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I'll admit that the answer to that question is certainly subject to personal opinion and I know many
respected optometrists who passionately stand by them - but I have to say no. I think it's time to
revamp our approach to contact lens services and fees in a proactive, patient-friendly way.
I hear from colleagues who are pro-service agreement that the strategy (a) ties patients to their practice
and (b) is a good money-maker. But I think efforts to tie patients to a practice often backfire. You
can't force patients to stay with you, and they can usually sense it if you try. They have to want to
stay with you and the only way to achieve that is with excellent, patient-first service. A program is
not a good money-maker if it drives some patients away.
Contact lens service agreements were devised decades ago to meet the needs of contact lens practice at the
time. Hard and soft lenses were very expensive single items, which were easily lost or frequently wore
out due to protein deposits. Contact lens insurance plans were sold by insurance companies to ease the
financial burden of replacing lenses, and doctors devised their own discount plan to serve the same purpose.
This went well, until contact lenses became disposable and were sold in multi-packs. With per lens prices
as low as they are today, and with so many buying options available to the consumer, paying an annual fee
in advance in order to buy lenses at a discount no longer seems necessary. It seems out-of-date.
The other main feature of some CL agreements is pre-paid exams and office visits. This could be good in
theory, except patients today aren't planning on needing many office visits. And, in truth, most don't
need very many. Most successful contact lens wearers only need an annual eye exam (with CL evaluation).
Efforts to try to tell today's consumer that they need more care could create a lack of credibility and
cause invisible attrition from the practice. Sure, there will be an occasional red eye or other problem,
but most patients can look at their own history and figure that's not likely. And if they did need
interim care, they are willing to pay for the office visit - or bill their medical insurance in many
Many service agreements include other benefits - such as discounted eyeglasses and sunglasses and contact
lens solutions. I'm not convinced that these discounts are really good for practice profitability because
the price cut falls right to the bottom line. Most of these optical purchases occur in your office
anyway - without the discount. Bundling solutions takes a lot of staff time and there is very little
profit. Patients prefer the convenience of buying solutions at supermarkets or retail stores.
The Circuit City Syndrome
Take an objective look at how patients feel when they are faced with paying for services they think they
don't need. How does the explanation of the annual service agreement fee really sound? We're all
accustomed to the 19-year-old sales associate in the big electronic stores who tries a little too hard to
sell the extended service warranty. When some one tries to tick off a multitude of reasons why I need to
spend more money, I start thinking there must be some big profit in it for the store. I also have to put
on my consumer hat and analyze the offer for myself to see if it's a really good deal, or just a lot of
smoke. I don't want my patients going through these mental gymnastics in my office. It's bad for our
Patients not complaining?
Doctors often feel that if they hear no complaints from patients, it proves that the system must be good.
In truth, most patients won't question a doctor's policies, so it doesn't mean much. Many patients will
stay with their optometrist because they love him or her, in spite of some policies that are outdated or
don't make sense. But its still not good business practice. If enough negatives add up in the patient's
mind, some will silently leave the practice.
A better system
It may seem scary to change well-established policies, but businesses must change to stay competitive.
I dropped my CL service agreement program many years ago and it didn't hurt a bit. I was worried, because
I looked at the annual revenue that had been produced by that agreement, and it looked significant. As I
dropped the service agreement, however, I raised my CL fitting fees, annual CL evaluation fee, and even
lens materials. Everything went just fine and contact lens revenue still grew nicely from the previous
year. I could tell patients were happy about the move to a fee-for-service, pay-as-you-go basis. I got
rid of the nuisance cases who came in for office visits because they were free, we no longer had to argue
if an eye problem was contact lens related or not, and my staff got to drop the administration of the
program. The office ran smoother with everyone paying the same fees and prices.
Patients will pay high fees for excellent care, but no one wants to pay in advance for services they don't
need and may not use.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
A Proud Supporter of
Send questions and comments to firstname.lastname@example.org.
Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.
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