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Have you ever wanted to give a scholarship to a vision therapy patient who had a genuine financial hardship but didn't know how to do it? There are just a lot of questions when reducing fees for a patient. Can you reduce your fees? Will an insurance company see this as payment discrimination? Does the patient have a real need? Can I ask for information about their personal income? How do you determine which patients would qualify? What if they have poor attendance or participation, can I revoke the scholarship? How do you give scholarships without it breaking the bank and affecting your ability to provide therapy to other patients? I want to let you know about an exciting partnership with the non-profit I'm a part of called the Foundation for Vision Therapy Awareness. This non-profit was started almost 10 years ago by patients of mine who saw the amazing benefits of vision therapy and wanted to get the word out. They also saw the need to raise funds for patients who could not afford vision therapy. If you've been a part of any non-profit, you learn very quickly that it is difficult to raise money. This is particularly true when we tried raising money for vision therapy. Generally, giving organizations prefer it when their donation is able to benefits many different people. With vision therapy, often thousands of dollars are needed for one person. What I did find is that this non-profit provided a great way for me to offer scholarships to my patients. It provided an easy way for me to track what donations I was giving. The donation came through a 501c3 nonprofit which alleviated any concerns with price discimination. I also didn't have to decide who was entitled to a scholarship and who wasn't. If patients had poor attendance or participation in therapy, then it was the nonprofit who revoked the scholarship, not me. We want to provide you with the same benefit. We've been trialing this program with several providers around the United States and it has worked really well. If you are interested in this program that allows you to give scholarships to your patients, we ask that you sign up here: Vision Therapy Scholarship Provider Sign Up We are still trying to gauge interest and determine if our small non profit can handle the volume of people that would be interested. Signing up for this program, helps to make that determination. Once you sign up you can send your patients to: https://www.fvtaware.org/scholarship-application where they can apply for a scholarship. There's also a link on our homepage. To be clear, we do not have funds to provide vision therapy scholarships to the masses. But, what we can do is to be a resource to allow you to provide scholarships to your patients. If you decide to fund a scholarship for one of your patients, then we let them know it was given through your generosity. If you decide you cannot afford or based on the information we gather that you choose not to give, then we let the patient know that as a non-profit, we do not have the funds available to provide a scholarship. If you'd like to learn more about this program, we've set up a provider website that provides more information www.fvtaware.org/provider Password: providerFVTA We do ask that you consider a donation to our non-profit. Not only do we help provide scholarships, but the money will go toward our efforts to get the word out about vision therapy and the battle to get better insurance coverage. Learn more at www.fvtaware.org.

Now that's a challenge! Here is the story from one of our clients, Joanna Haws, OD. She wrote us an email thanking us for some help our therapist, James Smith, COVT was able to give: First off, with deepest humility, I’d like to say thank you for your business model that has allowed James [Smith] to come visit us. He is SUCH a wealth of knowledge!...I asked about his insight on our patient with a left optic nerve and retinal coloboma. I mean, vision therapy is great, but restoring sight?? [JD] has 20/200 vision and you’ll see where the coloboma is from the picture attached [above]. He has a superior nasal field cut and fixates sometimes (after approx. 20 therapy sessions so far). When not accurately foveating (coloboma does not cover the fovea), he postures left esotropia and left hypertropia. James thought he’d have some insights as to how to help [JD], and boy did he! He started with C/P activity with picking up peripheral targets. Then he had him try luster activities with the white board, and then again with a glowing white ball, illuminated with his transilluminator. [JD] was not only able to get some luster a few times, but he also was centrally fixating for a few seconds at a time! Then he did some looking to find his centration point at near. I have not been doing this yet, so I was learning so much! We were able to find the point where his left eye started becoming engaged in tracking along with his right eye and it was so exciting. For those of you who don't know James Smith, COVT; he started as one of my vision therapists many years ago. He now works full time on staff at Emergent as our resident COVT. He directs and oversees all of our online vision therapist training and he does training when we do onsite visits for our practice management consulting. He also at times visits clinics on his own to offer his expertise like he did with Dr. Haws. After reading this email from Dr Haws, a quote from Star Wars came to mind, "Now the student has become the master." At Emergent, our mission is to help vision therapy clinics reach their potential, and yes, that includes doing whatever we can to help clinics succeed. In this case, James was at Dr. Haws’ clinic to help review an equipment order with them and the opportunity presented itself to work with this patient. The results were amazing and I couldn’t be more pleased with how it all turned out.

Between my Best Practices in America blog posts, I thought I’d start another blog series where I could share some pearls of my own that I’ve learned over the years. The first pearl I’d like to share is one of the best ways to grow your VT practice (yep, this is a cliffhanger, although the title may give it away). In business school, they teach you that you should avoid marketing products or services that require a lot of education. It is very difficult to educate the masses in the short chunks of time you get in mass marketing. This is a problem with VT. Few in the public even know what vision therapy is. So, mass marketing tactics such as radio, TV, or social media are not as effective as they may be in primary care. You can advertise a sale on glasses or the great beautiful practice you have and you are essentially connecting with those who are already in the market to get an eye exam. People who need VT rarely know that is what they need. The low hanging fruit, in the perspective of marketing VT, are really other optometrists. These doctors know what vision therapy is and see patients everyday that need it. I can see the eye rolling right now… “But Ben, our colleagues don’t understand VT, they miss kids all the time who need it, and when they do find someone, they never refer, or even worse - they discount the effectiveness of what we do.” I can definitely commiserate with this sentiment. I had one colleague jokingly say to me, “VT is voodoo, isn’t it?” However, my experience is that the vast majority of optometrists recognize the value of vision therapy. There may be a host of reasons why they don’t refer to your office, but I find that typically it is because they are so wrapped up in doing primary care (i.e. getting a good refraction, dealing with eye disease, and trying to stay on schedule) that it just falls out of their routine to check and discuss VT with patients. A newsletter to optometrists and other referral sources does two important things: Remind them what an impact vision therapy can have on the lives of their patients Help them feel comfortable referring a patient to you. If they see you have your act together and are going to take good care of their patients, it is going to make them look good for referring patients to you. So many VTODs understand how important newsletters are, and it is one of those things that everyone wants to do but never gets around to doing. Here is the problem. If the doctor is in charge of doing something time intensive, it will never happen. There are just too many things that are more pressing that need to get done. So the secret is this...hire a publicist. “Isn’t that something only big firms can afford to do?” Not if it is done right. Your publicist is going to be in charge of calling you once a quarter (or whatever cadence you decide to do your newsletter) and you both will decide on 3 stories: The first story is normally a patient success story The second story will be informational and related to the success story. If the patient had convergence insufficiency, then you could talk about the Convergence Insufficiency Treatment Trial or some other related research or tool they can use to detect these issues better in their office Highlight story. Highlight a staff member or new technology in your office. If you have the RightEye do a piece on how effective it is at communicating to parents the issues with their child’s vision. Now the magic is that the publicist does all of the work. With the permission of the patient, the publicist can contact them directly to interview them and write the success story piece. The publicist will call you, the doctor, and interview you on the informational article. They will call the staff member and write up the highlight article. You get the picture. A good publicist will also design the newsletter for you. This document here tells you how to hire a publicist. Even better, you can just hire my publicist (follow link for contact info). He already has done a lot of newsletters for me and now knows a lot about VT. I’ve directed him to allow all of you to use my content, so you won’t even have to come up with all of your own articles. In many cases, you can plug in your name and roll with stories all ready to go. His info is in the linked document as well. It is my gift to you to get you jump started on VT newsletters and help spread the wonderful news of vision therapy to the world. FYI: My publicist is also connected to a print shop that will print and mail the newsletters as well. You just need to provide an excel spreadsheet with contact names and addresses. Also, don’t limit your reach to just optometrists in your area--consider sending it to all professionals (OTs, PTs, teachers) that refer to you.

Get 90% of your patients to switch to remote VT. Many of us had hoped that this was going to be short stint before we could get our practices back up and running. It is becoming increasingly apparent that we’re in this for the long haul. As a result, those who have put off starting up a remote vision therapy program, this video is for you. I tried to jam pack it full with useful information. Here is what I covered: Getting your patients signed up for VT - I was fortunate to get 90% of our patients to switch from in-office to remote vision therapy. I give some things I think helped us do that How much should you charge for remote vision therapy How long should each session be What video conferencing platform should you use? What equipment do you need to do remote vision therapy? Our website: www.emergentvt.com Our remote vision therapy kit: https://www.emergentvt.com/remote-vision-therapy-kit To schedule a product demo or to get started with your free kit: https://calendly.com/drwinters/introduction-call

For my third installment of the Best Practices in AmericaBlog, I was pleased to be introduced to Dr. Corinne Odieal's practice, In-Depth Vision. To effectively portray Dr. Odineal’s best practice, I first need to share a couple of background experiences that really make her practice stand out, at least in my mind. Story #1: When I was in optometry school wanting to learn about vision therapy, I visited some VT practices. A particular practice I visited was very successful. This practice had a beautiful office with state-of-the-art technology for pathology and primary care; their optical had the highest end frames. All of this combined portrayed a sense that this practice had their act together. You can understand then how much anticipation I had to see their VT room. The therapist had me follow her up some stairs, down a hallway, to what appeared to be a neglected preschool room. There were charts taped all over the walls, games and activities were stuffed in every nook and cranny, and all of the equipment looked as if it came from a museum. I was so disappointed. I promised myself at that moment that my practice would be different. My VT practice would look every bit as professional, high end, and high-tech as the best primary care practices out there. Story #2: Fast forward a few years and I was looking for spaces to lease to start my first VT only practice. I found a space that I was going to get for a steal. It wasn’t in the best part of town, but it was around the corner from some very nice medical offices and it would only take a couple years for me to obtain a preferable location. I brought a good friend of mine to see the space I was looking at. I showed him how we were going to move this wall and fix things up here and there. I looked at him with the excited anticipation of any soon to be business owner, and said, “What do you think?” He hesitated and then looked me in the eyes and said, “Do you really think that someone is going to trust you as a doctor when you are next to a dog training facility?” For good or bad, we live in a world where perception matters. Fortunately, I never moved into that location. Instead we worked hard to find and design a location that I am proud of to this day. When people came to our clinic, they not only received world-class care, but they perceived they were getting that quality of care too. So, when I saw that Dr. Odineal was practicing out of what appeared to be a home, I was a bit concerned. However, I was pleasantly surprised to see that she had struck a wonderful balance between the warmth and comfort of a home, but also the sophistication and professionalism of a distinguished practice. When you walk into the entry way you are greeted with the now obligatory COVID screening station, but as you can see in the photos below, it is inviting and fun. The decor is matching throughout the clinic. She has cute but professional dog pictures throughout her practice reflecting one of her personal loves, but one I’m sure she shares with many of her patients. Her VT room is organized and the technology is well-displayed. I think it is very important that VT offices have good technology. Yes, brock strings and marsden balls should always be the mainstay of vision therapy, but technology helps to engage patients. It also comes with the added bonus that patients perceive the therapy they are receiving is cutting edge. Importantly, I didn’t find any curled and scotch taped hart charts taped to the walls. The charts that were hung were of good quality and professional. In sunny California, you have almost 365 days of sun to take advantage of. She has a nice outdoors area for her patients to go to do motor activities. Thank you Dr. Odineal and staff for a wonderful visit. Here is a clip of what Dr. Odineal thought of the visit.

By now you’ve likely heard of the CDC’s announcement asking healthcare practitioners to postpone non-urgent visits including routine eye care. This unfortunately includes vision therapy visits, which could be catastrophic for many vision therapy practices. In addition, current vision therapy patients are put in a very difficult predicament. Many practices in the country are looking to remote vision therapy as a means to continue care to their patients and cash flow to their practices. Fortunately, the President also announced yesterday an easing of regulations associated with telemedicine. This means remote vision therapy can be done with any video conferencing platform and associated HIPAA regulations have been eased. This is all to say that remote vision therapy is easier today than it has ever been. Here are a few tips on how to set up your remote vision therapy program: There are many video conferencing platforms that can be used including Facetime and Skype. In our office, we use Google Meet. With Google Meet you can simply follow these instructions to set up a remote vision therapy session: Go to your Google Calendar and create an event, in this case it would be your patient’s vision therapy appointment. Click on “Add Guest” and type in your patient’s email address. This will send an email to them with simple instructions on how to join the video conference at the appointed time. When it is time for their VT session to start, go to the appointment on the Google calendar and click on “Join Hangouts Meet” and then simply join the video conference. I recommend turning off your mic by clicking on the microphone icon. Then use the link that says “join using phone for audio” and follow the instructions. This will make sure that the call audio is good during your session even if the internet connection is poor. Setting up the VT session In our office, our rule is that anyone younger than 13 years of age must also have a parent join them in the remote VT session. For patients older than 13 we still recommend that they have a friend or parent there to help them during the session if possible. The parent or friend can be your eyes and give you valuable feedback since video conferencing can make it difficult to make certain observations. With the right equipment and set up there are relatively few vision therapy activities that cannot be modified to work in a remote vision therapy setting. For help with any activity, feel free to contact James Smith, our in-house COVT. james@emergentvt.com Vision Therapy Equipment At Emergent we have everything your patient will need to do their vision therapy from home. We customize our take-home kits to tailor to the needs of your clinic so that the patient will have exactly what they need. To help you during this time of transition, we are offering 2 free months of our new and improved product line and 100% free kit customization. All you have to do is schedule a call with me or James. One of the most difficult activities to do is smooth vergences which is a mainstay to most vision therapy programs. For this we recommend our Fusion Slider and Anaglyphs. This can also be done with one of several computer based vergence activities included in programs such as HTS or VisionBuilder. We hope this will give you a good start in getting your remote vision therapy program up and running. If you have any questions, we (Dr. Ben Winters, OD, FCOVD or James Smith, COVT) are making themselves available for anyone needing help setting up their remote vision therapy program. Reimbursement In President Trump’s announcement yesterday he also said, “Medicare patients can now visit any doctor by phone or video conference at no additional cost.” [see update]Given that optometrists have parity in reimbursement with Medicare, there is no reason to think that this would not include optometrists administering vision therapy (however, please be careful, there are a lot of rules that are in place for reimbursement of vision therapy in general for Medicare). As far as other third party reimbursement, you’ll want to check with your individual insurance carriers as to how their telemedicine policies have changed with the coronavirus. Most should have expanded their telemedicine and will likely be aligned with Medicare’s expansion but make sure to check with your contracted insurance companies first. Update - 3/18/2020 2:45 pm PDT: This is a rapidly evolving situation. I just heard that the AOA in their webinar last night stated that they did not feel vision therapy is included in the President's announcement. So, I would wait for more specific guidelines when it comes to your Medicare and Medicaid patients.

I'm starting a new blog series called Best Practices in America. It is a little play on words. As a consultant, I have the pleasure of seeing some amazing “practice locations” and “best practices” that have been implemented in those clinics around the US. I keep thinking, "These jewels have value that everyone would benefit from hearing in our VT community." So, here I am sharing the wealth :) My first jewel was provided by Dr. Christina Murray and her practice, Center for Better Learning, in Ft. Lauderdale, Florida. Dr. Murray started her clinic right before the COVID-19 shutdowns started. What a rough time to start a practice, but that hasn't stopped Dr. Murray. I think it would be tough to find someone to match her spunk and determination. She has grown to 60 VT patients in her VT-only clinic in the middle of a pandemic and now just took on 30 more patients from a practice of a local VTOD who just passed away. She also just had a baby a couple of weeks ago! The best practice I'd like to highlight is Dr. Murray's use of an online tool called Asana. One difficult part of any vision therapy practice is keeping track of new referrals. Not only should you be tracking where the referrals are coming from, but a referral thank you letter should be sent, patient welcome packet with history forms emailed, previous records gathered, etc. Any system should allow you to quickly see which doctors are your biggest referrers and how well your staff is doing at converting those referrals into initial evaluations. In our office, we had used checklists and a Google Form which populated into a Google Sheet. We then used pivot tables (all my fellow Excel nerds know what I'm talking about) to display how many referrals each doctor was referring to and what our activation rate was (rate that referrals or phone inquiries converted to initial evals). It was a great system that gave us a ton of information, but I'll be the first to admit it could be a bit clunky at times. Dr. Murray's use of Asana has streamlined all of this. When a new patient calls or is referred a templated checklist in Asana is instantly generated. The referral coordinator then just goes through and makes sure she checks off all of the items that need to get done. Any to-do items that cannot be done at that moment (like calling the patient back if they didn't answer) is created right then. These to-do items pop up on the calendared day for the referral coordinator to follow-up on. Also, Asana tracks the referrals that are entered as part of the to do items. You can see these referral sources and how many they have referred at the touch of a button. Super slick! Huge kudos to Dr. Murray! It was a ton of fun to work with her and her wonderful team. Check out this quick video they put together about our visit! If you are interested in our practice management consulting team visit your office, please learn more here.

We always put an Emergent twist on all our products...something that takes the equipment to the next level. Our new Brock String has 3: #1 - Normal on one side, Accommodative on the other If you hold the string from one direction you will see the normal red, green, and yellow beads. If you hold it from the other direction, there are letters on the beads. This is made possible through cutting edge 3D printing that allows multicolor plastic printing. It is amazing how the binocular posture can change when you add an accommodative component. Now you can work on this with one of the most basic but greatest tools we have in VT, the brock string. #2 - Glow in the Dark Comes Standard If you are trying to break down suppression, there is nothing like taking away all other visual cues, so that the patient can focus solely on where their eyes are pointing. So, why not make glow in the dark standard on every brock string. #3 - Luster Discs For those familiar with our brock string, this is nothing new. The white discs work just like beads on the brock string. However, when using them with Red/Green glasses, not only do you get the benefit of having luster on the disc you are looking at, but the phys dip of the other discs are in red and green. Great for breaking down suppression. The brock string comes with 6 discs (3 quarter sized and 3 half dollar sized), so you start big and work your way towards bead size. [Also pretty cool. Pictured in the back, is a strong magnet you can purchase with the brock string so patients can attach it to their fridge or other metal object]

In this video, James Smith, COVT shows how to modify the Marsden ball activity, even when patients do not have a lot of space at home. Learn how to still have a great localization activity, while keeping it easy to see remotely. We want to give credit where credit is due.  This activity was first demonstrated to us by the great W.C. Maples.

Thank you to all of those who contributed to the Vision Therapist wage survey. In total we had 34 respondants from all over the US and Canada.* For new hires the average wage was $17.03 an hour. For those who have worked 1-2 years, the average was $19.14. 3-4 years was $21.50 and 5+ years was $22.43. By no means is this a scientific survey, but to try and add another level of accuracy , we also asked for the mean household income of the city they lived in. Of those surveyed, the median household income was 10% higher than that of the US as a whole. I thought that might give perspective if you are trying to figure out how to adjust the wages for your area. (Formula: (Your cities mean household income/US household mean income = $62,843) x (average therapist wage from above x 90%) Many of the offices I've spoken with are really having a difficult time finding people which is a product of the post-pandemic economy. However, there are some strategies I wanted to share that I think will really help. First, remember if you want someone to stick around for their career, you've got to pay a career wage. We have found over and over where therapists are making near minimum wage. While there are many reasons to love being a vision therapist, this cannot make up for being significantly underpaid. Additionally, we surveyed wages for different lengths of employment because I also think that people need to see that there is a career path. Having transparency in how much of a wage increase can occur over time is something really important to people. My guess is that you would want to know how much you could eventually make at a job. In my office, there was a clear wage increase that employees would learn about on day 1. When posting for the therapist position, either say in the title of the job posting that no previous training required, or say that you are hiring a vision therapy assistant. Otherwise, a lot of people are intimidated by title Vision Therapist. *I ended up taking out the Canadians wage responses. No disrespect to Canadians intended. I realized that income/payroll taxes are significantly different from those in the US, so it would skew the results. On average, Canadian wages were 10-15% higher than what was reported by those in the US.

Here is my second entry into our new series "Best Practices in America." We had the pleasure of visiting Dr. Valerie Lam's (OD, FCOVD) practice in sunny Santa Ana, California. You can tell there has been a lot of thoughtfulness in all that she has done. The look and feel of her office is modern, yet cozy. The lighting is excellent. The VT room is not an afterthought, but well designed with a beautiful fountain to look at through large windows (talk about great peripheral stimulation). In her waiting room she has a kids’ corner in her practice that is very inviting to the little people she sees. There are display cases showing prizes that her patients can get for "VT dollars" that they earn, for example, by doing their VT home activities or good attendance. Importantly, she also uses it as a marketing tool. Kids get tickets for submitting a success story, liking them on social media, or referring patients. We did something similar in our Yakima clinic and found that this was really a great way to create buzz in your community about your practice. Positive patient to potential patient contact is always the best kind of community engagement you can get. The other amazing thing I loved was how she does her progress reports. You can see an example report here. It makes it really easy for parents and others to quickly visualize their progress in therapy. She gave me permission to share it with all of you. Good work Dr. Lam!!! Thanks for your excellent hospitality and an amazing visit. Dr. Lam also shared with us her thoughts on how our practice management consulting helped her practice!