Thursday, September 29, 2011

How to Increase your Revenue through Ophthalmology Practice


Retina Foundation Oration  
(All Gujarat Ophthalmology Conference 25 SEP. 2011, Hall A, 11:30am to 12:00pm)

How to Increase your Revenue through Ophthalmology Practice

Prof. Dr. S. Natarajan
Chairman & Managing Director
Aditya Jyot Eye Hospital


First of all I want to convey my sincere gratitude to Dr P. N. Nagpal for giving me this honor.
Retina foundation award was started in 1982 and was given to Dr S R K Malik.

Definition of success is different for different people. For Sincere Student to get good marks in exam is success while for an average student the goal is to pass. Same way for a doctor to treat patient is always the ultimate goal but along with that to increase profit is always a subject of concern for private practitioner.  
To achieve success one needs to have a vision for that. Visualisation of the dream and benefits is a first step to success. A guiding vision, a great dream, and a sense of focus gives one a goal and direction.  To achieve the visualized goal one need to have a “Passion” and “Courage”. Passion for the thing gives us energy and reason to weather the storms. Courage does not always roar, sometimes courage is the quite voice at the end of the day saying “I will try again tomorrow”. Life expands, or contracts, in proportion to ones courage, willingness to take risks, and acceptance of new challenges.  Ultimately it is the courage that counts, not success or failure. During the journey to success keep your character protected and your belief in yourself intact. Character is what endures you through your journey till you reach your destination.     Good is not enough; strive to be the best in your chosen field. Competence is the difference between mediocrity and excellence. And finally discipline in your work will take you a long way. Discipline means persistence and perseverance – the ability to continue through bad times, obstacles and problems. 
To increase profit from your practice start examining patient as a whole. Don’t give refraction only, start dilating the patients. Certain retinal disorders can be managed by general ophthalmologists in their initial phases. WHO and International Diabetes Federation (IDF) have predicted that the number of cases of adult-onset diabetes would more than double by 2030 from the present level of 171 million to 366 million-an increase of 214%. In developed countries, this increase in diabetic population would be around 42% and in developing countries, particularly in India, it is even higher; i.e. 150%. In India, the prevalence of diabetes mellitus in the urban population is around 12.1%, as reported by the national urban diabetes study2 conducted in six major cities. To handle this burden there are only approximately 500-600 retina specialists. Your involvement will help reduce our burden and will also increase your profit.
Diabetic retinopathy in its initial stages can be managed by strict control of systemic status and regular monitoring for early detection of progression. Refer patients showing signs of progression to retina specialist or you can advised required investigations like OCT and FFA to know the status of disease and further management. Retina person can further manage advanced cases with laser, Anti-VEGF injections or pars plana vitrectomy. Age Related Macular Degeneration (ARMD) in its dry form can be managed simple by anti-oxidant tablets. Each patient with dry AMD should be given  Amsler’s chart at home for monitoring. We have seen in our hospital that patients showing progression from dry to wet form are caught by newer machines like Preferential Hyperacuity Perimeter (PHP) in a very early state. Therefore we can intervene at early state to prevent further progression. Majority of hypertensive retinopathy patients are managed by simple control of hypertension.
For refractive surgeon, each and every high myopic patient coming for refractive surgery need not to be referred to retina specialist if they do fundus examination. You can easily go ahead with surgery in a patient having no treatable lesions in periphery. Refer only when required.
For that every emerging ophthalmologist need to strengthen their basic examination technique. They need to know binocular indirect ophthalmoscopy and Slit lamp biomicroscopy with 90D.
Regarding technical aspects of increasing your profit, you need to find ways to increase your efficiency along with reducing your expenses. According to one article in ophthalmology management, there are main 4 ways of increasing efficiency.
1)     Hire and office writer
         Save data writing time
         Can field your phone calls
         Can perform routine callbacks to patients and pharmacies.
I personally prefer two writers and at least two dedicated retina rooms. While one writer stays with me in 1 room for assisting and scribing, the other moves the patient to the second room or laser suite and carries over chart information needed for documentation. When I'm finished, the writer reviews any instructions and counsels the patient. If the patient requires surgery, surgical counselors take over and make the appropriate arrangements.

2)     Develop quick response report forms
Implement the use of fluorescein angiogram and OCT report forms using a "circle the appropriate response" or "fill in the blank" format. This type of form saves both time and dictation costs. Other testing can be reported in the same way.
“A circle-response/fill-in-the-blank form” that could be filled out immediately after a patient's examination and faxed/mailed to the referring physician. They get what they want the same day, patients are happy with the efficient communication, and we save time and dictation costs -- a win-win situation.

3)     Have a well trained technical staff
A well-trained staff of technicians is essential. Certified technicians can take the patient history; check vision, pupils motility, confrontation visual fields, and tensions; refract; and perform most of the external and anterior segment examinations.
A well trained optometrist is must for good and proper post-operative correction after a good surgery

4)     Have a surgicenter setting
      Surgical facility adjacent to your clinic is the ideal set-up. It increases efficient use of time, so one can see OPD patients till time of surgery. A professional, trained team in OT is crucial. With the advent of 25-gauge-transconjuctival vitrectomy, retina cases can be handled even more efficiently in this type of environment.
   Reduce Expenses:
    To keep your expenses low, look for ways to cut costs.Monitor supply usage and make certain it matches your patient needs. Consider reducing your printing and office supply requirements with streamlined documents and offer electronic documents whenever possible. Incremental reductions in expenses will increase your profit significantly on long run.
Increase sales:
Increasing sales of different products will increase your profit on each patient. Consider having Optometry outlet, Medical store, Low visual aids outlet etc. Look for services and items that are a good fit for the type of medical practice you run. The goal is to provide products and services that you can endorse and provide to your patents.
Insurance services:
Focus on maximizing your insurance payments. However, price control is increasing and recovery of the claim form the insurance company often takes long. You need dedicated staff to follow insurance claims. Working with insurance companies can be a time-sensitive process that requires attention to details and adequate tracking. Reduce the amount of money you lose because of incorrect billing or inadequate follow up and your profits will increase.
Cost effectivity:
Providing appropriate cost-effective care with compassion and competence is the right path to restore the lost prestige of this profession. Thus, the four "Cs" of a good doctor must always be kept in mind: Competence, Cost effectiveness, Convenience and Caring.
Referral Base:
A referral base a must for a VR Practice. Go out and meet the Practicing  Anterior Segment Surgeons and Physicians. Make it a point to write back to the referring doctors regarding the patient. There is enough work for everybody around. NEVER EVER try to grab a patient. Referred patients should ALWAYS be sent back to the referring consultant.
ROLE OF ACADEMICS & RESEARCH IN A VR PRACTICE
Try and be part of Clinical Trials carried out by large Pharma Majors. It would be financially as well as academically rewarding. Publications will help lend credibility and recognition amongst peers and patients and will also help in increasing Referral Base.
ALWAYS STAY UPDATED
Attend National & International Conferences, present papers and be the 1st to Adopt Newer Technologies.
AND FINALLY… BE REALISTIC
Nature of Retinal disease is such that many times even after perfect surgery one may or may not achieve Anatomical Success. Anatomical Success never ensures Visual Improvement. Patient  Counselling IS A MUST. Promise Less, Deliver More. A patient with lower expectations will be a more satisfied patient.
Key points to increase your practice
         Dedicated time to patients – Good counselling
         Thorough in your subject
         Satisfied and well managed patients will multiply
GROUP PRACTICE:
Partnership deal requires planning. Becoming a partner usually implies two things to an ophthalmologist: more money and more security.  New partners may be surprised to find their income dropping instead of rising if the deal is not structured optimally. Group practice has been adapted successfully in the West and in several places in our country. Colossal investments are required to put up vitreoretina service. Choose your partners wisely and set high standards for their selection Or else it’s a One Way Ticket for you..!! Select the right number of doctors for your Group practice. Never overload your practice as security rests in small groups only.
Remember….. A successful Posterior Segment practice stems from diligence, humility and steadfastness. One must remember to cater to all the socio economic strata of the society.Towards this, one must incorporate a service oriented approach by establishing a Charity based practice.
Few Pearls For Young Ophthalmologists
Building a practice is not an overnight project. It takes at least FIVE years to establish your practice. Patience is not the ability to wait but the ability to keep attitude while waiting. According to Yoinfo online newsletter 4 “As” for young ophthalmologist.
1)     Affability : Ease talking to patients, Good terms with staff members and Make a good team
2)     Accessibility : Easy access to referral sources, Willingness to take a phone call at any time and Provide urgent care  to patient  
3)     Ability : Your knowledge and ability is important but won’t help  without above two in a private practice
4)     Advertising : Do Not Market anything like Soap, market scientifically. Join local/regional societies, take lectures regarding any newer technology/method you are following and do publications

Lew Mc Bee – Administrator, Silverstein Eye Centers, Kansas, USA has said "Turn the medical practice into a Five-Star service organization. We want to build patients for life, we want these repeat patients, and we want these patients to tell their sons, daughters, mothers, fathers, grandmothers, and grandfathers to come see us because it's that important !"
Finally, I quote Swami Vivekananda… “Arise..! Awake..! Stop not until you achieve your goal”. To extend this to the Bhagvad Gita, Swami Chinmayananda says, “Have your goal sky high and do karma always with outstretched hands… You will rise to greater heights….!Nothing great will ever be achieved without great men, and men are great only if they are determined to be so.
In race of life don’t forget to take a break and Laugh. Keep enjoying life.

Wednesday, September 28, 2011

Happy Navaratri!



May Maa Durga empower you and your family
With her nine swaroopa of Name, Fame,
Health, Wealth, Happiness, Humanity,
Education, Bhakti & Shakti.
Happy Navaratri!

Tuesday, September 27, 2011

Sight of Compassion

Mumbai, 9th September 2011:

Cornea related problems are one of the most common causes of blindness around the world. According to the statistics of WHO, there are 45 million blind patients worldwide, of whom one-third i.e. 15 million reside in India. There is an estimated 4.6 million corneal blind people in India. Out of this, 90 percent are below the age of 45, including 60 percent children who are below 12 years of age.

If a cornea becomes irreparably damaged, there is only one solution: corneal transplant, which can only be performed using donated corneal tissue. Also known as “keratoplasty,” corneal transplant is performed by specially trained ophthalmologists who replace damaged corneas and correct conditions that would otherwise cause the loss of eyesight. Corneal transplants have a success rate of approximately 95% and can usually be performed on an outpatient basis. Corneal transplant is only possible through cornea donation, as there is no substitute for human corneal tissue. Without the generosity of cornea donors, thousands of Indians will be left in the dark.

There was a 5 months old baby, who was referred to Aditya Jyot Eye Hospital from South Africa. The baby had congenital corneal opacity due to raised intraocular pressure in both eyes, a condition known as buphthalmos. Descemet stripping endothelial keratoplasty (DSEK), a form of lamellar keratoplasty was done for the patient by Dr. Kavita Rao, Cornea Specialist, Aditya Jyot Eye Hospital Pvt. Ltd. DSEK is a revolutionary technique of corneal transplantation without sutures. This is a new advanced method of corneal replacement surgery without the need for surface incisions or stitches, unlike conventional corneal grafting surgery.

Their aim was to salvage the eye and restore the vision before irreversible damage occurs which would bring a lot of psychological trauma to the patient and his family. But the arduous task was to procure a donor cornea which was the most frustrating factor for us as here was a patient who was in an urgent need of cornea, we were ready to operate him but the precious corneal tissue was not available in Mumbai. Therefore, we had to procure the corneal tissue from L.V.Prasad Eye Institute, Hyderabad and perform the surgery said Dr. Kavita Rao.

Luckily for the patient cornea of good quality was available and hence the patient underwent this surgery. Patient received excellent care and the surgery was performed successfully but all patients are not so lucky. Sometimes procurement of cornea is very difficult as good quality cornea is not available due to scarcity of eye donors. 


100,000 corneas are needed for transplants each year in India but only about 10,000 are collected. This calls for a pressing need of launching a national awareness drive, backed by timely counseling of the grieving family, who are authorized to donate the eyes of their beloved relatives at the time of their death.

Remember, by donating a pair of eyes you can make a big difference to the lives of two corneal blind persons. Besides, nobody is going to live here forever so let us donate our eyes and light up the lives of others even after death. Also remember that common sense safety precautions such as wearing safety goggles or glasses may be your best approach to preventing eye injuries altogether and maintaining healthy vision for a lifetime.
 

Who can donate eyes?

Almost everyone from the age of one onwards can donate eyes. There is no age limit to become an eye donor. No matter if you have poor eyesight or have had cataract surgery, if you're young or old, have hypertension or diabetes, you can donate your eyes without any concerns. Even a person who has lost his/her sight due to retinal or optic-nerve related disease can donate eyes, given that the cornea is unclouded.

Those who wish to donate their eyes can make a pledge with any eye bank, resolving to donate their eyes after death. Even if the deceased family member has not signed a pledge form, their immediate relatives can give consent for the donation. As the eyes need to be collected within six hours of death, one must inform the eye bank as early as possible.


Eye Donation


HOMAGE


Self Love Is not selfishness


Apollo to offer bariatric surgery without incision


Dr. S. Natarajan's teacher expired on 8th September 2011


Rajni back in form


A Doctor? nay, a Saviour


Time to Smile, Happiness gene found


Monday, September 26, 2011

Prof. Dr. S. Natarajan, CMD (Aditya Jyot Eye Hospital) and also a world renowned eye surgeon received 3 gold medals in less than 2 months.

It gives us immense pleasure to inform you that Prof. Dr. S. Natarajan, CMD (Aditya Jyot Eye Hospital) and also a world renowned eye surgeon received 3 gold medals in less than 2 months. 

1)      IIRSI gold medal on 13th August 2011 at Delhi which was awarded by Smt. Sheila Dikshit, Hon'ble Chief Minister of Delhi for his immense contribution in the field of Ophthalmology.  This annual conference was being organized by Dr Mahipal Singh Sachdev. Intraocular Implant & Refractive Society, India, is registered society formed to educate the Ophthalmologists with the latest techniques in Cataract & Refractive surgeries by means of conducting conferences in all parts of the country. It is affiliated with All India Ophthalmological Society. The society has 860 life members’ ophthalmologists participating in various events throughout the year. The society has successfully conducted many ophthalmic conferences with International and Indian ophthalmological societies.

2)      BOA gold medal on 27th August 2011 at Mumbai for his immense contribution in the field of Ophthalmology. The award was given during the inaugural ceremony at Hyatt Regency. The chief guest was Dr. Vijaykumar Gavit, Minister, Medical Education, Govt. of Maharashtra & guest of Honour was Ms. Sujaya Krishnan, Joint Secretary, Health, Health Govt. of India. BOA organized its XIX annual conference – Focus 2011. 1700 delegates attended this conference. Padmashree Prof. Dr. T. P. Lahane is the organizing Chairman. Some of the finest minds of India, Maharashtra & Mumbai who have discovered path breaking new techniques shared their knowledge at this conference.

3)      Retina Foundation Oration Award & gold medal on 25th September 2011 at Ahmadabad for his immense contribution in the field of Ophthalmology at All Gujarat Ophthalmology Conference. 39th Annual Gujarat Ophthalmological Conference was organized at. Combay Resorts, Gandhinagar. DR. BHARAT.P.SHAH is the president & Dr.Amit Pathak is the Organizing Secretary.

Tuesday, September 20, 2011

Navagraha Homam & Sudarshana Homama at Aditya Jyot Eye Hospital


Aditya Jyot parivar performed Mahamrutyunjay Homam on Tuesday, 13th September 2011, Today Dr. S. Natarajan performed Ganpati Homam at his home & Navagraha Homam in the hospital premises. Tomorrow i.e. 21st Sept Sudarshana Homama will be performed at the Hospital from 7am to 10am. You are invited for the Purnahuti & Prasad at 9am. It is been performed to remove all obstacles & strengthen us.

Navagraha Homa
 ‘Nava’ means nine; ‘Graha’ means planets. As per Vedic Astrology, there are 9 planets that influence our lives. The position of planet at the time of our birth will have an influence on our actions and reactions to different situations in our life. Our Life will have its own ups and downs. In cases where there is an improper planetary alignment, it is termed as “Dosha” or negative influence. With Navagraha Homa not only the Dosha, but also our soul gets benefited and blessed.

The Navagraha are the chief deities of this powerful Homa. The 9 chief planets are the sole reason for the happiness and adversities that take place in our life. The 9 planets are:
  • Surya (The Sun): The Sun is the most powerful living God who bestows  with good health and prosperity
  • Chandra (The Moon): Moon is the planet, who rules our mind and brings success. The Moon, at the time of our birth is found in a particular star, and that will be considered our Moon Sign.
  • Kuja (Mars): Mars showers prosperity and wealth.
  • Bhudh (Mercury): Mercury is the planet of knowledge. He bestows with wisdom and wealth and is ruled over by Lord Maha Vishnu.
  • Guru (Jupiter): Jupiter blesses with education and knowledge. He cures from ailments and cleanses our negative emotions.
  • Shukra (Venus): Venus showers the knowledge of art and music. He is the bestower of long life, wealth, happiness, children, property and good education. He is ruled by Goddess Lakshmi.
  • Shani (Saturn): Saturn ensures happiness. He is known to affect adversely on occasions when he occupies certain positions in our horoscope. A prayer to him, especially on Saturdays, is said to mitigate our hardships. He is ruled by Lord Yama.
  • Rahu (Ascending node of the Moon): Rahu makes our life stronger. He is instrumental in strengthening our power and converting even any enemy into your friend.
  • Ketu (Descending node of the Moon): Ketu brings prosperity and negates bad effects, illnesses
Navagraha Homa is conducted on the grounds of connecting to the cosmic intelligence through fire rituals and to bestow with tremendous peace and success in life.

Benefits of Navagraha Homa
  • Relief from sufferings and hitches in life
  • Favorable situations in all our endeavors
  • The luck factor will favor a lot
  • Blessings from all the 9 planets for a successful life with reduced depressions throughout
Sudarshana Homa
This effective Homa helps to take charge of our enemies and to relieve from unexplainable sufferings and worries. One can get empowered with positive vibes by performing this Homa. It also helps stop unforeseen dangers and perils from pathway of success.

Lord Sudarshana is the chief deity of this powerful Homa who uses his mighty weapon “Chakra” to grant immediate relief to the sufferings of his devotees. Also, our sins are abolished by his grace. Lord Sudarshana/Narayana is considered as the first step to be adopted in the concept of realization of God.

The “Sudarshana Chakra” contains healing characteristics. Therefore performance of Sudarshana Homa relieves one from afflictions of fever and unknown health sufferings. This is the appropriate Homa to perform to conquer our enemies and other evil eye castings. A legend has it that Sudarshana Ashtakam helped recovering people of a village stricken by the plague epidemic.

Ekadashi, Dwadasi and Pournami Tithis that fall on Wednesdays and Saturdays, during the Budha Horas are considered favorable to perform Sudarshana Homa. 

Benefits of Sudarshana Homa
  • Relief from sufferings caused by hostile elements, poison, sorcery, thieves
  • Relief from unexplainable diseases and illnesses

Monday, September 19, 2011

The Ophthalmic Convene - 31st July 2011


5 months old baby from South Africa got operated at Aditya Jyot Eye Hospital

Cornea related problems are one of the most common causes of blindness around the world. According to the statistics of WHO, there are 45 million blind patients worldwide, of whom one-third i.e. 15 million reside in India. There is an estimated 4.6 million corneal blind people in India. Out of this, 90 percent are below the age of 45, including 60 percent children who are below 12 years of age.

If a cornea becomes irreparably damaged, there is only one solution: corneal transplant, which can only be performed using donated corneal tissue. Also known as “keratoplasty,” corneal transplant is performed by specially trained ophthalmologists who replace damaged corneas and correct conditions that would otherwise cause the loss of eyesight. Corneal transplants have a success rate of approximately 95% and can usually be performed on an outpatient basis. Corneal transplant is only possible through cornea donation, as there is no substitute for human corneal tissue. Without the generosity of cornea donors, thousands of Indians will be left in the dark.

There was a 5 months old baby, who was referred to Aditya Jyot Eye Hospital from South Africa. The baby had congenital corneal opacity due to raised intraocular pressure in both eyes, a condition known as buphthalmos. Descemet stripping endothelial keratoplasty (DSEK), a form of lamellar keratoplasty was done for the patient by Dr. Kavita Rao, Cornea Specialist and Dr. Mihir Kothari, Pediatric Ophthalmologist Aditya Jyot Eye Hospital Pvt. Ltd.  DSEK is a revolutionary technique of corneal transplantation without sutures. This is a new advanced method of corneal replacement surgery without the need for surface incisions or stitches, unlike conventional corneal grafting surgery.

Their aim was to salvage the eye and restore the vision before irreversible damage occurs which would bring a lot of psychological trauma to the patient and his family. But the arduous task was to procure a donor cornea which was the most frustrating factor for us as here was a patient who was in an urgent need of cornea, we were ready to operate him but the precious corneal tissue was not available in Mumbai. Therefore, we had to procure the corneal tissue from L.V. Prasad Eye Institute, Hyderabad and perform the surgery said Dr. Kavita Rao. Dr. Mihir Kothari said “it is probably first of its kind in the Country”.

Luckily for the patient cornea of good quality was available and hence the patient underwent this surgery. Patient received excellent care and the surgery was performed successfully but all patients are not so lucky. Sometimes procurement of cornea is very difficult as good quality cornea is not available due to scarcity of eye donors.

100,000 corneas are needed for transplants each year in India but only about 10,000 are collected. This calls for a pressing need of launching a national awareness drive, backed by timely counseling of the grieving family, who are authorized to donate the eyes of their beloved relatives at the time of their death.

Remember, by donating a pair of eyes you can make a big difference to the lives of two corneal blind persons. Besides, nobody is going to live here forever so let us donate our eyes and light up the lives of others even after death.
Also remember  that common sense safety precautions such as wearing safety goggles or glasses may be your best approach to preventing eye injuries altogether and maintaining healthy vision for a lifetime.
Who can donate eyes?

Almost everyone from the age of one onwards can donate eyes. There is no age limit to become an eye donor. No matter if you have poor eyesight or have had cataract surgery, if you're young or old, have hypertension or diabetes, you can donate your eyes without any concerns. Even a person who has lost his/her sight due to retinal or optic-nerve related disease can donate eyes, given that the cornea is unclouded.

Those who wish to donate their eyes can make a pledge with any eye bank, resolving to donate their eyes after death. Even if the deceased family member has not signed a pledge form, their immediate relatives can give consent for the donation. As the eyes need to be collected within six hours of death, one must inform the eye bank as early as possible.