o.d. to o.d.
Optometry's Changing Model
How can optometrists respond to lost sales, reduced reimbursements and other variables that affect profitability?

BY WALTER D. WEST, O.D., F.A.A.O., Chief Optometric Editor

Historically, the business model of optometry has been one of providing vision care including refractions, eye health evaluations and along with it, spectacles and contact lenses. Optometry's past has been so closely tied to the provision of spectacles and contact lenses that the majority of the population saw an optometrist for their routine vision care, yet never thought of going to an optometrist for eye pains or eye infections.

One of the reasons that the historic model was so successful was convenience. Think about it: You could have your eyes examined and purchase glasses and/or contact lenses at the same time, during the same visit without having your eyes dilated. Profitability has been -- and is now -- largely a function of the sales generated in the optical dispensaries. A practice generates some 42% to 54% of its gross income through the sale of frames and lenses.

The model changes

Profitability in optometric practices has begun to decrease as a result of fluctuations in the economy, reduced reimbursements as a function of managed care, loss of sales in the optical, reduced contact lens sales and other variables. Also, a lack of management skills certainly exists.

If you'll allow a pun, optometry's focus has changed. Optometry's attention has been turned from the business model of providing glasses and contact lenses, which existed for more than 50 years, to a model that has begun to focus more on the primary care opportunities that exist in eye care, which generate 12% to 15% of a practice's gross income.

Although primary care is an important addition to the optometric practice and it has been available from optometric practitioners in some states for decades, most patients continue to see medical practitioners for primary eyecare needs.

Some of these facts exist because the public is unaware that optometrists can provide primary care, some because perhaps patients have relationships more with general medical practitioners than with optometrists. And let's not forget that ophthalmology has long been considered the place to go if you really have a need for primary eye care.

Why not optometry?

So why don't more people seek primary care from optometrists? Of the many reasons, the following identify but a few:

• Optometry doesn't have an eight- to nine-decade history of providing primary eye care, as do the medical professions. We as optometrists are the new kids on the block with West Virginia leading in that experience. (The Mountain State's optometrists are closing in on three decades of providing primary eye care.)
• The current patient demographics in most optometric practices -- typically a younger, healthier patient base -- are a function of the more vision-related care that those practices have historically provided.
• A lack of education as to optometry's ability to provide primary care exists not only among the general public but within most optometric practices as well.

Get the message

So what's my message in all of this? Simply, we as optometrists need to treat primary care as an important addition to an already successful business model. We need to focus on providing, as well as educating, our patients regarding our ability to provide primary care and to continue to expand our ability as well as our responsibility in primary care.

Simultaneously, we need to direct, in proper proportion, our time and attention toward that which has always been our core business: optical and contact lens.