Tracy Carpenter Sepich, OD, MS, of Sepich Eye Care, takes her low vision practice to patients with a mobile care segment for nursing home residents and other limited-access patients

Getting started, building momentum, and maintaining a healthy low vision practice takes involvement in many levels of practice, including community outreach, medical modes, and business savvy.

Tracy Carpenter Sepich, OD, MS, of Sepich Eye Care, P.C., in State College, Pa., is dedicated to serving people with vision impairment and special needs patients. Her approach to mobile low vision care entails three basic segments: Start-up, business savvy, and everyday expertise.

JUMP START

After selling a successful primary care and low vision practice in 2004, she relocated to State College where low vision services were available in her new community, but with few nursing home or home visits.  

Initially, she met with nursing home administrators as well as rehabilitation hospital administration in order to present her primary care and low vision services.

Next, she introduced her services to attending physicians, psychiatrists, and nursing home staff who write referrals.

"Low vision services are often poorly understood, so I spent a lot of time and effort in education," she says. "I provide in-service continuing education for staff members."

Finally, she introduced her servi-ces to the Pennsylvania State Bureau of Blindness and Visual Services (BBVS). "Many of my referrals come from BBVS and from professionals," says Sepich. "I only provide the services requested, then turn the patient back to the referring doctor's care."

BUSINESS MODEL

In 2005, Sepich opened a full-scope practice including low vision, primary eyecare, ocular disease management, and vision therapy, plus mobile low vision services. Mobile low vision isn't marketed directly to the public; patients are generated by referrals only.

Her current business model utilizes an assistant who schedules appointments and handles billing using an electronic medical records program. Patient care staff members are educated to describe services to the public and referral sources. "I always send reports to referral resources. I track procedure codes, which are different for nursing homes, home visits, and office visits."

Quick Tips: Here are suggestions from Tracy Carpenter Sepich, OD, MS: Knowing how to set-up and stock-up for mobile low vision helps make being on the road easier. Call low vision companies with a basic list of required devices. Put together a portable exam room, which should include charts, occluders, retinoscope, lens rack, ophthalmoscope, tonopen, portable slit lamp, and a backpack-capable binocular indirect. Carry an electronic magnifier to demonstrate the idea of a CCTV. Pack low vision devices in various cases. Consider using a wheeled luggage carrier to get around. Most places you'll visit are handicapped accessible, so supplies can be wheeled in with ease.

A Day in the Life

Some practical advice on how to manage low vision mobility:

1. Limit time for mobile services; for example, one afternoon in a rehabilitation hospital and one morning for nursing home rotation. Work home visits in before or after primary patient care.

2. Limit the number of patients seen on a mobile visit to three to four per half day. Consider travel time and schedule patients in geographic clusters.

3. Keep equipment organized to adapt to a new settings without wasting time. Carry paper towels, tissues, sanitary wipes, and sanitizing lotion.

4. Be up on common conditions. Macular degeneration typically requires illuminated stand magnifiers, low vision lighting, and electronic magnification, task-directed lighting, and high-contrast images. Head injury/stroke patients usually need prismatic correction or therapy, updated eyewear with higher reading addition and education on eccentric fixation, contrast, and lighting.

5. Emphasize education. Rehabilitation patients must understand prescribed devices and techniques to use them effectively. Observe the patients' environments to maximize their vision.

6. Tap into Medicare and health insurances. While Medicare doesn't pay for all low vision services, it does pay for medical consultation that accompanies low vision services. With non-covered services, advise the patient in writing prior to the service and get an authorization signature.