Article Submission Guidelines for Practice Management, EHR, Glaucoma, and Managed Care

Exclusive Date: June 18, 2014

Filling Your Own Eyeglass Prescriptions

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In my consulting work, I’m quite surprised at how infrequently optometrists measure and monitor their eyeglass prescription retention rate. The Management and Business Academy (MBA) Key Metrics report for 2013 shows that only 23% of ODs track their Rx capture rate! That is a very low number for a metric that is so important to practice revenue and profit. In this article, I’ll explain the two methods for measuring this data: one very easy and one a little more complex, but more accurate. I’ll also cover the norms for these metrics and what to do if your capture rate is too low.

Method #1: Based on total exams
The easiest way to track your Rx retention rate is to take the total number of glasses made for a month and divide by the number of eye exams performed. Both of those values are easy to obtain from your office management software reports. I define a pair of glasses as a pair of lenses, because even if the patient uses his own frame, we still filled the Rx. So, add up all pairs of lenses sold. We also must decide what we mean by an eye exam and in this case it actually means refraction, but you must think about what services you bill for and what is in your software report. If you always itemize refraction, you will have that as a service on the report and you can use that number. Otherwise, just add up all codes for comprehensive exams, but omit office visits and lower level exams.

The median for this metric according to the MBA is 61%. That seems like a low number of Rxs to retain, but it is based on all refractions and many refractions do not result in a new prescription. In some cases, the doctor does not recommend glasses at all.

Method #2: Based on new prescriptions
Another method of tracking the Rx retention rate still uses pairs of lenses sold, but we divide that by the number new eyeglass prescriptions written and recommend by the doctor. The best way to track this is to actually count the number of people who walk out with their spectacle Rx (your staff knows who they are) and add that to the number of pairs of lenses sold and that is the total number of Rxs written. Tip #590 goes into this method in great detail.

I have not seen any national data with this method, but this percentage should be much higher than method #1 since we are only basing it on actual prescriptions, not refractions. I like to see this metric at about 90% and that is what the percentage is in my practice.

For extreme accuracy
There are two factors that also should be corrected for when using either method above:

  • Multiple pair sales should only have one pair of lenses counted. We are looking at patients who fill their Rx with you and that is one person even if he buys three pairs.
  • You should not count walk-in eyeglass Rxs since those are not your prescriptions, but these do help replace some of those folks who take their Rx out.

Why the low rate?
If your retention rate is lower than the norm, here are some things to consider:

  • This point only applies to the first method of tracking, but the doctor may be very conservative in prescribing. This is professional philosophy, but some doctors do not believe in making small prescription changes or recommending upgrades in lens design even if the patient is wearing old technology. I think under-prescribing is as much of a disservice to the patient as is over-prescribing.
  • A large medical eye care practice (often with a high percentage of older patients) can result in fewer spectacle Rxs. This would lower the percentage in the first method but would have no effect on the second method.
  • A large contact lens practice can also lower the number of spectacles prescribed. But ODs with practices in this category and the one above are often guilty of not working hard enough on the optical and just accepting poor optical sales as a necessary byproduct of their specialty. I know many medical eye care and contact lens practices that have outstanding optical sales.
  • An optical that is not impressive can be a big problem. It could be a small frame inventory or outdated d├ęcor and displays, but people make snap judgments about where they want to buy. Optical dispensaries are actually a retail environment and patients want to feel they are getting the best selection and the latest products. If your optical looks small and old school professional, many people will take their Rx to the super discount store or the mall or online.
  • A pricing problem. Optical pricing can still support strong profit margins, but the quality, service and value must be perceived as high. We must also consider the local economy and median household income levels as we design the price list and mark-ups.
  • Poor customer service in general. If the doctor and/or staff are way behind schedule, rude, rushed, inconsiderate, or there are other aspects of the patient experience that are poor, more patients will decide to take their Rx elsewhere. Conversely, developing a trust and a friendly bond will make more patients want to buy glasses from your practice.

Best wishes for continued success,

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