A: Many doctors, as evidenced by one of these questions, are frustrated with the process of making contact lens exams profitable for the practice. With some strategic planning and the desire to expand one’s horizons in the contact lens arena, contact lenses are an excellent means of growing our businesses. Here, I will share some key elements that my practice has found effective in our contact lens practice:

CHAIR COST: MATCH FEES TO TIME, EXPERTISE

Knowing where your practice stands will provide a starting point for setting fees that keep your practice profitable (see the equations for figuring this out, on p. 28). At Medina Vision & Laser Centre, we calculate both chair cost per hour and chair cost per eye exam to determine our fee structure. The time taken to evaluate newly fit lenses represents billable time.

If a patient in our practice is to be fit in contact lenses for the first time or is re-fit in a new modality or type of contact lens (toric, multifocal, hybrid, scleral, etc.), they are charged a fitting fee based on the time it will take to properly do the job. Our fitting fee schedule is based on the expected number of follow-up visits and time needed by the doctor and staff during the process. For example, a patient re-fit from a reusable contact lens (two-week or monthly) into a single-day lens will need to be educated on the many benefits of their new lens, all of which we estimate to take about 3 to 5 minutes in one visit with one possible follow-up visit, when necessary. A conversation about hybrid or scleral contact lenses will, of course, be more involved and take more doctor and staff time: Discussing the advantages of a specialty lens, determining the initial diagnostic lenses, assessing the fit and finalizing the prescription are all steps that require the doctor’s expertise and, therefore, time, so they should be taken into consideration when calculating the fee schedule.

Knowing how much your practice spends per hour of operation is also a useful guide for determining how to schedule exams, follow-up visits and contact lens fits.

THRIVING PRACTICE: CREATE A PROCESS

Delegate. Establish a system in which you “hand off” a new contact lens fitting or a re-fitting to a trained technician to allow you to spend your time where it is most beneficial to patients and profitable for the practice — in the exam lane.

For several years, our practice has employed the services of a full-time contact lens technician. Her role is to work one-on-one with our patients in all aspects of the fitting process. Also, she maintains our contact lens inventory, our fitting sets, our contact lens supplies and is trained in contact lens-fit assessment and over-refracting. This individual maintains her own patient schedule and works in concert with our O.D.s when it comes to troubleshooting.

Additionally, we hand off among the optometrists in our practice. We are fortunate to have doctors in the practice who excel at fitting specialty contact lens designs (which we define as all non-spherical lenses). Referring to each other maximizes the efficiency of the fitting and minimizes the frustration and inefficiencies that can arise with an inexperienced fitter. My business partner is an expert in specialty RGP lenses, for example. When I see a patient who is in need of a bi-toric, a multifocal RGP or a scleral lens, I set up a consultation with my partner. I am known in my practice as the soft multifocal lens fitter. Also, we have an associate who is amazing at working with patients on myopia control. By playing to our contact lens-fitting strengths, we can fit patients more efficiently, and the patient experience is enhanced.

Calculate Chair Costs

 

 

Curate offerings carefully. Our soft contact lens practice (sphere, toric and multifocal) is over 90% single-day lenses. We make it clear to our patients that, as a policy, we always fit a single-day lens as our first option. There will be times when patients need an extended wear option, or we are unable to find a daily option in their prescription parameters. However, these patients are the exception to the rule. By having a soft spherical policy that is single-day only, we are able to focus our fittings on those single-day lenses that offer the best optics, comfort and convenience for our patients.

It is important to work closely with the manufacturer(s) that offer lenses that fit your fitting philosophy and your fitting strategy. By focusing on a couple manufacturers with whom you fit most of your patients, you can maximize volume discounts and rebates, which go directly to the bottom line. This will effectively reduce your cost of goods. We have found it most beneficial to choose a first and a second line of lenses, which combined has allowed the successful fitting of about 90% of patients. Getting to know the lenses you fit most often ultimately leads to increased confidence in making recommendations. Utilizing the manufacturer’s sales team and working with them on the science behind the lenses, as well as the proper way to fit the specialty lenses, minimizes chair time and increases success and patient satisfaction. I have found this to be most true with soft multifocal lenses.

Offer new technology. Soft spherical contact lenses are the “bread and butter” of any contact lens practice. It goes without saying that roughly 50% of my practice’s contact lens fittings are soft spherical lenses. And while these lenses are the most often used, there is no reason they cannot be an excellent problem-solver for patients and a great revenue generator for our practices. Again, the key to success lies in offering the best in soft spherical lens technology.

I believe a healthy contact lens practice will continue to thrive so long as it continues to offer patients the latest and greatest in contact lens materials and designs. A patient can go to any provider and continue to be prescribed the same lenses year after year. Patients who use the word “fine” to describe their experience with their lenses offer the opportunity to satisfy an unsaid issue. (Read more about this process on “When F.I.N.E. isn’t fine!”)

Provide excellent customer service. I tell every contact lens patient that there are three areas I must get right to successfully fit them. I call these “The Three Cs:” clarity, comfort and convenience. If I successfully address these, patients are happy. In my experience, the most advanced technology in optics, materials and designs are in the most recent single-day spherical lenses (as well as toric and multifocal). Having patients try on the lenses and wear them for a few days will typically sell them on the advantages of this modality.

As a policy, we have always offered a discount on an annual supply and have set up programs that allow our patients to return unopened/unmarked boxes within six months of the purchase, should the prescription change. Patients always appreciate knowing that they will not be “stuck” with lenses they can’t wear. When patients order an annual supply of contact lenses, they are also offered a discount in our on-site optical: We encourage patients to have an up-to-date pair of back-up glasses for times when contact lens wear may not be ideal. We have inventoried our top-selling soft single-day spheres for years. (Nothing will reduce a patient’s desire to shop for contact lenses more than having an annual supply in hand when they leave your practice!)

CONTACT LENS EXAM FEES: HAVE A SYSTEM

Having a system that allows clear communication of the fees and what the fees cover is crucial for patient acceptance. For example, for all our specialty contact lenses (hybrid, scleral, myopia-control, etc.), we have developed information folders that contain frequently asked questions and pricing that the patient is given at the time the fitting is scheduled. The patient then has all they need to know to make an informed decision prior to beginning the fitting process vs. being “surprised” by fees they might have otherwise viewed as unnecessary.

It is no secret that talking about contact lens fitting fees and materials pricing is not something all optometrists feel comfortable doing. If you are not comfortable discussing the specifics of pricing, you, at least, need to be able to speak to patients in general terms about what costs they should expect from their new lenses. Generally speaking, a discussion with a patient who is being re-fit in a single-day lens should include: “Ms. June, now that you are no longer in a multi-use lens, you will no longer have the costs associated with either solutions or the eye drops you’ve been using to increase comfort. Also, the manufacturer of this daily use lens offers an excellent rebate as well as no-cost shipping to your home.” At our practice, we also dispense a form that breaks down cost and details these benefits.

NEVER A BETTER TIME

Taking the time to determine chair cost, create a process to enable a thriving contact lens practice and have a system in place to discuss exam fees will translate into a successful contact lens practice for years to come. OM

DR. EARLEY is the co-owner, vice-president and human resource manager at Medina Vision Centre, Inc. in Medina, Ohio. He is the clinic director of Bright Eyedeas Vision Clinic, a local free clinic serving the uninsured. He has lectured nationally on the topics of dry eye disease, AMD, contact lenses and practice management. He is a member of the Ohio Optometric Association and the AOA. He is on speakers alliance and advisory boards for Alcon, Maculogix and MacuHealth. He can be reached at drearley@medinavisionandlaser.com.