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 By Neil B. Gailmard, OD, MBA, FAAO, Editor August 31, 2011 - Tip #497 
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Pretend Your Services and Products Are Free

  Sponsor: SofLens® daily disposable

I was speaking to my friend, Walter Choate, OD, of Nashville, TN, by phone today and he shared a novel idea that he said I could use in a tip article. It's a great way for doctors and staff members to overcome price bias and prejudging patients. So here it is: recommend eye care services and products as if they were free. What would you prescribe or recommend to your patient if everything was free? How does that treatment plan differ from the one you usually would design?

Let's take a look at this approach in various areas of your practice.

Contact lenses
If contact lenses were free, and if the fitting services necessary were also free, what would you prescribe? What disposal period? What lens material? If you examined a patient wearing an older lens design, would you simply replace that lens with no change? Under our fantasy conditions, many optometrists would prescribe a high percentage of daily disposables. Many would recommend silicone hydrogels. In the real world, patients are left to wear older technology every day, without the optometrist even bringing up the idea of trying something new.

Of course, lenses and fitting services are not free and I don't think we should be insensitive to the financial impact of eye care on patients, but I think we it's a disservice to patients when we prejudge their ability to pay or what is important to them. I believe doctors and staff should recommend the best eye care, not the cheapest. The "what if it was free" exercise lets us see past our bias. It may be easy to just let patients stay with their old contact lens technology; it is certainly less risky, but it's not the best eye care.

Optical dispensing
If optical products were free, would optometrists be so shy about telling their patients about eyeglass features in the exam room? Would you simply write the spectacle Rx and let the optician handle it? Probably not. If glasses were free, ODs would want to help their patients with their lens options and they would very likely recommend free-form lenses, high index materials, a specific brand of premium antireflective coating and additional options like Transitions.

What about frames? If frames were free optometrists might actually advise patients to get a new one! Why not enjoy a new look and the latest fashion? Why not get a frame that fits better and looks better? No one would ask the question "Do you want to use your old frame again?"

How about multiple pairs of glasses? Patients would select a few colors and styles of frames to change their appearance and match various outfits. Doctors would write prescriptions for a special pair of glasses for office use and additional Rxs for hobbies and TV viewing. Of course, prescription sunglasses would be selected for every patient.

Opticians would no longer lead patients to the budget frame display first. Instead of spending a lot of time discussing various levels of progressive lenses, they would simply recommend the best.

Exam services
Exam services and diagnostic procedures may be a little more immune to the "what if it was free?" test, but there are still some lessons to be learned. I think eye care professionals don't hold back on necessary testing when vision and eye health is at stake. We order the tests that are needed—no more, no less. But look at the following services and consider if there are times you might recommend them if they were free:

  • A panoramic laser image of the retina
  • A screening OCT
  • A thorough low vision evaluation
  • A comprehensive binocular vision evaluation for a child
  • A multifocal contact lens workup
  • More frequent follow-up visits to monitor a problem
  • A wave front analysis coupled with corneal topography and a computer program to modify the subjective refraction to produce a spectacle prescription that optimizes vision in a patient with higher order aberrations.

Of course, eye care is not free and we should have options for patients who indicate cost is an issue. And I'm not recommending that we order diagnostic tests that aren't needed or bill insurance plans for things outside the standard of care. But it would be just as bad to pre-judge the patient's budget based on his clothing or the kind of car she drives. The people you least expect can be millionaires and people with average income may place a very high value on eye care and optical products. Let's let them decide what they want by offering the best first. It is good for the reputation of your practice.

Best wishes for continued success,

Read Past Tips 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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