Focus on vision care
Local physicians’ groups expanding throughout region

Dr. William Hancock and Laurie Creasey, certified ophthalmic assistant, work at Bellingham’s Whatcom Eye Surgeons, a division of Northwest Eye Surgeons.

By Kate Nichols

Ophthalmologist, optometrist, who do you see when you need your eyes checked? This isn’t a trivial question, because the right doctor makes a difference. An optometrist is the medical doctor who can diagnose and treat your eyes. If you need surgery on your eyes, an optometrist, or a medical doctor, will refer you to an ophthalmologist.
These professions demand rigorous training and doctors with flexibility and the capability of learning astounding technological advances. Doctors from both fields often work together to co-manage a patient’s treatment. And for the individuals taking care of your peepers, the profession requires not only the medical expertise but a clear focus on the business aspects of the practice.

Northwest Gains New Eye Professionals
This corner of the Northwest is getting some of the best of both professions. Optometrist Dr. Mark Aginsky, who started VisionPlus, gets great praise from his patients. In turn, he is pleased to see Northwest Eye Surgeons of Seattle expand into this area and attract ophthalmology specialists in cornea and retina surgery to their branch in Mount Vernon, and to Bellingham at Whatcom Eye Surgeons, a division of the center.
Although Northwest Eye Surgeons recruited specialists to the area, Aginsky came to Bellingham to be near his wife’s family. He probably came farther than any medical doctor in the area – he came from South Africa via London and Texas.
“When I arrived in the United States from London, my optometrist training didn’t count,” Aginsky said. “I was at a crossroads and could be anything I wanted to be, and I chose to be an optometrist again because I’m excited to go to work and see patients.”
He dedicated the next two years to complete the four-year training at a university that accepted international students. “It was crazy,” Aginsky admitted. “I could take a third year class in the morning and a first year class in the afternoon.”
When Aginsky first moved to Bellingham he leased space in the Sears Optical department. But the lease gave the corporation control over how he ran his office. After two years he decided he wanted to run an office differently – with more emphasis on patients. He went out on his own and leased space in Sunset Square. For his new shop, VisionPlus, he used a European shop model with bright, lively colors and an area for children.

Expanding Area Medical Facilities
Five years ago Aginsky started expanding VisionPlus by joining with a group of doctors to share a lab, payroll facilities, human resources and marketing. He said, “I have had obstacles and made mistakes through the years, but I have learned from them. It takes a year or two for a shop to prove [itself]. We need to train staff and build a customer base.”
VisionPlus is doing quite well: “The company has no debt and is growing at its own pace.”
Our doctors travel to cover the different offices,” explained Aginsky of the operations. “Generally we each work at two shops.” Most doctors want to spend weekends with their families, so the clinics are closed on Sundays, and group members cover for each other. Aginsky was able to visit his family in South Africa for a month last year with the other doctors covering for him.
The group has expanded to seven locations including Burlington, Tulalip, Mill Creek, Marysville and Ferndale. In March, the lab expanded to a new space in Burlington.
The latest addition is a branch in Oak Harbor. Because Dr. Nikki Robertson’s husband is in the military and she might have to move, she didn’t open her own office, so becoming part of the VisionPlus group was an ideal solution for her.
Northwest Eye Surgeons started in 1986, in Seattle, when three doctors decided to join their practices. When most ophthalmologists were using hospitals for their surgical procedures, they built an ambulatory surgical suite.
“Other doctors told them they were crazy,” said Maureen Tipp, CEO and executive director of Northwest Eye Surgeons. But 22 years later their foresight has made it possible to keep up with the most advanced equipment and provide excellent patient care.
Northwest Eye Surgeons now have six centers and they are building a surgery center in Mount Vernon, the Northwest region’s central location. Most of the doctors and staff rotate between two different clinics, but the Mount Vernon clinic will have permanent staff five days a week. They will be closing their Smokey Point surgery center when the building is finished.
Aginsky said he is pleased to see Northwest Eye Surgeons move into the area because now Bellingham has surgeons that specialize in cornea and retina surgery. Northwest Eye Surgeons intends to increase its focus on the needs of Whatcom and Skagit counties in the future.

Advantages of a Local Surgery Center
There is a tremendous cost difference between eye surgery in a hospital and at a surgery center. It can cost $15,000 for surgeon and facility fees at a hospital. But at a surgery center the same procedure costs approximately $3,000. For a patient, that means less cost on their deductible. Medicare also pays higher reimbursements for out-of-hospital care.
In addition to the cost, the doctors who own the surgery center are invested in staying on top of the new technology for the eyes. It is harder for a hospital to keep up on all the new technology in every field. New laser technology has cut the time and risk of procedures.
Access to surgery facilities can make a big difference to patients as well because they can get their eyes treated more quickly. An ophthalmologist can have more time in a surgery suite at a surgery center dedicated to eye surgery. Northwest Eye Surgeons perform 7,000 surgeries annually between their three surgery centers. About 2,000 of those come from Skagit and Whatcom counties, said Tipp, who expects that number to rise with the opening of the new Mount Vernon facility.

The latest technology
Keeping up with the latest technology is a vital part of providing what’s best for the patient. The higher-end equipment can make better diagnoses. “With the latest technology,” Aginsky said, “I can give projections about what someone’s eyes will do. It only takes two visits to start projections because it only requires two points on a graph to have a line.”
In keeping up with technology, the office has gone paperless, which means instant referrals by e-mail. The new technology means that a patient no longer looks at a paper eye chart but at an electronic one, which can be changed to meet the needs of a patient. For example, a child who can’t read yet may be able to express what they see on a chart using symbols.
Aginsky is an adjunct professor at Pacific University in Oregon, which helps him keep up on the latest technology. The contact with the school also provides the clinic with interns who need to do rotations, after students graduate and before they take the boards. VisionPlus is one of the school’s most sought-after internships. The exchange works well for both the student and the clinic because the students are learning the newest technology and they bring that information to the clinic and the clinic offers the student a good learning experience.
In ophthalmology the rapid changes in technology are astounding. “Cornea surgery can take as little as 10 minutes now and doesn’t need stitches, which can cut the recovery time and risk of infection. The stitches used require a year or two to heal and there was less chance for success with an implant and the risk of infection was higher,” explained Tipp.

The Business of Vision Care
Vision care, like most medical professions, has changed radically over the years. Now it takes business acumen to run a successful practice. Tipp explains, “Medicine is my business. My background is as a CPA.”
“Insurance reimbursements are about one-third [more] of what they were in 1980s,” Tipp pointed out. “So doctors need to be smarter.
“Patients have choices where they go for their eye care, so it’s all about patient satisfaction and outcome.”
Northwest Eye Surgeons was independent from 1996 until 1999, when a Canadian company bought them out. “But the larger company wasn’t focusing on the needs of the patients,” Tipp said. “So six concerned doctors bought back the company. Now six and a half partners, or seven doctors, are shareowners in the business.”
In the next three to five years, some of the doctors will be retiring and the centers will be bringing in more doctors. When a doctor is hired, they look for someone with “partner potential” who intends to stay with the company. Tipp said, “We look at this as a long-term marriage. We need to talk about quirks, strengths, weaknesses so we know if we can work well together for a long time.” Students coming out of residency are looking to access the latest technology, so having up-to-date technology attracts a good pool of new doctors.
“The work force is changing and is more business focused,” Pipp acknowledged. “Daughters are getting sent to college and getting an education in business so there aren’t as many people available to take the technician jobs.”

Patient Care First
Relationships with clients are important Aginsky believes. He’s gotten close enough to some patients that he’s been invited to weddings. When a patient comes in they want to see the same doctor, they can at VisonPlus. Aginsky commented, “It is not like a corporate place where the doctors keep changing.”
Patients are asked to fill out a postcard giving their feedback. The clinic receives “phenomenal ratings” and comments such as “you guys know your stuff.”
Aginsky had the idea of putting a Vision Plus in a Haggen grocery store. He met with Craig Haggen and pitched his suggestion and it was met with enthusiasm. The placement works for both businesses because customers can shop at the Haggen store while their eyes are dilated and they can use the child care during their exam. Furthermore, when patients are given a prescription, they can fill it at Haggen. They are looking at the Barkley location for a possible space, but space is limited at most Haggen stores, so the idea won’t expand until a store has space available.

The Cosmetic End of Business
Only 10 percent of Northwest Eye Surgeon business is for LASIK surgery or Laser-Assisted In Situ Keratomileusis, the procedure used to correct vision by using a laser to change the shape of the cornea. Two different lasers are needed for the procedure. One of the lasers actually diagnoses and shapes the eye to the right prescription. The procedure is only available in Seattle and Vancouver B.C., and at $1 million for the equipment, it probably won’t be cost effective to bring the equipment to this area.
One of the most frequent services Northwest Eye Surgeons performs for eye correction is “corrective procedures for a bad experience,” Tipp said. Advances in the technology have changed lasers so that people who didn’t qualify for LASIK surgery two years ago, may qualify now.
Although optometrists don’t perform eye surgery, Aginsky said he and other doctors at VisionPlus can co-mange with an ophthalmologist by doing pre- and post-operation eye care.
Botox injections are also available at Northwest Eye Surgeons. The injections started as a procedure for muscle spasms. Then someone noticed that it smoothed the area around the eyes and the injections became a popular cosmetic procedure as well. Tipp joked that when she is having a bad day a doctor might come by her office and offer her an injection. But, in all seriousness, it is still a medical procedure.
Giving back to the community
The optometrists at VisionPlus believe in giving back to the community and do some work at Lummi and Tulalip Reservations. In addition VisionPlus is one of the few clinics that accept DSHS patients. The reimbursement payments are so low most optometrist won’t accept those patients. Aginsky believes one advantage of having a billing department is that the doctors don’t know how people are paying so there is no prejudice toward a low-income patient.

The Bellingham location of VisionPlus was the first of what is a growing local chain.




Optometrists Nikki Robinson and Mark Aginsky of VisionPlus.

Aginsky uses a European model for his vision clinics – including bright, kid-friendly spaces.