Optometric Management Tip # 162   -   Wednesday, February 23, 2005
Expired Contact Lens Prescriptions

Itís no secret that I am a strong believer in the power of patient satisfaction in practice building. To that end, I seek out and study situations, in my own practice and in optometric practices in general, which have the potential to make patients unhappy. Managing these tough situations properly is a big step toward success in practice. Handling a request for a contact lens prescription, especially when the Rx is expired, is the mother lode of such situations. This happens frequently in optometric practices today, and we need to step back and evaluate our policies.

Itís easy to get caught up in defending our rights under the new Fairness to Contact Lens Consumers Act (FCLCA), and in watching the competition like a hawk to make sure they play by the rules. Admittedly, they donít always play by the rules, but my best advice is to focus on the patient more than the contact lens seller. It seems to me that many ODs are so interested in being right, that they forget the more important task of satisfying the patientís wants and needs. Do that well enough and no one will ever leave you! Spend your time trying to figure out a way to deny the request from a mail order company or discount chain store, and you will alienate the patient and heíll go elsewhere not just for materials, but for professional care as well. And heíll take his family with him.

When a patient calls your office, or when a contact lens vendor contacts you on the patientís behalf, your patient has a need. How well do you really handle that need?

Put yourself in the patientís shoes

Letís develop an analogy that puts you in a similar situation. Suppose you take a medication for gastric reflux disease called Nexium. It works great for you and youíve taken it successfully for years. You see your physician regularly, but maybe not quite as often as you should. You order your medication from a mail order pharmacy in conjunction with your health insurance plan. Knowing you have another unopened bottle of pills, you take the last pill in a bottle. The next day, however, you discover that spare bottle was old and empty and you are out of pills.

You call your physician, and speak to a rude receptionist who seems busy and uninterested as you tell her your plight. She says sheíll have to pull your chart and someone will call you back. As heartburn develops (in more ways than one), a nurse from the office finally calls you back and tells you that you are past due for an exam with the doctor and you need a blood test to check your liver profile (she reminds you that the drug does have serious side effects). They offer you an appointment a week from Friday. You explain that you need the medication now. Youíre willing to have the needed exam, but you remind the nurse that you are feeling fine and you just need some more pills. You arenít sick Ė you just need a refill! You get the picture.

At this point, the medical office might do various things to help you out Ė or you might be munching Rolaids for the next ten days waiting for your appointment.

What would you expect the doctorís office to do? Youíd probably be happy with any of the following:
  1. Offer you a 2-week supply of free sample pills to get you by until your appointment.
  2. Offer you an immediate Rx for a 30-day supply of pills that you could take to the local pharmacy and have filled, even though the Rx is technically expired, taking your word that you will schedule an appointment with the doctor and have the blood test.
  3. Offer you an appointment at 2pm this afternoon, in which case the doctor can examine you, order the blood test and write a new long term Rx.
Now, letís put a slight twist on our scenario. Suppose you contact your pharmacy for more pills, instead of the doctorís office. For realism, pretend itís either the mail order pharmacy or the pharmacy in one of the big discount stores. The pharmacy technician says you are out of refills, but she will contact your doctor and have the Nexium Rx renewed for you. You say fine and you wait. Behind the scenes, the pharmacy contacts the doctorís office by fax or leaves a message on the office answering machine (doctors often have strange hours). The nurse eventually looks at your chart and sees the Rx is expired because you are past due for an exam. The medical office faxes the Rx form back to the pharmacy stating that the Rx is invalid. Or perhaps the office just ignores the form altogether. Eventually, the pharmacy contacts you and informs you that the doctor will not approve the refill request.

This scenario is enough to evoke anger. You may even be tempted to find a new doctor. Are you angry at the pharmacy? No, probably not. Youíre angry with the doctor for not caring about your situation and for not helping you out.

So, what should you do in your practice?

The lesson to learn is to help your patient out, as quickly as possible. Today. Do so and youíre a hero, fail to help and youíre a jerk. Donít assume the patient is just out to trick you or avoid care or stockpile lenses. Donít be offended if the patient wants to buy lenses elsewhere. Be realistic about the health risk of supplying more lenses until the patient can get in for the exam (itís minimal). Donít worry if the patient obtains a few more lenses than the exact quantity he or she needs to reach a specific date on the calendar. Assume the patient still wants you as his eye doctor and is willing to come in for the follow-up visit until proven otherwise. Sending a signal that you donít trust him, or that you doubt his word, is a certain way to create bad will.

Consider offering a grace period on the expiration of CL Rxs, say for 3 or 6 months. During that time, your staff will know that youíll allow a refill of the smallest available quantity of disposable lenses, as long as the patient commits to scheduling an exam. A grace period policy will reduce the stress on your staff immediately, and patients will love the fact that you helped them out of a jam.

By all means, have your staff call the patient as soon as you get a request for an Rx that has expired. Explain the situation and offer ways you can help. Your patient is due for an exam and you may be able to convert the patient back to your office for lens sales, especially if you have them in stock and you make it convenient.

What are your options?
  1. Dispense a trial pair of lenses to get the patient by until his next visit. See the section below for why this is not the best option.
  2. Write an Rx for the minimum quantity of lenses available (frequently a 6-pack for each eye). This is an excellent image builder because it says youíre interested in the patient first and foremost. You gave the patient what they wanted and needed. You also gave the patient adequate time to schedule the eye exam with no pressure. Donít forget, there is an unspoken financial burden in scheduling an eye exam and CL evaluation. Some patients may not have budgeted properly for that, but donít want to say it. This policy lets them save face gracefully. Angry confrontations that donít make sense often occur because there is a hidden reason.
  3. Accommodate the patient for an eye exam very quickly and issue an Rx for a full year Rx. This obviously depends on the availability of the patient and the doctor, however.
Misuse of free samples

While the free sample route seems like an easy answer to the problem, and many optometrists do this, itís really not a good answer. Free samples are made available by the manufacturer as an aid for fitting the lens, or in drugs as an aid in starting a new prescription. They are not intended to be a convenient method to help people who run out of the product. Abusing samples in this way only drives up the cost of the product, and since trial allocations are determined by ratios based on product sales, overuse could lead a practitioner to run short on his or her bank of trials, and not have enough for fitting purposes. A better answer is to write a short term Rx for a drug or a lens and let the patient buy the needed product, if they also schedule the exam.

History

Our heritage with contact lenses may actually make optometrists behave in a way that seems irrational to those who donít understand it. Many ODs felt like the supply of contact lenses was integrally connected to the professional care, and as such did not want to release the prescription for the patientís own welfare. Back when contacts were custom made, that was true. In fact, before the FCLCA, a large percentage of ODs refused to release CL Rxs (which is actually why the FCLCA exists). Many ODs feel that mail order suppliers and big box discounters are the enemy Ė and any cooperation with them is personal and painful. We need to get over these feelings, because times have changed, and patients donít get it or care about it.


Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management