Read more from the Q&A issue

• Methodology: Keep the questions coming
• How can optometrists efficiently schedule ocular disease patients in light of the COVID-19 pandemic?
• How can optometrists create a successful dry eye disease spa?
• How can an optometrist include the patient’s opinion when it comes to glaucoma treatment?
• How can O.D.s differentiate the neovascular form of AMD from similar diseases?
• How can an optometrist obtain diabetic patient referrals from a primary care physician?
• What should optometrists know about effective management of myopia?
• What is the value optometrists can provide and communicate for the fee charged?
• How can O.D.s get more engaged in luxury frame sales?
• How can optometrists get more new patients?
• How can an optometrist create a successful practice sans third party health plans?
• How do O.D.s create a system for quick and efficient coding?

A: Specialty contact lenses, such as custom soft lenses, GP lenses, hybrid lenses, orthokeratology and scleral lenses, can be life-changing for patients. As rewarding as it is to help these patients, it is equally as important to ensure your fees and reimbursement are healthy to generate a profit. Gasp – the P word?! Yes, it is very important that the services and products offered in your office are profitable, so you can continue to help these patients every day.

Here is what to consider when setting your fees:

EXPERTISE

Consider the amount of extra time you invest in learning how to fit specialty contact lenses. Attending workshops, viewing webinars and learning about the ins and outs of these lenses is an investment of your time. You have taken an extra step to add an additional service to your clinic, so you should consider this when setting your fees.

CHAIR TIME

Figure out how much time you will be spending with specialty contact lens patients. For example, you plan to take two hours for the fitting, one hour for the dispensing, one hour for the training and at least four follow-up visits at 30 minutes each. This results in a total of six hours of precious chair time. This is just an example of how long a traditional scleral lens fitting may take, and it will vary by practitioner.

Then, consider the amount of income generated by comprehensive eye exams that include optical sales on days where you have zero specialty lens patients. For example: Let’s say that you see two eye exams per hour and you earn about $200 for each exam (assuming patients purchase glasses or contact lenses or spend additional money above and beyond their comprehensive exam). So, now you know that if you see two exams per hour at $200 each, plus product purchases, that equals $400 per hour. This number can be considered when setting your fees for specialty lenses. Using the example ($400 per hour) and my estimate above (six hours of chair time), you would need an income of about $2,400 for a specialty fee to generate the same amount of money as comprehensive exams. (Please note your numbers will vary depending on your chair time and exam fees; this is just an example of how to understand setting appropriate fees.)

When I was fresh out of residency, I didn’t know how to set my fees. So, I just used the same pricing structure at the clinic as the university used. Big mistake! As a teaching facility, the prices are set much lower than at a traditional setting. I figured this out quickly because when I did the math from above, I realized I would be making more money if I stopped seeing specialty contact lens patients. However, I am incredibly passionate about helping patients through specialty contact lenses, so I had to figure out a fee that would enable me to do so.

Once I knew what to charge, seeing these patients was easy. I felt great about it once I could qualify my specialty lens fees.

SPECIALTY CONTACT LENS SERVICES

Respondents to OM’s Q&A Survey, who indicated that they offer specialty contact lens services, said they offered the following specialty contact lens services, specifically:

 

 

STAFF INVOLVEMENT

In the beginning of establishing a specialty lens practice, you, as the doctor, will be doing most everything because the staff will neither know about these lenses nor how to help you.

The first thing I would recommend in training staff is to have them assist with insertion/removal training for patients. If you already have a technician or optician who trains soft contact lens patients, it is fairly easy to teach them to assist with specialty contact lens training. First, have the staff member observe you teaching the patient, and have them take copious notes. Next, observe the staff member teaching a patient and take copious notes to provide feedback. You will do this a few times until you both feel comfortable that the staff member is fully trained.

Other areas in which staff can help:

Scheduling: Teach the staff how much time to book for each patient depending on their appointment type: new fit vs. dispense vs. follow-up visit. These should all have a pre-determined amount of time associated with them. This ensures efficient time management.

Operating equipment: Teach staff members how to acquire topography images, OCT images over scleral lenses, anterior segment images and videos and to use any other pertinent instrument. This will save tons of doctor time.

Over the years, I developed a system in which my staff can perform essentially every task, lens preparation, insertion, OCT images, anterior segment photos, etc., within the specialty lens workup under my careful supervision. I step in at the necessary point in the process, checking the lens fit, checking over-refraction and discussing important questions, such as lens expiration, with the patient. I still prefer to order the lenses myself, but in other clinics, the staff members may over-refract and order the lenses. It will take a while to achieve efficiency, but it can be done! The reason I prefer to order the lenses myself is because, sometimes, the consultants will have questions about the fit for which the staff member may not have an answer. And with increased efficiency comes increased profitability and increased capacity to aid patients.

SET APPROPRIATE FEES

Take a few minutes to figure out what your chair time is worth, and make sure you are setting your fees for specialty contact lenses appropriately. Remember that this service is above and beyond a traditional eye exam and requires special knowledge, equipment, and supplies. This should be considered a premium service, and your fees should reflect this. OM

Resources

   Check out non-profit organizations, such as the Scleral Lens Education Society, sclearllens.org , and the Gas Permeable Lens Institute, gpli.info , for more guidance on fee schedules and assistance with determining costs. This fee question gets asked so often amid my consulting clients, that I created a free calculator to help practitioners figure out their fees. This can be found at drstephaniewoo.com/calculate-my-fees . 

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. Dr. Woo can be found on Facebook and Instagram at drstephaniewoo.