By 1995, Jorge L Alió MD, PhD had already attained broader influence than most in ophthalmology. As professor and chairman of ophthalmology at Alicante University in Spain, his clinical and research activities were internationally known, and his teaching was shaping a generation of ophthalmologists.
Yet Dr Alió’s vision for his practice and for ophthalmology was even broader. He constantly saw opportunities to improve patient care and expand services with new procedures, technologies, research partnerships and innovative staffing. “We wanted to create new devices and treatments for our patients; to bring innovations directly into practice,” Dr Alió remembers.
But making such changes at a public university was cumbersome. Partnerships with device manufacturers and other outside partners were difficult to negotiate and it could take years to secure funding for new programmes. “The academic structure is too rigid,” he notes. “You have to convince everyone to go along and it takes too long, so you lose the opportunity. There is no way you can make decisions quickly and independently within the university.”
So Dr Alió set out to build a completely new, private practice model that would give him the flexibility to innovate. The result was VISSUM Instituto Oftalmológico de Alicante, a practice that has revolutionised not only the clinical practice of ophthalmology in Spain, but its financing and organisation as well. Dr Alió, who is also VISSUM medical director, and others will present on how they developed their practices at the second annual Practice Development programme at the XXVII Congress of the ESCRS, in Barcelona.
The biggest challenge in putting VISSUM together was assembling a team with a common vision, Dr Alió said. He is always looking for doctors inside and outside Spain to join the team. “It is more than a business project, it is a shared vision of practice that combines medical assistance and research, and making it work together with support from a financial structure. Some team members come by themselves, some you change and others you look for. Every person has a different approach, but they all have the same vision.”
VISSUM integrates clinical services in all ophthalmic subspecialties, medical research, university teaching activities and humanitarian services under one umbrella organisation. Services are delivered by an integrated team including ophthalmologists, optometrists, medical technicians and researchers. All are trained to work together render personal service and the highest quality of evidence-driven care. “This is a co-management model that did not exist before in Spain,” Dr Alió says.
VISSUM also supports the Fundacion Jorge Alió for the prevention of blindness, which provides services for those in need in Spain and abroad. “As doctors we need to devote time to humanitarian services,” he adds.
VISSUM is supported by business operations, including billing for private insurance and self-pay, and financing for developing new procedures and devices. The structure allows practice leaders to quickly fund new services and open new locations as needed. It also provides flexibility to form research and business partnerships with outside companies that would be difficult for a public institution, Dr Alió explains.
The concept of integrating research and business management to provide better clinical quality and improved service has been highly successful. VISSUM now operates 43 clinics across Spain run by more than 500 employees including about 60 ophthalmologists. Nine clinics include refractive laser and operating rooms to which patients are referred for surgery. Preoperative care and postoperative care are mostly done in local clinics, closer to patients’ homes. Dr Alió notes that excellent service is essential to success with private paying patients. About 30 per cent of the clinic’s business is refractive, another 50 per cent is cataract, including premium IOLs, and the rest other ophthalmic specialties, including glaucoma, ocular surface and vitreo-retinal. The practice serves about 200,000 patients annually and is growing despite the severe economic downturn.
Dr Alió and his VISSUM colleagues have also conducted research on dozens of new procedures, devices and device applications including multifocal lenses and microincision cataract surgery. The hundreds of papers, books and presentations they have published have advanced and shaped the field of ophthalmology and benefited patients far beyond their own practice – just as Dr Alió envisioned.
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