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| A Comfortable Choice for Monovision |
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I often hear doctors complain about the relatively low profitability of contact lens practice,
usually blaming the low lens prices offered by big box retail stores. We really do have quite a
bit of control over contact lens profits, however, and I'm puzzled why more doctors don't exercise
it. It seems we can become paralyzed by low prices in the marketplace. In this tip, I'll offer a
three point approach to improving contact lens net income.
Contact lens products
Back when all contact lenses were custom designed rigid lenses, doctors were protected against
people shopping and one could claim that the lens design was so superior that it rightfully commanded
a higher price. Well, times have changed and we need to get over our longing for the good ol' days.
Now, the most frequently prescribed lenses are mass produced and they are the exactly same no matter
where they are purchased. But the service that goes with the sale of lenses is not all the same.
If you keep your customer service levels very high and you instill a high degree of trust in your
patients, you do not have to match or even come close to the lowest price in the market.
Most practices spend too much time worrying about the competition and not enough time improving
internal operations and service. Forget the competition. Let a few patients who want the lowest
price take their Rx out, but release the Rx gracefully so you keep the family as patients. Most
patients will continue to buy lenses from you because it's convenient and they like your practice.
Enhance that natural tendency by making sure your office is easy to do business with in every way.
Contact lens professional fees
Many eye care professionals grossly undercharge for their services related to contact lenses.
This is an area that you have direct control over and it makes the difference between a good profit
margin and a poor one. And these fees are generally not covered or restricted by vision plans,
except for a mandatory discount in some cases. I charge and itemize a separate contact lens
evaluation fee in addition to the eye exam fee whenever I examine a patient who wears contact
lenses. Patients are informed of this fee over the phone when the appointment is scheduled and it
is well-accepted in my practice. This contact lens evaluation service has become the norm among
optometric practices nationally. The evaluation fee applies even if there is no change in lens
prescription because it covers additional testing that I do for contact lens patients, such as
over-refraction, evaluation of lens fit with the slit lamp and corneal topography.
The evaluation fee changes to a fitting fee if a significant change in lens fit, Rx or design is
needed. My practice has five levels of contact lens fittings and the fees vary based upon
complexity and previous wearing history. These fees may include insertion and removal training
and follow-up visits.
Delegation in contact lens practice
Most eye care professionals recognize the need to delegate optical dispensing and some clinical
testing duties, but they drop the ball when it comes to contact lenses. Patient education on
lens insertion and removal and lens care is one element of contact lenses that has been
traditionally delegated to an assistant - but there is so much more. As we look to increasing
profitability in a field where some fees can't be increased due to market pressure, we must look
to being more efficient. If a contact lens fitting can consume less doctor time and more
technician time - it immediately becomes more profitable!
- Can all your technicians insert and remove contact lenses on a patient's eye and do it with at
least as much skill as the doctor? If not, train them and have them practice on co-workers.
- You can greatly reduce doctor time on new contact lens fittings by telling your technician what
lens brand and Rx you want to see on the patient - and then move on to your next patient. The tech
finds the trial lenses, inserts them and makes sure they settle properly. You will return later to
check the fit.
- While waiting for the doctor, the tech can take visual acuity with the lenses, perform an
autorefraction over the lenses and even perform a spherical subjective over-refraction with the
phoroptor. Subjective refraction is obviously much easier if cylinder is not being tested.
Always work within your state laws when delegating.
- Based on your comfort level, some technicians can perform slit lamp exams and check lens
centration and movement as well as toric markings.
- Technicians can assist with these same procedures during progress checks.
Make sure you are up to date with your contact lens procedures. Lens materials, designs and
prices have all changed greatly over the years and our evaluation and fitting process must change
as well. Don't make things overly complex. Patients love simple and quick procedures. That
actually impresses them even more than complexity.
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 neil@gailmard.com.
Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.
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