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 By Neil B. Gailmard, OD, MBA, FAAO, Editor February 17, 2010 - Tip #418 
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Dramatically Increasing Your Contact Lens Productivity

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Additional Information

It's easy to just put your contact lens practice on auto-pilot and not make any policy or procedure changes for years. I'll admit that I did that for awhile, but there are some excellent reasons to develop a new strategic plan for contact lenses right now. Consider these questions:

Do you really want to prescribe more contact lenses?

Surprisingly, many eye care practitioners (ECPs) are fairly neutral about fitting contact lenses. Sure, they are happy to fit contacts if the patient requests them and if he is a "good candidate", but may ECPs have lost some enthusiasm over the process. It is extremely rare for the ECP to bring up a serious discussion about contact lenses if the patient did not ask about them or show some interest on an intake form. At best, ECPs may mention contacts as an option, but that is far short of making a strong recommendation for them.

If the patient does ask about contact lenses, many ECPs launch into a somewhat negative tone on the subject, perhaps with the goal of screening out the under-motivated. If the patient is a preteen, we warn about being responsible enough. If the patient is over 40, we make it clear that multifocal contacts are not perfected yet. We warn about allergies and dry eyes and we start talking about fees, which are very complex. We most likely reappoint the patient for a fitting visit. Yes, I know the reasons we do all this, but bear with me and see this through. If you step back and look at our typical approach, it becomes clear that we must not really want to fit contacts all that much. Why is that?

  • The contact lens fitting process is often viewed as taking too much chair time.
  • We might rather just prescribe glasses. After all, optical dispensing is very profitable.

Both of these possible reasons tell me we are not charging enough! Chair time? Isn't chair time what we want to have happen as long as we are getting paid well for it? Most optometric practices need to be way busier, which means you need chair time! A vague feeling that you would rather prescribe glasses than contacts indicates glasses must be more profitable. But that does not have to be the case. You could make contact lenses more profitable tomorrow and that is exactly what you should do. Let's make contact lenses so profitable for your practice that you want to bring the subject up to nearly every patient!

Contact lens fees

Contact lenses used to be the darling of optometry because they were a luxury item that carried higher fees. Large contact lens practices were the elite in the 1970s and 1980s. Of course, we've seen many changes in the contact lens field since then, including disposability and e-commerce. That changed the market and pricing structure for contacts, but it does not mean that we can't control our fees. It just means that we need substantial change to our professional fees in much the same way that contact lens products have changed.

Since it is easy for consumers today to price shop for contact lens products, it is a good strategy to set your lens prices to be competitive. You may not be able to be the absolute lowest vendor, but you can retain most contact lens sales and still make a moderate profit on the materials if you price properly. Add to that moderate profit a much higher fitting fee and ongoing yearly evaluation fees, coupled with special testing like corneal topography, and the total revenue and profit from fitting contact lenses can equal or exceed that from other practice categories like optical dispensing or managing ocular disease.

Raise your contact lens fees to a point that makes you want to fit them. If patients decline due to the fee, then so be it. That is what you wanted to happen anyway with your old fee structure! But most patients won't decline. Read on to see how to increase your fittings dramatically even if you raise your fees.

Why is it smart to grow your contact lens practice?

Naturally, it's smart to grow any segment of your practice, but with vision plans covering such a high number of patients in most practices, contact lenses look even better. Vision plans require very deep discounts on basic eye exams and eyeglasses, but contact lenses are still pretty much left alone. Most vision plans provide an allowance amount that may be used toward contact lens products or services, but the practice is generally free to charge usual and customary fees. In some cases, a discount off the service fee is mandated by a plan, but that is not that damaging to profitability.

Routine yearly exams for contact lens patients also produce a higher profit level than exams for eyeglass wearers because vision plans allow us to charge an additional contact lens evaluation fee which is either paid directly by the patient or vision benefits may be used. That is a very strong reason to increase your contact lens practice.

Let's also note that virtually all contact lens patients have eyeglasses as well. There may be some rare exceptions and the glasses may not always be up to date, but there is a genuine need for glasses. I always review the contact lens patient's eyeglass status at every exam and there is the potential that new glasses will be needed. The opposite is not true of eyeglass wearers. Most of them do not have contact lenses. So contact lens patients provide two revenue streams and eyeglass wearers only provide one. One more thing: contact lens wearers return for eye care much more frequently than eyeglass wearers. The average exam interval is every 18 months for contact lens wearers compared with every 2.4 years for other types of patients.

How can you fit many more patients with contact lenses?

Now that you want to fit more contact lenses, the secret to doing so is simple. It is a two-prong approach:

  • Bring up the subject of contact lenses with the patient and make a strong recommendation about how great they are. Don't wait for patients to ask about contacts. Recommend contact lenses to virtually everyone unless there is a contraindication based on your exam; don't limit your recommendation to just the obvious great candidates. Open up your own paradigm about who can wear contact lenses (kids, presbyopes, high astigmats, senior citizens, etc.). Great advancements have been made in contact lens designs and materials and our fitting philosophy must keep up with those advancements.
  • Break down the barriers to letting the patient try on a free pair of lenses after an eye exam. Just put them on the patient and send them out to the reception area or the optical to see what they think. Just say "I'd like you to try a pair of contacts on to see what they're like." If you make this super-easy, you'll fit many more patients. No fee is charged for this trial experience, no discussion of fees, no warnings, no scare tactics, no speeches, no disclaimer forms, no education, no videos, no insertion training, no discussion about the type of lens or the disposal schedule. We can cover all that later. Let's put the cart before the horse and allow the patient to just experience contact lenses. If this becomes a very frequent procedure, and it should, you can get to the point where you delegate the lens application process to a technician. You will just indicate what lens brand and powers to put on and move on to your next patient. It is very easy if the technician is scribing.

After a few minutes, either the doctor or the technician will check with the patient and ask about the experience. Now is the time for patient education and answering questions. In most cases the patient will be very excited about the idea of contact lenses and the consultation takes on a very positive tone. In some cases, it will be obvious that the patient is not a good candidate and the lenses are simply discarded.

At best, this patient will become a long time contact lens wearer in your practice. At worst, the patient will have a very cool experience in your office and they will tell others about it.

Can you think of any problems with this approach? Can you overcome them?

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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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.

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