fees

How to Set Your Fitting Fees

Use the medical model philosophy to determine your fee structure.

Jack Schaeffer, O.D., BIRMINGHAM, ALA.

Because contact lenses are a vision correction modality with the complexities and complications of a medical ocular device, contact lens evaluation fees should be based on these complexities and complications. This way, you, the doctor, receive an equitable compensation for the medical/optical services provided. (See “Define the Comprehensive Eye Exam,” page 22.)

During the contact lens evaluation, you may discover the patient has dry eye disease or a systemic condition, such as Sjögren’s syndrome or thyroid disease, that requires a more detailed ocular surface disease (OSD) evaluation. Our ability to administer medical eye care — in this case monitoring for and treating contact lens-related conditions — is what separates the medical model practice from the $59-and-out-the-door optical stores that focus on inexpensive and/or basic contact lens fittings.

Here, I discuss three methods for setting your fitting fees based on the medical model. Please note that these methods do not cover any materials, but only the services of the contact lens evaluation. Contact lens material fees should be based on market factors.

1 Use the ICD-9 code levels as a baseline.

To help you determine the appropriate fee structure under the medical model, use some of the common codes and their levels to guide you.

For instance, let’s consider that a typical spherical contact lens comprehensive evaluation should equate in time and expertise to the same level of care as a 99213. Your base contact lens evaluation for a spherical lens should start between $64 and $94. Now, add a follow-up visit at a level of 99212 (office or other outpatient visit for the evaluation and management of an established patient with a problem-focused history and examination, and straightforward medical decision-making). Your follow-up visit should be $39 to $59. So, for a base spherical contact lens evaluation for a current contact lens patient on a yearly basis, you should charge between $113 and $163. If the patient is a new wearer, you must add an educational service at the level of $29 to $49. On more difficult cases, you may also add an additional follow-up visit of $39 to $59.

To summarize:

Spherical lens evaluation with one follow-up visit: $113-$163

New patient educational session: $29-$49

Added office visit: $39-$59

The more complicated patients, such as those who have astigmatic and multifocal lens evaluations, should be charged $50 to $100 per category. This increase is based on the complexities of the evaluation, the expertise needed and the required follow-up appointments.

Astigmatic: $143 to $213

Multifocal: $213 to $263

It is important to remember that when you are charging full medical-based fees, you are obligated to deliver a higher level of service. Measuring visual acuities is not enough. You must perform complete ocular surface evaluations that include appropriate staining of the cornea and conjunctiva and accurate spherocylinder over refractions. To accomplish an ideal cornea-contact lens fitting relationship, you are responsible for prescribed solutions, comprehensive educational systems and patient compliance tracking.

2 Employ RVS units as a baseline.

Another method to aid you in determining the appropriate fee structure under the medical model: Use a Relative Value Service (RVS) unit. Operating the typical optometric medical model practice costs $5.84 per minute, says Key Metrics: Assessing Optometric Practice Performance: 2012 Edition, from Alcon and Essilor’s Management& Business Academy (www.mba-ce.com/2012-key-metrics-assessing-optometric-practice-performance.aspx)

To summarize:

Spherical lens evaluation: 25 minutes @ $5.84 = $146.00

Additional office visit: 10 minutes = $58.40

Astigmatic lenses: 35 minutes = $204.40

Multifocal: 45 minutes = $262.80

(These include one follow-up visit.)

Expertise factors, fee considerations and additional time are required when servicing special needs and conditions. This is the essence of the medical model contact lens practice. Let’s look at a few of those categories:

► Children and teens. A growth in contact lens complication rates exists in children and young adults due to their increased likelihood of non-compliance to contact lens wearing and care instructions. These patients must be scheduled every six months for a complete contact lens evaluation, which includes re-education on the importance of patient compliance to your directions.

► Extended wear patients. As extended contact lens wear is a primary cause of infiltrative keratitis, schedule these patients at six-month intervals for a complete contact lens evaluation, at which re-education on the dangers of overwear is provided.

► Systemic disease/ocular disease patients. As diabetes, hypertension and meibomian gland disease, among other conditions, can cause contact lens wear issues, such as keratitis and dry eye, see this large category of patients on a more regular basis — determined case by case — to ensure a healthy wear experience.

► Silicone hydrogel lens wearers. SiHy materials can place patients at risk for conjunctival splitting, non-severe infiltrative keratitis and giant papillary conjunctivitis. Therefore, schedule a follow-up exam that includes fluorescein staining of the cornea and conjunctiva. Then, schedule these wearers for a complete contact lens evaluation on a more regular basis, if needed, to monitor ocular health status.

You may prefer to develop a global fee, which incorporates all the charges already discussed. It would cover unlimited visits for the determination of safety and clarity — for up to 90 days. Also, it would include education for new wearers, those at risk for complications and any lens changes.

3 Establish a global fee for specialty fits.

I highly recommend setting a global fee for RGP and specialty lenses because of the complexity of some of the evaluations.

For the RGP lens, develop a fee package that includes the lens-fitting fee, as you will be using multiple lenses and cost structures for each patient. To make this cost-effective for your time and expertise on the new evaluation or prescription change, charge a fee that ranges from $350 to $950 depending on the lens design complexity, which includes sphericals to multifocals. This should include all lens changes and visits needed within a 90-day period — and be prepared to make multiple changes.

Complex RGP lenses, that include lenses for keratoconus, scleral lenses and lenses for OSD, are by far the most challenging and, therefore, the most rewarding. These fees can vary from a minimum of $500 per eye to as much as $2,000 per eye.

Final thoughts

Your contact lens fees should be based on your level of expertise, the complexity of the patient’s ocular condition and the ability of you and your staff to deliver the highest level of care to your patient. OM

Dr. Schaeffer practices at Schaeffer Eye Center, a medical eyecare practice, in Hoover, Ala. E-mail him at drschaeffer@schaeffereyecenter.com, or send comments to optometricmanagement@gmail.com.