Optometric Management Tip # 149 - Wednesday, November 24, 2004
Restoring Profitability to Your CL Practice
Are you unhappy with the landscape of contact lens practice today? You arenít alone. Many of our
colleagues today feel like there is little profit left in materials as they try to compete with big-box
stores and on-line resellers. Add to that a trend toward patients wanting their CL prescription, but not
understanding the need for ongoing eye health exams or the professional fees that go with the service.
Contact lens practice is changing fast, but it can still be rewarding and profitable. Hereís how.
Patient not the enemy
First, we have to get our mindset back on the side of the patient. We can even learn a few things from
them, but we have to step outside of our strong optometric paradigm. We have to accept that we need to
look at contact lenses from a fresh point of view. That shouldnít be too hard Ė the old point of view is
not that great anyway! We have not been successful trying to change the patientís thinking, so maybe we
should look at our own thinking.
What you can control
The frustrating thing about contact lens practice is that so much is happening beyond your control. The
CL prescription release act, the various forms of competition, the fact that patients are more inclined to
shop around, and more. So lets look at the factors you can control. With all the change going on, what
have you changed about the way you practice? Probably not much. Letís review two steps to make contact
lens work more profitable:
- Raise your fees. Review all your CL fees: the fitting fee at all levels of complexity, the ongoing CL
evaluation fee and the lens materials. If your fees have not been increased for a while or if they are
still fairly low, increase them. Material prices should remain in the ballpark of online sources, but
they donít have to match them. Your office need not be the lowest price because you offer many more
advantages than other sources. Patients rarely complain about an increase in exam fees Ė they only
complain when they think they are being forced to buy services they donít need. More to come on this.
- Assuming your fees are at the maximum you feel comfortable with, you can make your existing fee
structure more profitable if you spend less time delivering the service. You can actually do both at
once: raise fees and spend less time.
Most of your CL procedures are based on what you learned in optometry school, but contact lenses have
changed drastically since then and so has your skill and intuitive ability to fit lenses. Iíll bet there
is waste in your clinical procedures. All you have to do is find it and eliminate it. Ask yourself these
- Can you fit and dispense a new CL candidate on the same day as his eye exam even if you didnít know he
wanted CLs ahead of time? If not Ė why not? What would you need to be able to do it?
- Reducing chair time is a huge factor in your profitability and if the patient is already in the chair
itís far more efficient to just finish the job.
- You have all the data you need after the eye exam Ė why not just put lenses on, check them and
- Youíll get a bonus of more referrals and loyalty because people love instant gratification! New
contact lens wearers are enthusiastic and want to tell others about their experience. Donít throw cold
water on the experience by slowing it down!
- You need trained staff to make fittings happen on the same day. Delegation is the only way to make
contact lens fitting more efficient. It doesnít cost to have a technician assist with the fitting and
dispensing; it pays off in efficiency because the doctor can do other things at the same time and
productivity goes up!
- Do you reappoint for a new CL fitting because you feel it may be more impressive to the patient that
way? Do you think prescribing contacts quickly and easily after a general eye exam trivializes the care?
Do you think reappointing develops a rationale that supports the fitting fee?
- I find that patients are more impressed with my ability to fit CLs easily than they are with repeat
visits and lots of clinical time. They will even pay more if they can get it done with less hassle.
Patients have been telling us they want contact lens care to be fast and easy Ė why not provide it?
- How many follow-up visits do you need after a fit Ė and how often do you need to see the patient for
ongoing care in year 2 and beyond?
- Donít require more visits than you really need, and re-challenge your philosophy on what you do need.
Daily wear disposable contact lenses are very safe and risks are minimal. There are risks, but the
consequences are reversible. Even if a complication does occur, the patient will develop a symptom and
removing the lenses will generally resolve the problem. In a worst-case scenario, you will prescribe the
proper medication to restore eye health. Iím not convinced that evaluating the healthy patient at the
6-month period will prevent an infection at the 8-month period. Iím certainly not suggesting no follow-up
care or no ongoing evaluations, but can your protocol be reduced?
- Resist the thought that you need to make contact lens care seem more complex by requiring more visits. Patients are smart and they learn quickly that all is fine, and they feel like extra visits are a waste of their time and a money-maker for the doctor. When they sense that, they will become complainers and will eventually seek other sources for lenses and care.
Please donít misinterpret this streamlining concept to imply that I endorse shoddy care. I know contact
lenses are medical devices and I respect every doctorís individual professional judgment to decide how
much care is needed. Fitting contact lenses is like any other professional service, whether it be
prescribing glasses or treating glaucoma; we each must decide for ourselves what tests are needed and how
frequently we need to see a patient based on the inherent risk.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management