Have you been to a meeting or read an article about specialty contact lenses and thought to yourself, “I have a few patients I think could benefit from this, but I don’t really know where to start?” If so, you are not alone. Many practitioners see the value in offering specialty contact lenses, but do not know how to implement this optometric niche within their own practice.

The good news: Several optometrists have started exactly where you are, seeing many patients for a myriad of exams, such as comprehensive eye exams, contact lens exams, medical eye exams, for prescribing glasses and more, and they have gone on to have successful specialty contact lens practices!

When I started practicing, in general, I joined a private practice. In that practice, I saw what most eye doctors see: patients for regular eye exams, soft contact lens fittings, eye emergencies, post-operative care, etc. Fresh off my cornea and contact lens residency, I was determined to add a specialty contact lens component to the practice. Born out of this determination was a system that follows a series of since fine-tuned steps, to develop an efficient and effective specialty contact lens service:

STEP 1 COMMIT

If you want to fit specialty contact lenses, such as GP, hybrid, scleral and multifocal contact lenses, you must fully invest in this cause. Dabbling in specialty contact lenses here and there, for example one corneal GP lens fitting and one scleral lens fitting per year, is not helping your patients or yourself. You have to constantly practice your skills to branch out.

Imagine if you went to a dermatologist and found out she removed skin cancers on one or two patients per year. Would you feel comfortable staying with that dermatologist? My bet is you would prefer to have a practitioner who does 50 skin cancer removals per year. Think about the patients and what you would do in their shoes. If you are not committed to learning all there is to know about specialty contact lenses and applying that to your practice, you are wasting your patients’ time and your own.

Since much learning happens with a hands-on approach, I’ve found it is best to attend a wet lab or workshop, so you can gain the tactile skills of insertion, removal and lens care. Once you have mastered the technical skills, you can search online for free webinars or magazine articles to help develop your practice management of specialty contact lenses.

STEP 2 INFORM YOUR STAFF

It is critical to make sure all staff members are on the same page as you. To accomplish this, educate the staff on this new type of service, and get them familiar with the terms and conditions associated with these lenses, for example, keratoconus, corneal transplant, irregular astigmatism, scleral lenses, hard contact lenses, etc. Every staff member should be in the loop and know the type of patients you can help. Weekly staff meetings or lunch and learns are the best approach. This allows staff members to truly focus on what you have to say and ask questions.

STEP 3 DEVELOP A FEE SCHEDULE

This is an important action item that should be completed before seeing any patients. I developed fees in the beginning and adjusted them over time. To accomplish this, sit with your financials and come up with a fee structure that is fair to your time and expertise.

Consider this: You will be spending much more time with specialty contact lens patients than standard patients, and this needs to be accounted for. Free calculators, such that can be found at gpli.info, can assist with this, if you have no idea where to start.

STEP 4 CREATE A PATIENT SCHEDULE

I recommend starting with one patient slot per week. For instance, you can tell your staff Tuesdays from 11 a.m. to noon should be a slot reserved for a specialty contact lens patient only. Once that slot starts to fill, you can start adding more slots to your schedule.

STEP 5 TRAIN YOUR STAFF

In the beginning, you will need to allot a large amount of time for each patient because you will be the only person in the practice who can do the necessary tasks. I suggest having your technician follow you during this time to observe and figure out how to help these special patients. Over time, you will be able to train your technician to assist with lens insertion, removal and even lens training. In my practice now, I have a system so that the technicians know exactly what to do for each patient. Because this system is structured so well, I rarely have to remind them of what to do. We also have designated staff to help with the contact lens training.

STEP 6 GET BILLING HELP

Billing and coding for medically necessary contact lenses can certainly seem foreign to most medical billers. To instill familiarity, I recommend having staff members watch webinars, read related articles and call insurance companies to ask for help.

Also, consider developing a protocol so that intake staff members call the insurance companies prior to the patient visit. This way, they can find out whether the patient is eligible for the designated diagnosis and CPT codes. This will help streamline questions to make sure everyone is aware of copays, deductibles and covered services and materials at the time of the visit. After the patient has been fit with the specialty lenses, I suggest working with your medical biller to make sure the claim is billed properly with the appropriate codes. Ensuring accuracy will help you get paid appropriately and on time.

STEP 7 CREATE PATIENT CONTRACTS OR AGREEMENTS

This is a critical piece I did not do in the beginning of my career, and it was a major mistake. I highly recommend you make sure you have a contract that spells out exactly what is covered under the service fee and the material fee. Specifically, this would list what the price includes and also what happens in the event of certain circumstances. For instance, if the patient drops out of wear for any reason, will they get any sort of refund? What happens if the patient breaks or loses a lens? Do you have a payment program set up? I have found that having everything in writing makes it very easy and crystal clear to everyone. You can simply refer to the contract that both you and the patient have signed and review it together in the event that an issue arises. When there are no questions about what to do, everyone is on the same page.

STEP 8 PURCHASE ONE FITTING SET

When you get a fitting set, it is already intimidating opening up every little contact lens case, looking at the parameters and trying to comprehend the fitting guide. If you have to do that with more than one set, you can become easily confused and frustrated. A good analogy would be like learning how to drive: If you have no idea how to operate a vehicle, and one day you are learning on an automatic Honda Civic and the next day you are learning on a giant lifted pickup truck with manual transmission, that would be incredibly difficult. You are learning how to drive, so having too many vehicles to operate would certainly be stressful and delay your learning. This is similar to specialty contact lens fitting: Pick one fitting set you like (or use the laboratory you are already using for your GP lens orders), learn it really well, and then explore other options later.

Therefore, the best advice I have is to purchase one fitting set and become super familiar with how to select lenses, how to adjust the parameters, how to order lenses, and develop a relationship with laboratory consultants. Once you become incredibly comfortable with one fitting set, you can expand and purchase others. But, if you purchase too many and try to learn them all at once, it can become overwhelming.

STEP 9 FIND A MENTOR OR SYSTEM TO HELP YOU

If you still are unsure of how to fit and evaluate specialty contact lenses, workshops at conferences, as well as laboratory-sponsored events may help. Some examples include scleral lens workshops offered at major optometric meetings, such as Vision Expo or the hosted American Academy of Optometry. For a more in-depth training, many laboratories offer daylong workshops, such as the Scleral Consultative Institute (Drs. Jeff Sonsino and Mile Brujic) or my own offering via Woo University. These daylong events are jammed packed with high-quality information, along with live fitting demonstrations. The courses also cover real-life practice management topics, such as billing and coding, staff training, patient education and more.

On the business side of things, a practitioner who is well versed in specialty lenses can help you build or grow your specialty contact lens business as a mentor or consultant. The Gas Permeable Lens Institute, for example, has an advisory board full of specialty lens experts. You just have to take action and ask. Additionally, you may also consider coaching or consultation services. The beauty of a consultant is that they can condense a ton of information into an organized and sequenced approach. After a year of spending many hours watching webinars and reading articles on specialty lens billing and coding, my staff and I were still confused on certain topics. We hired a billing consultant at an hourly rate, and we asked him a ton of questions. The cost of the hourly service seemed quite high at the time, but after meeting with him, we realized how many hours (and likely many frustrations, too) we had saved by asking an expert. Also, hiring a consulting service (which I offer) may help you to develop a system that works for your practice and goals.

SET YOUR SIGHTS ON EXPANSION

Specialty lenses were nonexistent in my practice, but my passion to help patients through specialty lenses helped me create the specialty lens portion of the clinic. I am proud to say that this niche has led me to develop a new clinic, which is completely dedicated to the needs of specialty contact lens patients. By implementing systems to help develop and expand your specialty lens population, you can certainly help many patients with their vision needs. Helping patients achieve great vision has made a remarkable impact on me as a practitioner; I highly recommend pursuing specialty contact lenses, if your heart is in it. OM

DR. WOO owns the Contact Lens Institute of Nevada, a clinic dedicated entirely to custom contact lenses. She is past president of the Scleral Lens Education Society. She owns drstephaniewoo.com , an optometric consulting company. She is a consultant to many contact lens companies.