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Vision Eye Institute – a vision realised

CEO JAMES THIEDEMAN discusses how Vision Eye Institute leverages its scale to provide industry-leading eyecare. He also delves into how the organisation is tackling challenges on several fronts with health funds, workforce shortages, wage escalation and other increasing operational costs.

The genesis of Vision Eye Institute (VEI) – known as Vision Group when it launched in 2001 – involved a handful of established Australian ophthalmologists who figured private specialist eyecare could be better delivered and sustained at scale.

Capital to access leading-edge technology, a comprehensive clinical support staff workforce and an emphasis on real world ophthalmic research and collaboration have been hallmarks of the organisation – and remain so in 2022. But, most importantly, it features a complementary treatment network comprising some of the country’s best sub-specialist ophthalmologists, aiming to provide tertiary eyecare to any patient, regardless of their eye condition.

VEI’s roots are in the Victorian suburbs of Camberwell, Blackburn and Coburg where it set up its inaugural clinics, operating as the world’s first publicly listed ophthalmic company and one of the earliest publicly listed group medical practices.

Now privately owned by China’s Jangho Group (acquired for AU$200 million in 2015), it has progressively expanded along the eastern seaboard, and more recently South Australia, with 21 VEI clinics and 10 day hospitals operating under the Vision Hospital Group banner. A laser eye service will be established in its existing North Adelaide clinic, and last year VEI opened its first overseas clinic west of Shanghai. In November 2021, the organisation also launched its not-for-profit Future Vision Foundation to support research initiatives.

While VEI was officially established 20 years ago, many of its eye clinics and day surgeries that have joined the group have been operating for far longer – some for more than 60 years. The organisation now employs ophthalmologists, optometrists, orthoptists, nurses and support staff, comprising 130 doctors and nearly 500 ancillary staff treating over 100,000 patients annually.

Vision Eye Institute CEO James Thiedeman says the organisation is increasingly being challenged to deliver more with less.

As the country’s largest private provider of specialist eyecare, CEO and managing director Mr James Thiedeman says access to technology and a long-standing culture of collaboration and innovation are VEI’s key differentiators. VEI ophthalmologists have been responsible for many ‘firsts’ in Australian eyecare, including LASIK surgery with the intralase femtosecond laser (2005), corneal transplant (2006) and cataract surgery (2011) with the femtosecond laser, and an Australian trial of an intraoperative OCT scanner (2016).

For ophthalmologists who join the network, one of VEI’s major functions is allowing its “doctors to doctor”, taking care of the important administrative tasks such as marketing, procurement, accounting, legal and logistics that often lead to fatigue for smaller practices and detract from time with patients.

“If you think about pathology, diagnostic imaging, cancer care, fertility and other medical fields, that coalescence around scale and putting more organisational rigour around those private specialties has really started to play itself through,” Thiedeman, who has led VEI for almost five years, says.

“It’s rare nowadays to go to an independently-owned pathology provider or diagnostic imaging provider because it makes more sense to have an organisation that runs those services at scale. Then they can afford to put the capital into new technology, they can afford to have risk and quality managers and big procurement teams who can buy equipment and consumables cheaper, so you can keep the service affordable to patients.

“We’re doing the same in ophthalmology and are unique to the extent there isn’t another ophthalmology provider out there at such scale, who looks after the whole care continuum. From the first time the patient sees an ophthalmologist all the way through to an operation, and then having a post-operative review. It works extremely well because you, therefore, provide continuity of care for the patient.”

When VEI acquires a practice, it typically involves the ophthalmology practice operating under the VEI banner. The partner ophthalmologist works as an independent contractor and clinical support staff are employed by VEI. The clinic bills the patient, with a portion going to VEI for each patient, or some clinics have adopted a profit-share model.

Due to the nature of medical care, Thiedeman says VEI is careful about who it brings into the network, which boasts internationally renowned ophthalmologists such as Professor Gerard Sutton, Associate Professor Michael Lawless, Professor Rasik Vajpayee and Dr Joe Reich.

“We’ve got a reputation we’ve crafted over 20 years, so we are very selective about who we invite into the organisation – we make decisions based on professional reputation and whether that particular doctor is a good sub- specialty fit into the ecosystem. It’s about succession planning as well, finding the next person to take over when an ophthalmologist starts thinking about transitioning to retirement,” he says.

“Within that there are certain expectations we reinforce and codify. Our doctors have a number of expectations and protections in those contracts, as well as service standards around how we will behave as an organisation.”

Operational challenges and opportunities 

Despite its success to date, Thiedeman is under no illusions of the challenges VEI faces as the COVID-19 pandemic slowly moves out of the spotlight.

Financial challenges, additional PPE and hygiene costs, insurance premiums and supply chain cost appreciation aren’t showing signs of abating. Coupled with funding compression from Medicare and private health insurers, he says operators like VEI are challenged to deliver more with less.

More recently, the organisation has been hit with workforce constraints due to COVID, with 10-15% of its workforce unavailable at any given time. It comes amid a cost-of-living squeeze that has VEI’s single biggest cost (staff) seeking wage increases – and understandably so. There’s also a considerable patient backlog still to work through due to service restrictions imposed by state governments during lockdowns.

“A significant portion of what we do is funded by private health insurers and there’s no doubt there is tension between what we are seeing as the rising cost of delivering good quality care versus what the private health insurers are paying in terms of increases in funding. We are happy to work with them to ensure they understand we are doing everything to minimise our costs and drive efficiencies through our facilities, but it does feel like that tension is just going to continue to rise,” Thiedeman explains.

“With our scale and innovation culture, we’re working hard to implement new cost saving methods while maintaining exemplary care and outcomes.”

Digitalisation of certain components within the patient journey has been an important part of this. Clear patient communications have been vital to ensure patients turn up prepared at their allotted time, while avoiding breaches of density limits in waiting rooms.

The Chatswood clinic comprises 14 consulting rooms and a treatment room for minor procedures.

“We’ve had to moderate the pace of how some of our doctors work because on occasions, we haven’t had the full complement of staff. We’ve also had to use more agency staff, which is not ideal, because they won’t be as familiar with our facilities or our protocols. These are the types of things we’ve been contending with. How have we been tackling it? Well,

the available staff have been fantastic in terms of working over and above their typical hours – and we’ve tried to get smarter with the way we interact with patients,” Thiedeman explains.

“We’re now doing as much as we can with patients digitally before they arrive at our facilities, rather than sitting for 20 minutes filling an admission form in the waiting room, all the way through to sending them information ahead of their visit that prepares them for what to expect when they see the doctor. That way the interaction with the doctor and the support staff is a much richer interaction, rather than repetitive questioning about your age, your family history of diabetes, heart disease, glaucoma etc.”

The roll out of a digital platform in VEI clinics also allows patients to provide anonymous real-time feedback to monitor delivery of patient expectations.

Nurturing a culture of innovation 

VEI prides itself on giving patients access to the latest clinical technologies. Recent examples include A/Prof Lawless performing Australia’s first SMILE Pro laser surgery this year with one of the Southern Hemisphere’s first installed VISUMAX 800 femtosecond lasers. Its ophthalmologists are also involved in trials of new intraocular lens (IOL) technology providing patients with enhanced depth of vision with a monofocal-like visual disturbance profile.

This emphasis on ophthalmic research to improve patient care was the reason for VEI to establish its Future Vision Foundation in November 2021, which is a passion project of Thiedeman’s.

It aims to support the research endeavours of Australian eyecare professionals, including those with little-to-no formal research experience, through funding, clinical resources and mentoring. It has secured high- powered board members such as Professor Fiona Stapleton (UNSW), Ms Fiona Davies (CEO of Australian Medical Association, NSW), Mr Joe Redner (former head of Zeiss ANZ), and Associate Professor Tim Roberts (former national medical director, VEI).

VEI received almost 20 applications, with the bulk of those being clinically- related projects for research into developing synthetic corneal tissue supplements through to better engagement with educating children with eye conditions. Some applicants are seeking ways to remove pain points when patients walk into the clinic, addressing issues such as anxiety about their condition and treatment cost transparency.

“Not only do we hope this will help VEI improve, but the industry as a whole. That’s why we have effectively opened it up to whole industry; all we ask is at least one VEI co-researcher is involved in the work,” Thiedeman says. “We want to keep promoting and nurturing that culture of innovation and looking at new ways of doing things – and we want anyone who has a good idea to put their hand up say ‘let’s test this and see if it makes sense’.”

Click here for a timeline on Vision Eye Institute’s history.

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