low vision
Making the Specialty Pay
Serving low vision patients lets you both help people and boost profits.

If you ask doctors why they practice low vision, you'll probably get answers like "helping people," "serving the community" or "providing a service that no one else does." Very few will answer "to make money." In fact, when I ask doctors why they don't practice low vision, the answer I most frequently hear is, "I can't do it and be profitable."

And indeed, this seems to be what optometry schools teach � even professors of the subject perpetuate the myth that low vision practice should be a charitable endeavor, or at best, a labor of love.

I beg to differ

I truly enjoy practicing low vision; I couldn't do it if I didn't like it. There are days when I love it. I love the feeling of helping people accomplish something they had written-off as impossible � seeing someone read a newspaper for the first time in many years, or giving a visually impaired student the tools to help her through college. Do I consider it charity work? Absolutely not.

One of the reasons that low vision is such an enjoyable specialty for me is that it combines the reward of helping people who truly need it with the reward of financial success. In setting up a low vision practice, or adding a low vision specialty to an existing practice, follow these steps to maximize both the personal and financial rewards that come from providing this care.

See low vision patients during non-profitable times

Because you are providing a more specialized level of care and are presumably not in competition with all of the other doctors in your town, you have more flexibility in choosing when to provide low vision care.

If your Saturday morning hours are typically filled with a parade of Prada-wearing presbyopes, then scheduling low vision patients is neither practical nor profitable. However, if your Tuesday mornings are so slow that you are sitting around surfing E-Bay for Star Trek paraphernalia (or worse, considering adding a low-paying vision plan just to give yourself something to do!), this may be a perfect time to see low vision patients.

Even if you have yet to see a low vision patient, schedule "Low Vision Evaluation" slots during slow times in your schedule, and try to block low vision patients together during those times. Even if you only see two low vision patients in a month, see them both on the same day. It lets you and your staff get in to the low vision mindset and set up your equipment.

Buy the right stuff

Doctors starting out in low vision often feel they need to get every piece of low vision apparatus before seeing their first patient. I hear from doctors who tell me they've met with a company rep, spent $15,000 on a "starter kit" of low vision equipment and ask me, "now what?"

While you do need to have enough equipment to serve a wide range of patients, you don't need everything all at once. If you make a huge financial investment in special equipment, it will be harder for your low vision practice to become profitable. Speak with your colleagues who practice low vision and ask which devices they use most frequently � the old, "If you were practicing on a desert island and could only have five low vision aids, which would you pick?"

You can get a good variety of low vision aids (from basic magnifiers to high-tech equipment) for under $5,000. Be aware of the devices that you aren't buying, though, so if you see a patient who needs something you don't have, you can order it. You will add to your equipment arsenal as you see more low vision patients, learn what their needs are and develop your own "desert island survival kit" of low vision aids.

Marketing your specialty

Low vision practice is easy to market � in many areas, doctors are just looking for someone to whom they can refer patients. You just need to tell them you're available. Here are some ways to let them know:

► Register with your state's association for the blind � many have a certification process that allows you to become a member doctor. The association will refer its clients to you for services.

► Send a letter to area retina specialists, ophthalmologists, and optometrists, announcing the addition of low vision services to your practice. Follow-up with a phone call or a meeting to share your enthusiasm for low vision care and generate additional referrals. Send letters or newsletters every few months to mention new low vision technology, share a particularly good case, or just to remind the doctors that you exist.

► Each time you see a patient, send a letter back to the referring doctor. It lets everyone know what you have done for the patient, and again serves as a little reminder of your existence. If a patient compliments you profusely, ask him or her to please let the referring doctor know that he or she is happy with your services.

► If you have the opportunity to go in to your referring doctors' offices, speak with their office staff as well. Many patients may not tell the doctor that they are having trouble reading, but will mention it to one of the nurses, or as they check out at the reception desk. If the staff is empowered to give your card to patients, it creates additional opportunities for referrals.

Good relationships with several referring doctors may be all you need to create a steady flow of low vision patients into your practice.

► You can generate additional low vision business by marketing directly to patients, to gerontologists and primary care doctors and through senior health centers and nurses.

► Low vision is a specialty that lends itself naturally to media, so keep that in mind for your marketing strategy. If you have a particularly interesting patient who you're able to help with a specific goal, contact your local newspaper or TV stations � "Doctor helps legally blind patient read again!" makes a great human interest story. If your name and practice information are listed, such media attention can generate free publicity and a tremendous number of referrals.

Maximize money

In a low vision practice, you are providing specialized care that requires additional knowledge, equipment and time. Charge fairly for your services and products � but do charge! Manufacturers of low vision products will tell you what the average retail price is in your area. If you find patients who truly need charity care and you wish to provide it, then do so, but set your fees based on the assumption that most of your patients will pay for them. Here are some additional tips:

► Don't be tempted to try a loaner program, where you provide patients with a free "loaner device" for a period of time while they decide if they want to purchase the aid. While a nice idea in theory, this is a logistical nightmare in practice. Many low vision patients are elderly with multiple health problems and rely on outside transportation to get to your office. Even if they are successful with the device, it's not easy for them to get back for multiple visits, and if they already have the device in their hands (for free!), they have little motivation to return and finalize the process.

If the device isn't useful to them, it may get lost or broken ... or in the worst case, the patient becomes ill (or dies!) and your staff has the task of calling the family to get the device back, or asking them to pay for something that wasn't useful to begin with. Managing a loaner program can easily become an unpleasant and unnecessary full-time job for a staff person. Not managing your loaner program is a surefire way to lose money by giving away your inventory!

► Once you are seeing low vision patients consistently, stock some of your frequently-used devices to allow the patient to leave with his (purchased) aid immediately after the visit. This increases patient success and decreases work for your staff.

► Be goal-specific. Ask the patient what his or her goals are, and know that often there is not one device that meets all of the patient's needs. If multiple devices are necessary, then prescribe multiple devices, making sure the patient understands the benefits and limitations of each.

► Don't watch patients' pocketbooks. If your child, spouse, or parent needed a vision aid, you would want the best possible solution, regardless of cost. Your patients expect the same care.

A Utilize technology. In my low vision training at a VA Center, high-tech devices like CCTVs were used only as a last resort. In real-life practice, patients come to you for the best and easiest solution � in many cases, this requires a higher tech product. Utilizing multiple aids when necessary, and providing the best, highest-tech devices will result in better help to the patient and more profit for you.

What not to do

I speak to a lot of doctors who see low vision patients and choose not to make money in the process. These doctors accept insurance payment for services, often waiving co-payments or non- covered refraction fees. Many also provide vision aids at their wholesale cost, ignoring shipping charges, administrative time, etc.

These same doctors often complain about their low vision practices, saying it's so much work (and not really fun). The end result is that they lose enthusiasm for their low vision practice, or may stop seeing low vision patients all together. Their knowledge and inventory go to waste, and the patients in their area need to look elsewhere for care. This serves neither the doctor nor the low vision patients.

Low vision is an important service to provide in a community. It also can � and should � be an important profit center for your practice. Doctors who make money while providing low vision care will enjoy this specialty and actively seek out more patients. If more doctors practiced low vision, more patients would have access to low vision services, which is a benefit to patients and doctors alike.

Dr. Fishbein and her husband, Jonathan Fishbein, O.D., have a private optometric practice. They are also directors of the Low Vision Center at Robert Wood Johnson. In addition, Dr. Fishbein is the Director of Low Vision Consulting Services for The Power Practice, in Hawthorne, N.J.