Optometric Management Tip # 336   -   Wednesday, July 09, 2008
More Good Questions!

Continuing with the Q and A format, here is some more reader mail of interest.

Q. (Editor's note: this question was sent by a practice administrator and it refers to Tip #330.) I very much appreciate your weekly tips but I must admit some confusion over the one received today (Pricing Optical Products: Mistakes are Costly). I agree that our strategies are not well thought out on our pricing and we need to deeply consider all the services that go along with our products, but I am confused as to what you are suggesting. I was hoping for a mathematical equation that would be the end all to the issue. Probably the only statistic that I do not track is 'Rx capture rate in our optical'. Would you suggest I use this statistic to determine if pricing strategy is where it should be?

A. Yes, to some degree. I think it's smart to experiment with pricing and try to judge reaction any way you can. Rx capture rate is one tool if you know the usual rate before any change and the normal variability of the rate (the degree to which the data can change for no reason at all). See the question below for more on Rx capture rate.

I received several emails from readers in recent weeks who wished I had simply been more direct about how to set prices for optical products and contact lens services. There are two major reasons why I can't be very specific: first is the anti-trust concern about price-fixing and second is that the practice's market strategy and local economic conditions must be considered.

Q. Neil, I honestly do not know how you continue to come up with relevant business ideas over and over again. Every time I open your "tip" I am pleasantly surprised to find that you have done it again! So many appreciate what you do, but do not have time to express their appreciation. Let it be known that you are read faithfully by many and you continue to impress.

My question involves finding the best way to determine one's optical capture rate. We have three docs in one office so it is not as easy as a one doc practice. We could not even agree on how to define the capture rate. I think it is only patients who say they want new glasses and those to whom we recommend a change.

A. Thank you for the very nice compliment!

You're right to try to define the capture rate process as exactly as possible. I agree that we really only want to count patients who actually receive a true spectacle prescription (including new Rxs, Rx changes and requests for new glasses), but that can be hard to track and keeping things simple is important too. As long as I understand where the data comes from and as long as I keep the source of the numbers constant, it really doesn't matter. Once a baseline for your practice is established, you can just look for changes. You can also compare your data with other practices as long as they define it the same way.

We provide eye glass prescriptions to every patient as required by federal law, but if the patient decides to go elsewhere for glasses, the technician rewrites the Rx on a special two-part no carbon Rx blank. The tech signs the doctor's name and places her initials after it. The top copy is given to the patient and the second copy is dropped in a box in our optical area. The second copies are counted every month. We divide that number by the number of refractions for the month and that is our “Rx to go rate”; the inverse is the capture rate. I look for the capture rate to be at least 90%. I also track the number of spectacle Rxs my office fills that are written by other doctors. That offsets our prescriptions that are filled elsewhere.

Q. Some patients come in for a prescription renewal of their present contacts with their lenses on their eyes while others do not, even when told to do so. We have even had siblings coming in together where one is wearing the lenses and the other removed them after school. These patients are happy with their contacts and just want to reorder the current Rx. How do you justify a fee for the non-wearer (a corneal topography and keratometry – even though the lenses may have been out for several days) and how can you charge the wearer a CL evaluation fee if she could have avoided it by removing her lenses first? I've heard from many patients who have had doctors charge a fee in this instance and they were not happy about it, thus ending up in my chair. I also wonder how many patients put off an exam because of resistance to another CL fee.

If someone wants to try a new lens, fine a fee is justified, but I can't see how the prescription check of the same lens warrants a separate fee since I'm not doing anything I wouldn't do in the typical annual exam.

A. The vast majority of eye care practitioners (ECPs) charge an additional fee for the evaluation of existing contact lenses and related corneal health and we can make an excellent case that additional tests are indeed performed which are not done in a typical annual eye exam. I like the way you considered if patients might be put off by the additional fee because I always look at that also, but I'm still convinced that the fee should be charged. The patient dissatisfaction with the CL evaluation fee could be avoided if the office staff quoted it in advance over the phone. I don't think the fee drives a significant number of people to avoid care and the increased revenue more than makes up for the few that do. One reason that CL evaluation fees are so prevalent is that major vision plans allow the fee to be charged to their member patients. I don't recommend that ECPs pass up that opportunity.

As for the case you describe where a patient may arrive for an eye exam and not bring their lenses, I assume that is a very rare occurrence. I would prefer to see the contact lenses on the patient's eyes, and if they didn't bring them I may simply apply a pair of diagnostic lenses. In the end, though, if the patient wants to have the CL Rx renewed in order to purchase more lenses, a CL evaluation fee will be charged in my office. A technician will perform corneal topography and I will interpret all the data. If the patient reports no problems with the current contact lenses and my slit lamp exam is normal, I can renew the Rx based on the subjective refraction even without the contact lenses being present.

Best wishes for continued success,

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