kids and things. And so we really got strategic about how to scale down, maybe not see as many patients. I was seeing like 20, 25 a day before. Now I see about 15. Really focus on our revenue per patient, bring in more quality, higher dollar frame options, lens options, and then really dig deep into our dry eye services diagnostic ability. And then of course move from that to aesthetics and anti aging. And so we were able to really maximize the things that we provide for the patients that come into the office. So we wouldn't have to really be focused on volume versus just really leveling up the quality of care and the services and products that we provide our patients. And so my ability to just stay ahead of the curve is just, I really think outside the box and I really utilize innovation and different ideas just to bring my patients a more elevated experience in eye care.
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Eugene Schottzman
Yeah. And that's one of the reasons why I really wanted to talk to you today, is because I do think you're doing a few things differently. And once I heard about how you're doing those things, I thought it'd be interesting for the audience to hear it as well. Now, you know, one thing you mentioned, and I think most practice owners go through this at some point where they build out where they start with their first practice and they realize they've made some mistakes. So you mentioned that when you moved, you had this opportunity to start fresh and to correct some of the. Or to really do what you really wanted to do in your new office. So what were some of the mistakes that you made in your first office that you kind of, you know, you got a chance to correct and you got a chance to do over in the second one?
- [06:15]
Dr. Janelle Davison
One was just kind of really being conscious of fixed costs, location matters. Right. And so even if it's a high traffic area, but the area is not really the ambiance that you want to be able to sell. Higher dollar frame items, higher quality lenses. You're just not going to have patients that are willing to spend the dollars. And so when I moved, the setting matches what I want to provide a boutique. It's mixed use. They're nice, high end condos, nice restaurants. And mostly all the businesses in the strip mall as well are kind of unique boutique style things. We have like a nice boutique veterinarian, we have a bookstore. And so it's a whole different environment that I wanted and I was trying to project that within my office, but the surrounding area didn't match. Right. And so I was kind of trying to fit my office into something that, that it wasn't really designed to be in. So that really helped propel us to be able to really increase our capture rate per patient, increase our revenue per patient. We actually increased our revenue 30% by just having an ambiance that really fit where we were trying to sell packaging, everything. So everything in my office we sell like it's a good, better, best package. We use a proprietary software to help us be able to calculate charges for patients. And so really, really got into virtual paperwork. Efficiency, efficiency I wasn't very efficient in my other office. And so it always required me to have a lot of payroll because I had a lot of people, but I wasn't as efficient as I could be. And so just being able to really manage cost of goods payroll allow us to be able to spend more time with patients because we were more efficient and those patients felt more confident to go out and really, you know, make those purchases on those higher dollar frames and be able to spend time and talk about the quality of lenses. And so that's one, and then two, you know, don't be afraid to let some individuals go. Right, Covid. You know, one, finding staff was difficult, but at the same time, staff that really wanted to kind of be the vision that you wanted of your practice sometimes that was challenging. So allowing me to be more efficient thinking outside the box and allow me not to have to rely on people just to have bodies in the office, or not being able to find someone because employees are still, it's still a challenge. Even post Covid, it's still hard to find people who want to actually, you know, work in person regularly. I have patients, you know, having me fill out paperwork to try to get them to work for home if they have a sty or something. And so it's just trying to hard time finding employees. So I've gotten a lot more efficient so that if I don't have certain staff members, we can still operate accordingly.
- [09:00]
Eugene Schottzman
Yeah. So when you got more efficient, I'm just trying to understand, was it the physical footprint that made you more efficient or was it something about the technology that you were using in the office or the flow in general that allowed you to be more efficient? And describe it for me.
- [09:18]
Dr. Janelle Davison
Okay, so all of the above. So I went and I have a lot of handheld mobile pre testing. So one, I have the patient, they come in, they swipe, they pay their co pays, their paperwork is filled out virtually before they even get to the exam room, into the office, and they go straight back. And so I have more functional lanes in a smaller space because I'm not holding up one room for a bunch of clunky equipment that you can use a lot of those things as a handheld option. I came up to the idea because when I go to my other, my kids, like pediatrician appointment and everything was coming to us, we weren't going from room to room to room to have things done. The nurses were bringing things into the room. So that's one and then two. Like I said, the software that I use is a proprietary Software that I actually designed myself and my partner, my husband, but it calculates charges for my staff. So we reduce errors in calculations and allows them to determine the patient cost out of pocket faster. And it gives the patient a good, better best option. So it's less back and forth, less nickel and diming. And then also it verifies insurances. So usually when we come in the morning, we have a dashboard of all our insurances verified. We're just keying in and it pulls their co pays over. And so we just started using a lot of technology to just expedite. So my patients are usually in and out, picked out glasses, whatever they're going to do within an hour. Right. So that allows me to really use my main office as a referral center for my dry eye facility as well, because we get to spend the extra time doing my biography if we need to, or TRS molarity, whatever we need to do for screenings. Because we've gotten so efficient in getting that patient through for that routine annual eye exam that it's easier to add on little things that we may find that keeps us different. We'll probably talk about a little bit more in a podcast where we offer different opt in screenings when they check in in their paperwork. And it's no big deal to add those in as part of the routine exam because we have gotten so efficient. We're not wasting a lot of time checking in, we're not wasting a lot of time calculating charges, verifying. We're just super efficient. So the patient, it gives me more opportunity to offer services and products to patients.
- [11:26]
Eugene Schottzman
Makes perfect sense. So maybe let's address, let's talk about dry eye in a little while. I want to come back to dry eye in a little bit now. Let's talk more about the, the specialty screenings or anything else that you have in your office. Like, you know, it sounds to me like you're trying to do unique things during your pre testing and whether you're using handheld or whatever devices. But let's zoom in on what you're actually doing and what kind of things that you offer to your patients from a screening standpoint.
- [12:01]
Dr. Janelle Davison
So we offer a drug eye screening that includes my biography that the patient can opt into. We have a handheld mibographer that allows us to do that.
- [12:09]
Eugene Schottzman
What do you charge?
- [12:11]
Dr. Janelle Davison
Yes, we charge. We charge for it. I think it's like 25 or $26 we charge for it. So it's in addition so way it works is that we have virtual paperwork. So allowing virtual paperwork, it takes a Lot of the back and forth out, right? So we have a screening for dry eye. We have a retina screening, which you can get a fundus photo. We also offer the reversal drop. Dilation, reversal drop. And you pay extra for that. You opt into that. And then we offer. We did. And we're going to be going back to it. We had a anti aging because we had two drops that came out in 20, 19, 2020 that were to lift the lid and help with presbyopia. We're going to talk about some exciting things that's coming with that. And so we offered all those things in the paperwork. So we would have patients paying their copay for their routine exam and doing a contact lens fitting fee. And then they may opt in to two or three additional things that are on that paperwork. And they have probably swiped $120, $130 at the front before they even got to the back. And so, and we take all co pays up front. And so then that allows me to be able to have a conversation to see if the patient is a candidate, if they fail their mammography screening in addition to their speed scores off. And that's an automatic referral. We usually start them on some warm compresses and tears and we sell all those things in the office. And so we've just gotten really, really savvy about not being so sour that the vision plans only reimburse $40, which most of them do is pretty crappy. $40, $55. But just figure out how we can bring additional value to the patient and make them opt in things that they're choosing to do that doesn't necessarily have a medical diagnosis. Because right now you're just opting in for these additional screenings and you're paying up front for me to evaluate. And then if we find something, then, hey, now you'll come back for additional testing that may be required for some medical issue that's come about from US screening. So it's no different than what doctors do with aptos. They've gotten really good about doing vision retina screenings. But why can't you do a dry eye screening? Why can't you do an anti aging screening? Why can't you offer the reversal drop? The reversal drop came out a couple months ago and I think I've already gone through like 200 people and they keep asking me, well, how do you get so many people to sign up? I'm like, we just put in the paperwork, right? And we require the paper paperwork to be filled out before the Patients come in so they have time to read over the paperwork and they see the different things. They opt in. We have what it is, any adverse events, and we don't second guess. When they come up to the front, it says, you opted to this, this, and this and that. Your total is $150, whatever it is, and they swipe it and then they go back and then we start the whole process. And so I think the more you can get that check in paperwork and get things in there and figure out how to get that done. For the most part, we're about 95%. There's a few patients who, when they come in, we have to kind of go into a kiosk mode and give them the iPad to fill it out. But the majority of our patients fill out the paperwork before they come in.
- [15:13]
Eugene Schottzman
So the patients fill out the paperwork before they walk in the door. They've selected the screening. Do they know how much the screening costs when they select it?
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Dr. Janelle Davison
Yep, the price is there. I'm pretty transparent.
- [15:22]
Eugene Schottzman
So what, what percentage of patients go ahead? What. What percentage of patients end up selecting the screenings? Is it. I. I would imagine, because we have.
- [15:34]
Dr. Janelle Davison
Go ahead. I'm sorry.
- [15:35]
Eugene Schottzman
Oh, no, no. I go, please.
- [15:38]
Dr. Janelle Davison
I'll say. Well, we offer, so, you know, say, for instance, have a retina screening, and we say if you're diabetic, if you have a family history of glaucoma, we kind of lead with, you know, if you're this age, pick this, pick that. And so we have a high because we have more than one screening option. So we'll have days where like all 14 people pick everything, right? And then we'll have days where people pick a retina screaming screening and dilation reversal. And so we're batting really well. I'll say. Most of our patients come in, they're picking one, multiple screening options. And so it allows us to be able to provide a higher value exam for the patient and then bring in additional revenue where we're not so bummed out about, you know, $40 reimbursements and then two with capture rates just in general going down. A lot of patients like to purchase glasses online. We're. We're finding other ways to make sure we're bringing revenue into the practice. And then on top of that, those patients are still going. And if they purchase glasses, then that's just. We're just kind of compiling our ability to get revenue from those patients. So I see less patients. That's my goal. I don't want to see a lot of patients. A lot of my colleagues like the volume aspect of seeing patients. I don't want to see 25 people, 30 people a day. I've done that. I do not want to do that, and I don't have to do that. Being innovative, bringing more value to the annual exam, having the patient opt into to things. Right. And being more efficient. I make just about as much money as some of those patients, doctors who are seeing 25 people a day and maybe more, but I only see 14 to 15, and that's kind of how I like to stay. And I work four days out the week, half day on Friday. So it's definitely doable, but you just kind of have to be a little bit more fluid, think outside the box and just really utilize technology. And virtual paperwork is a game changer. You can figure out how to really implement virtual paperwork.
- [17:27]
Eugene Schottzman
So I like the language thing, and I'm going to have you elaborate on this just for just a second. So, like, what do you say, for example, with your retinal screening? And because, I mean, I think that's the one that almost everybody knows, right? Everybody's got something that they're trying to get their patients to opt into. And, you know, I'm curious what percentage of patients opt into it and like, what's the language that you use to get people to opt in?
- [17:49]
Dr. Janelle Davison
I would say at least 80 to 90% opt in. And we say this screening is in addition to dilation, because I don't say it's in lieu. In addition to dilation, allows the doctor to get a deeper look into the back of the eye. We, we recommend it if you're, I think we put an age limit on it, you know, 21 and up. If you have a family history of any eye disease, like glaucoma, if you have diabetes, I don't know a word for word, I wrote it a while ago. But we basically talk about what age you recommend, what is allowing me to do, why is it beneficial for me and gonna help me determine what's going on with you. And then if, let's say you don't have diabetes, but if you have a family history of diabetes, glaucoma, this is something that you want. And then I usually say, I recommend you have it done at least once a year. So we put that as like a little paragraph. Then for dry eye, we say, are you experiencing, you know, any redness, burning, tearing of the eyes or allergies? And you're not sure if it's dry eye related or if you spend four hours or more on the computer. Then you will want to do this additional screening. It's going to take a look at your oil glands to help see if you're at risk for early signs of eye disease and then for anti aging. I had to put an age on that because at first I just had anti aging. If you, are you noticing a droopy eyelid? Are you having trouble seeing up close? I had like 20 year olds picking that. I'm like no sweetie. And so now it says like if you're between the ages of. I believe it's my sweet spot is 40, but 45 to 64. If you're over 64, there's no anti aging. In my opinion at this point you're, you're aged. Okay. And so because a lot of these that we're going to talk about, these drops and things, they work better in a certain range. And so we put the age bracket that we recommend and then we put some symptoms that this person with these patients will be experiencing. And then what we're going to look for, see if you qualify for a drop that's going to help non surgically raise your eyelid. See if you qualify for drops that are allowing you to be able to see up close without having to rely on reading glasses all the time. So it's really no more than three and four sentences. But it's basically put some guardrails on who you recommend it for because you don't want little kids and teenagers picking certain things they don't necessarily need to have. How is it going to benefit the doctor to help the patient and then what they're actually going to be qualified for? And so we put a dollar amount on each one so they know what they are. And then they kind of say yes or no. And the paperwork allows you to do that. They check yes or no. And then my staff, what we do is once we have the patient come in, we open up the screening bundles is what we call them, we like to use the word bundle a lot in our office screening bundles. And they'll just add those prices up in addition to their copay or if they're doing a contact lens evaluation. And then they say, well Ms. Jones, her total for today is for your screenings, for your exam copay and for your contact lens evaluation. It's this amount. And then they swipe and they go back into the exam room. And then we come in and we bring all our whatever they opted into, we bring it into the exam room doing all the pre testing. So that way when I go into the exam room, everything is already in the chart. I know what they opted in for. And then we just get right to it.
- [20:48]
Eugene Schottzman
That's awesome. So the one I hadn't heard of that you mentioned is this anti aging thing. So talk a little bit more about that.
- [20:58]
Dr. Janelle Davison
Yeah, so I came up with that. You know, we, we're all aging and I'm at the point now where I'm going to be. My birthday's ending this month. I'll be 46 and the first sign of aging is presbyopia. Right. And so I can feel like I'm 20 all day long. But once I start reaching and pushing my arm out, which has happened a lot now. So when we had different, we had the opportunity for these presbyopiatric drops to come out in 2019, 2020. I just wanted to be kind of innovative how I can really use this to elevate my practice. We already had a non surgical lift drop that was out. So I said, hey, how about I couple these options together and create like an anti aging screening or consultation. Because usually with these, before you add any of these drops, you do have to make sure the eyes are healthy, check the pressure screen, the retina, which you're already doing anyway for the annual exam. Because I don't see a whole bunch of patients. I have things allotted. I have patients check where they will. They wanted to be screened for anti aging to see if they qualify for any of these therapeutic options that are now available for droopy eyelids, presbyopia. And it was a big hit. You know, then we have both of those, those drops kind of take a dip in, I guess, not necessarily accessibility, the excitement. Because I think a lot of my peers kind of underestimated the how patients wanted to be involved in this process. Like patients would want these things, but they had a hard time figuring out how to implement into the routine exam. Do they bring them back for appointments? I think things get shaken. We start bringing patients back for like a presbyopic drop or a droopy eyelid drop when you can handle a lot of those things. And so unfortunately, I think a lot of my colleagues weren't writing scripts at the levels that these companies thought they were going to be able to do. And so some of the excitement kind of died down. But now there's some new opportunities available. So I'm excited to bring my anti aging package back. I've even gotten more savvy where I'm going to add in sunscreening. So sunscreen and so I sell sunscreen already in my office. So I'm always thinking about bundling. How can I make a value? Because if you pay a dollar amount, what can I give the patient that's going to increase the value? So we're going to talk about droopy eyelids, presbyopia and another easy thing to do for anti aging is making sure they wear medical grade sunscreen. So I'm really excited about the options, the new price. We have a job that I think we're going to talk about a little bit that's going to be available soon. That's going to be a part of my reinvented anti aging package.
- [23:30]
Eugene Schottzman
Well, and actually let's zoom into that. So what does the patient experience with this? Like when, when you're, and you, you mentioned, did I hear you correctly? You said you've already had like 200 prescriptions for the, for this or you've, you've gone through 200 models or was that the, that's the lid lift stuff.
- [23:46]
Dr. Janelle Davison
So yeah, that was lit lift. And also the reversal drop for dilation. I, I've done about. There was another drop that was out. We're going to talk about it. Beauty and compared to closely that's coming out. I did about 100 scripts there and so that's what I did. My anti aging number one time the rep came in and was like, what are you doing? All of a sudden you're just like really writing. I was like, well, I started doing like an anti aging packet and let patients opt into it. And that's when I realized I had to put some guard wells because like I said 21 year olds, I'm like, you're not. Why are you worried about aging? You're 21. And so, but so the package, the bundle is basically a consultation. So not everybody necessarily will qualify it. But basically the consultation fee is me taking that additional time in the exam room to explain this to you if there's any additional measurements that I need to make and then have that consultation with you. And so we had a pretty good uptake in patients that would opt in for those screenings. I would say we had about a good 60%. So if we had a certain patient number that day, about 60%, if they were in that age bracket, would opt in at least saying, hey, I want to see if I qualify for these things. And so most patients understood it was a consultation because I offer more than one thing in the bundle. If you didn't necessarily qualify, let's say for a presbyopic drop because Your prescription was out of range, you would still qualify for the lid lifting drop, or you would still qualify for something else that I would add in there. So I try to make sure there's opportunity for patients feel like they're getting value for the dollars that they spent for me to have this conversation with them and do these additional measurements that sometimes they require for us to be able to determine if they're a good candidate.
- [25:26]
Eugene Schottzman
So how much was the. It was the anti Aging.
- [25:30]
Dr. Janelle Davison
It was 89. 89. I usually always included a fundus photo in that. So that way I've covered the retina. So I include a fundus photo, which, you know, most doctors charge a lot less for a fundus photo. The fundus photo, I think on average, I think it's like $39 or optos or a fundus photo, but I would include that in there. It includes the prescription if you qualify for the presbyopic drop. It includes a prescription if you qualify for the lid lifting drop. Then it also includes the consultation and the patient education for those things.
- [26:04]
Eugene Schottzman
And with the presbyopic drop, how does that work with their prescription, with their, with their glasses, what did you find and what kind of feedback did you get from the patients?
- [26:14]
Dr. Janelle Davison
So those patients with the presbyopic job, we're really targeting patients who don't necessarily have to wear glasses full time. And so the sweet spot there are those patients that are 45 to 60 ish who see well in the distance. And we're called them emotropes. And they really only wear glasses for computer and small print. And so those are like your golden ticket patients for the presbyopic drops, patients that are outside of that range, your myopes, and you usually don't want to go past, I think between -2, -4 patients that may have a gap still with their multifocal contact lenses. But patients in my experience that did the best in my practice with the presbyopta drops. And we're getting more and more of those patients who come in who see well in the distance, whether they had some type of refractive surgery in the past or they're just an emmetrope, and now they're in that 40ish, late 40 presbyopic range and they're having to pick up reading glasses and it gets really cumbersome for them. And so in addition to prescribing glasses, I'll always say if they opted in for these screenings, then you had an opportunity to be able to see if you qualify for These drops. Now, if the patient did not opt into the screening, doesn't mean that they couldn't get it right. So if they say, hey, I saw that and I didn't opt into the screening, then those are the cases. I'll say, well, actually, we'll have you come back now. You have to come back for a separate visit for us to take an evaluation, because then I can't take the extra time because I need to move on to the next patient. But there are, there are parts of time where patients who might not opt into the screening, once they got into the exam room, I say, hey, you should have. You know, I think you would be a good candidate. You might want to come back. So we could talk a little bit further about these presbyopic drops, but especially with the new drop coming out, closing a couple, I think couple months, couple weeks, they'll be out. A good, good target for me. And my patient base was immature, 45 to 55ish, who didn't really wear glasses in the distance. I mean, they really enjoyed having the option, the millennials, just the youngest millennial, I think, turned 40. And so we're going to have a bunch, a bunch of people who are going to be 40 plus who are still super active, who need options. If you have a lot of millennial patients, and I'm a Gen X, there's not a lot of us, we like options. You know, it's not just one. You have glasses, you have contacts, or you have drops. It's all of the above. You, I say you want tools in the toolbox. And so I think this is a really great time for presbyopia and aging because they're, I think the millennials are the largest generation now, and they just turned 40, the youngest one. And so. And my sister's millennial, I think she's 41. And so there are going to be a lot of patients who want to look good on Instagram and they don't want to have their reading glasses on.
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Eugene Schottzman
And, you know, with, with those particular types of patients, do you bring them back after you prescribe? Do you bring them back for another, for, for another, for another exam at some point or how does that work?
- [29:03]
Dr. Janelle Davison
So, yeah, so two things. And so if they're. Overall, their eyes are healthy, I don't see any risk taking this medication. I'll usually do a teleconsult, you know, so if you have your fee set up, that included the teleconsult, which is really quick. The system that I use is, I think it's inexpensive. It's doxy me it's not expensive at all. I think I have the free version. Quick check in, make sure they have any issues and then I'll just write for the year. I just made sure they come back for their regular annual eye exam. If they're a patient where let's say maybe they were previous refractive patient, they're still within the vision range far as a prescription. But if I think there's somebody that I might want to see back before I do a whole year prescription, I'll usually do a six months and they have to come back. But on average, you know, if I feel the patient is going to do well overall eyes healthy with the new medication especially the adverse events are really, really, really low. The risk is low. I don't necessarily make those patients come back. I just tell them they need to keep their annual exam and then kind of go from there. But it'll be to each practitioner, you know, whatever kind of works with your office flow. But I say case by case, some patients you may want to bring back at six months and some of them you'll probably feel very comfortable with writing a prescription with enough refills for the, for the annual.
- [30:20]
Eugene Schottzman
Got it. That makes perfect sense. And I think that it is interesting in to consider this as a part of practice flow because I, I do wonder if it makes the patient a little bit more loyal because they're now having to come back to evaluate whether or not this is a good fit for them. And also it almost feels like a little bit more of a managed component of their vision, like you're managing their presbyopia in a way that they didn't necessarily expect. I didn't necessarily need to get readers anymore. And maybe this is enhancing the relationship with the doctor. Possibly.
- [30:59]
Dr. Janelle Davison
Yeah. I think it depends on your demographic. I think it depends on your region. I said my patients, they are having a hard time getting back for contact lens follow ups. And so people are super, super busy.
- [31:09]
Eugene Schottzman
Yeah.
- [31:10]
Dr. Janelle Davison
Saturdays.
- [31:11]
Eugene Schottzman
But when we come back, Janelle, I want to ask you about your dry. When we come back, I want to ask you about your dry eye center. I want to ask you about your and what you're doing from a, from a dry eye standpoint since you were a leader and innovator in this particular area. So after the break, we'll zoom in on that.
- [31:33]
C
An eye Drop for Clear Near Vision Cloy is a prescription eye drop that treats presbyopia by improving the eye's natural ability to focus on nearby objects and small details closely is indicated for the treatment of presbyopia in adults. Closei is the first and only eye drop with IQ formulation. It contains the lowest concentration of pilocarpine at 0.4% which is a third of the concentration of previously approved pilocarpine drops. It has near neutral PH which increases bioavailability, is preservative free and contains HA and HPMC lubricating agents. Using Closei, people were able to see up close much better after just one drop with improved visual acuity during continued use after installation. Many people in Closei studies identified more letters on an eye chart, experienced improved near vision in as little as 30 minutes and improved vision on average from day one to day eight with continued use and achieved enhanced near vision with no impact on average distance vision under different lighting conditions. Near vision improvement was achieved in minutes. In under 20 to 30 minutes, near vision was improved well enough for people in clinical studies to read print like on a menu, care labels on clothing, print on the back of a package, recipe instructions, directions on a map or even picture details on a phone. A low likelihood of side Effects Most of the side effects reported in closely clinical trials and there's a low likelihood of side effects. Most of the side effects reported in the closely clinical studies were mild and went away in a short time. The most commonly reported side effects in 5 to 8% were eye discomfort and headache. It's also designed for eye comfort. In clinical studies, people with different ages, pupil size and eye colors who use closely IQ formulation reported favorable comfort scores and it's a well studied solution. Closei was studied in five US Clinical trials with people who have blurry near vision. Chlosi Pilocarphine ophthalmic solution at 0.4% is a prescription eye drop used to treat age related blurry near vision in adults. For more information and important prescribing information, please visit closeieecp.com that's Q L O S iecp.com important safety information there is some hypersensitivity with warnings and precautions. Advise patients not to drive or upright machinery if vision is not clear, that is Blurred vision. Exercise caution in night driving and other hazardous occupations and poor illumination. Rare cases of retinal detachment have been reported with meiotics. Examination of the retina is advised in all patients prior to initiation of therapy. Advise patients to seek immediate medical care with sudden onset of flashes of light, flight, floaters or loss of vision. Closei is not recommended to be used when iritis is present. Closei should not be administered while wearing Contact lenses. Remove lenses prior to installation of closi and wait 10 minutes before reinsertion. Avoid touching the tip of the vial to the eye or any other surface. The most common adverse reaction, 5 to 8%, are insulation, sight pain and headaches.
- [34:26]
Eugene Schottzman
All right. And we're back on the Power Hour with Dr. Janelle Davison. And I am excited to as you were talking about some of the different screenings that you do in your office, I know that you were an early innovator on the dry eye side, so I'm excited to zoom in on that part of the equation. So talk to me about what happens at your dry eye screening. And kind of, I think I heard you say earlier in the episode that you then refer them to a dry eye center that you own as well. So just describe all that for me.
- [34:55]
Dr. Janelle Davison
Yeah. So at minimum, everybody gets a speed score screening that is in the paperwork. So I've added speed to paperwork. I have that for annual glasses, contacts and medical office visit. If the speed score is 6 or higher, myself and my associate, we know at least to dig a little bit deeper with the patient. So we're either referring them for additional testing or we may be implementing some foundational things like warm compresses, lid cleaning, and nutraceuticals. And then we offer an option for a patient to opt into a paid screening. I've learned over time that if the patient puts a little skin in the game, they're more likely to be serious about what's going to be the next steps. And so in addition, if something opt in, they have a speed and then have a my biography done. Then of course, with our regular slip lab exam, if we're seeing certain things that are off, just like today, I said I'm concerned about your meibobian gland imaging. You're complaining of excessive tearing that has not gotten better. We need to dig deeper. And so I'm going to go ahead and refer you to our facility that's dedicated to figure out what is going on. Meaning is it dry eye if it's allergies, if it's something else? And so we make that referral. So we have referral pass that refer to the center that is outside of our current office. So it's basically dry eye specialty that I built up within the practice that was really getting cumbersome within inside the department of care. So it's down the standalone center because the vision is for not only to be a referral center for my current practice, but but I do get outside referrals from other optometrists and ophthalmologists who are not quite interested in going into that deep with dry eye specifically. And then I get a lot of self referrals at the clinic. We do offer all the advanced therapies that are going to include ipl, radio frequency, thermal pulsation membranes, serum tears. We have all the diagnostic ability so it allows us to take that time where we're not mixing with eye, optical and contacts, disposable contacts. It's just only ocular surface disease really being able to spend that time to educate the patient and create that loyalty. And so April will be a year and we're doing really well already profitable. And I'm only over there three days and so it's to the point now where to figure out how to get a little extra time over there. But it's going great. It's going great.
- [37:13]
Eugene Schottzman
So how far away is the dry eye center from your practice? And you know again, when, when you tell a patient you have to set up an appointment at this other, at our other location or at our dry house specialty center, what percentage of patients actually take you up on that?
- [37:30]
Dr. Janelle Davison
Actually they all do. It's only three miles up the road and it's a whole different thing. It's in a medical complex center and so it's right off the highway. So most patients say oh yeah, my primary care doctor is over there, oh my dermatologist over there. And so pretty much everybody would refer because they're having issues. And I say I need to dig deep, we can handle those but we have a dedicated facility so it's only three miles from where I am. So if you drove to the current primary office, they only three miles up the road to get where you need to go. I actually have had less pushback for CO pays, less confusion because when those patients will come back, if we haven't come back for a full evaluation at our primary office, then you get back into that well, I have dsp. No, we need to use your anonymity healthcare for this. Well why is my copay $50 when it was $10 before? And so by them leaving out of this primary facility that we have that has glasses, contact lenses, they lose that confusion because then they walk into a medical complex where they see dermatology, orthopedic, rheumatology and so their mindset immediately changes. We don't hardly get any pushback on CO pays when and there's no confusion why your VSP is not going to be used over here versus your blue cross portion, your Nadia healthcare. Because this is only medical. And so actually I like it over there. There's a lot less drama, a lot less back and forth with patients when it comes to medical care because they are not confused. Right. One thing with an optical, a lot of times it causes confusion because I was just here buying Ray Bans and now I gotta come back and pay 50 in the same place because you want to look at my glaucoma or my dry eye. We don't have any of that. And then I've noticed an uptake in referrals from primary, from other colleagues because there is no optical. So there's no reason why their patient may get lost in. Oh, you have Christian Dior, you know, and so it's. It's only medical. So it's worked out very well. And I don't regret my decision at all. I think if you have an opportunity to be able to do it, it's really good because you have a complete mindset shift in the patient. And then I think with just the way the tide is going in eye care, having a medical specialty and being very diversified in your portfolio, even where you provide those services are going to be beneficial.
- [39:45]
Eugene Schottzman
So in that office, what is your staffing model like? And you mentioned you're there three days a week. Are you performing the treatments or do the patients come back and you know, they see your staff and because I imagine that's the main pushback that somebody has in their mind to say, oh, if I have to open another location, I got to pay more rent. Okay, well, maybe it's a small office in the medical building, maybe it's worth it. But then I got to staff that office and you know, you got to probably remind people that it's probably by appointment only. Right. So you know when they're coming.
- [40:15]
Dr. Janelle Davison
Yes, by appointment only. I mean, I guess if those are all your hiccups in what I'm doing is not ready for you. Right. If that of those are your challenges, they're going to stop you from doing something that has low cost of goods and profitable in three months, you're not carrying $50,000 worth of inventory for frame, then that particular business style is not ready for you. Then you continue to do it within your practice that has their pros and cons as well. My staff follows me. So yes, it's by appointment only. And my retail office by appointment only. Because if you're doing anything upscale, we don't just have randoms coming in because I want to be able to spend the time that is necessary for you to have the experience that you want. You can go look at my reviews, right? So you want a certain experience, and to do that, it has to be exclusive, Right? So when you come in, it's a family environment. That's what patients said. They love my main office because it was like, it's so warm and vi. It's like a family over here. It's by appointment only. I go over there, and when I'm not over there, my associates at my main office for me. And I have a staff member that follows me. Right now, I do the treatments. Will I stop doing treatments? I don't know. There's. Would I be over there five days a week? Probably not, because there's no need for me to be able to do that. I do other things as well, like some pretty diversified in income streams, but I don't get pushback for that. Right. But it's all about how it's coming from the provider. So if those are my hiccups or my hesitations, and I articulated that in the way that I'm talking to my patients. And yes, they wouldn't come. Yes, they wouldn't want to pay for the copay. Yes, they will. You know, I don't. I don't necessarily have that issue, right. It's all about the relationship that you have with your patients and the level of care, care that you want to be able to provide. The level of dry eye care that I wanted to provide, I cannot do that. Seeing primary care patients mixed in. And then I didn't want to take an entire day from that and have another doctor causing clutter and chaos. So I move out, the other doctor comes in, and my one staff member follows me. And so right now, I was talking to one of my colleagues who is a cornea refractive surgeon up in New Jersey. He was just like, that model you have is just amazing. He was like, you know why it's amazing? Because you're. You're doing it. He was like, you're creating the loyalty. I do the diagnostics, I do the treatment, and I enjoy doing the treatment two, three years from now, maybe, maybe not. But I enjoy doing the treatment because I have that such loyalty and trust with the patients. And if you're a patient that is suffering with dry eye, it is a debilitating condition. And I have dry eye myself, so I think I can bond with those patients a little bit more. But then I don't have issues having patients opt into treatment plans. My treatment plan doesn't necessarily require IPL for everybody. I think If IPO is the answer for everybody and you're not doing other things, there's something wrong with that as well. And so it works for me. But I will say if those are some of your hesitations and then probably what I'm doing is not something that you might be ready for.
- [43:07]
Eugene Schottzman
Well, so let's actually go through the pros of what you're doing, because it sounds actually really, really unique in the positioning standpoint that you're repositioning, you're resetting the patient's expectations, which then allows you to get probably the best possible at bat to get that patient to accept the treatment plan. So let's go through some of the numbers. So potentially, if I'm a patient, I walk into your practice, I did my paperwork. Before I walked in on the paperwork, I said, I want to pay the $26 for the, for the dry eye screening. You do the dry eye screening, you see that I have that, I need something, you schedule me for the appointment somewhere else. And then I come to that appointment, like, talk me through, through acceptance rate. So you scheduled me for the appointment, you said that there's a really high acceptance rate on that. And then I show up to the medical facility. And in the medical facility, what is that like? I mean, what's the flow like and what is the, you know, how does it work in terms of, you know, my first appointment and how do you. How much are these treatment plans and what is it and what's the acceptance rate on those?
- [44:16]
Dr. Janelle Davison
So you come in for your appointment, the office visit is billed to your insurance. So whatever your office visit copay for specialties is, you will pay that. There is an additional fee that you will pay for reporting. And so if anyone's ever listened to Crystal Breimer's billing and coding for dry eye, if there's things that you can do that you cannot get through a regular sit lamp exam, certain measurements to your interferometry ocular redness score. I have a Cardiograph 5. And so the patient's going to leave a report. You're going to pay a certain fee for that, right? So you're paying your copay plus that fee up front. And you go back, you do a full exam which is going to encompass all the imaging on the carotograft 5, all the entry segment images. We do inflammadry and we do tear osmolarity. My technician actually does all that for me. Then I come in, we have a consultation. So my appointments are about 45 to 50 minutes. We go over everything that we see there and we devise a treatment plan for you. Our treatment plans, depending on what is prescribed, not all cases, a lot of cases it's going to be an ipo. And a lot of my packages that I offer treatment in are bundled. And then some patients need treatments that are easily billed to their insurance. So if they're getting any regenerative therapy with amniotic membranes, plugs, dilation and irrigation, those things are billed to the insurance. And there's things that they may be doing that are billed directly to the patient. And over there, just like I do in my other office, most things are bundled and so we add value to their packages and our packages start as low as for IPL packages, $1900, it can go as high as $2900. And pretty much I would say, you know, you're not gonna get everybody, but I have a pretty high. So I would say about 85% of patients that come over that I recommend IPL package for get it. And if they don't, they call back. Because the thing about dry eye is chronic and progressive and all my patients live with a folder, they live with me with a dedicated written out, customized treatment plan for them. And so I've had patients come back a couple months later and say, you know what, I need to go ahead and move forward with this treatment because it's not getting any better. We do offer installments, so we offer some bit and then we offer CareCredit because I do take, I don't have payments like where you could pay half or pay per treatment. Because I want my patients to be vested in their improvement. And I will say once those patients are a lot better if they were self referred to. They're continuously coming back. All my patients, it's not like you have IPO and I say, hey, see you. See you when you get symptoms again. No, now you're somebody. We're going to be monitored every four to six months or once a year. But I do want to make sure that we get to talk about some of these cool drops that are coming out. But it's a model that works great. I love it. I don't regret any of my decision. It's kind of innovative. We have more and more people who are opening up dedicated dry eye facilities. Facilities. But it's unique in that I still have the primary care office as well.
- [47:17]
Eugene Schottzman
Yeah. And I, I do like the, I like the idea of the fact that you get a super high acceptance rate because they're in a different setting and because the doctor is the one doing the case presentation. I think people might say well it's a, it's a lot of time to Invest to spend 45 minutes to 50 minutes with the patient. But I'm sure it's rewarding number one. And number two is if you have a high case success acceptance rate, it's also, it's rewarding for the patient to get relief. But I, and it's also the economics make sense when you think about revenue per doctor hour in that particular case.
- [47:54]
Dr. Janelle Davison
Yeah. I mean your dry eye is not going to be every 30 minutes. It's definitely not anything that you're going to do volume based. And if you are really questioning the impact that you're making because I do get a lot of patients who self refer from other providers and I have patients that drive four or five hours. The furthest has been eight hours. So this condition is not something I think it's going to be every 15, every 30 minutes to really counsel these patients and really get these patients to be back to some sense of normalcy. The way I'm doing, I feel like I'm making an impact.
- [48:30]
Eugene Schottzman
Yeah, I think that's really, really interesting. So I'm excited about that part of the office. Janelle, thanks for, thanks for sharing that with the listenership. Now I know I mean you mentioned this earlier that you're a consultant for Orasis and I think that you chose to do that because you had this whole anti aging part of your business and as you had this anti aging part of your business it seemed to make sense for you. So I know you wanted to talk in particular about some of the things that you're excited for with that, with that organization.
- [49:06]
Dr. Janelle Davison
Yeah. And so like I said, there was a presbyter drop beauty that came out in 2019 and that's what started me this whole anti aging screening opt in package. And unfortunately it wasn't as successful with patients as some may have wanted it to be. And so I think last quarter Q4, Q3 closely was FDA approved and is set to hit the market in another month. I've been a part of helping to bring this to market, consulting, talking about different avenues that patients, sorry providers can bring this into the practice thinking outside the box the way it can be able to be a revenue generator for the office but at the same time offering these additional services to your patients. What makes this drop different and more exciting than beauty is that it is pilocarpine but it is the lowest concentration that is safe to be able to use to get the same the similar effect. And so, for instance, beauty was 1.25%. Closei is 0.4%, which is a third less the amount of pilocarpine compared to beauty. What really intrigued me about it is that it is preservative free in individual vials. So someone who really does aqueous surface disease. I'm very conscious of what I recommend patients to put into their eyes, whether it's for presbyopia, dry eye allergy. I don't want to be continuously adding preservatives to a compromised surface. And then it's individual vials, which is really cool. So that way patients have a little bit of autonomy of how they want to be able to use this drop. I think I mentioned it before when we talk about presbyopic drops. I'm not using this as I recommend this drop or I'm prescribing this drop now. You don't have to ever use glasses again. It's in addition to. Right. Tools are important. I always jokingly say we have more than one black pair of shoes because they all look different with their outfits. At least women do. I don't know about men. And so having this opportunity to be able to improve near intermediate vision with a individual vial that is preservative free, free. Also the drop, it has a new near neutral ph, which is important, exciting, because it's going to make the bioavailability a little better. And so this medication is really exciting because we all kind of dipped our toe into this anti aging with presbyopia drops. We got burned a little bit because the particular drop just didn't necessarily rise up to the occasion. But we got our patients excited. Right. And so I have patients coming back. There's like, I'm like, wait, I got something for you. We got something coming. And so I'm really excited about this drop. And then one other thing that I like about it is a lubricating agent. Two lubricating agents are in the drop. So comfort is important. If the drop is really comfortable and the safety profile is much more improved.
- [52:03]
Eugene Schottzman
Fascinating. And kind of excited for this innovation to hit the market. I think that it's. If you're saying that the patients like it and there's demand for it, then it seems like it should be added. Every eye care professional should at least evaluate whether or not this is something they should add to their repertoire.
- [52:22]
Dr. Janelle Davison
Yeah, I mean, I definitely think so. Like I said, I jokingly say, you know, I'm at that phase of life where the first sign of aging for a lot of us is presbyopia. And so the fact that there are options available, I jokingly told a patient today, because we're gonna launch and we have access via able to start writing prescriptions within the next week. I said, yeah. So I was like, I was excited to have something for you to in addition to your glasses. I said, hey, this is not our parents or our grandparents presbyopia. Right. So we have options now in our 40s, and so to allow us to be able to see comfortably with a really great safety profile that's comfortable, preservative free, which I'm really excited about. Like I said, being really in tune to the Aqua surface. And so definitely, if you, even if you didn't offer a presbyopic drop before, definitely consider this as an option. Because patients want options, and sometimes they know these options are out there and sometimes they don't. And so they're looking for their providers to able to bring up new innovation. I do a lot with contact lenses, and there was a study that said 8 out of 10 patients expect the doctor to start the innovation or the option conversation with them. So they may come in with thoughts in their head, but they expect that provider to let them know what they're a great candidate for. And so definitely don't forget about presbyopia.
- [53:38]
Eugene Schottzman
Yeah, well said, Janelle. I think that's an important point, is that as doctors, we always have an opportunity to be leading and, you know, very excited about some of the. Some of the innovations you shared with us today. And interesting to hear how you're running your practice, which I think is very, very innovative. So thank you so much for your insights. Thank you so much for being on the show. Janelle Davison, thank you for being on the Power Hour.
- [54:02]
Dr. Janelle Davison
Thank you.