Article Date: 4/1/2007

fix this practice

 RICHARD S. KATTOUF, O.D., D.O.S.

You Decide On Discounts

Be sure that both staff and patients understand your office collections policy.

Patients keep asking for “discounts” on services and materials. How do we handle this growing problem in our practice?

F.L. Perkins, O.D. Via e-mail.

A: First, I would suggest independent practices eliminate the word “discount” from the office vocabulary. This is a retail term. Replacing it with words such as “savings,” “courtesy” or “professional discount” will help refocus both patients and staff.

Getting the best “deal”

This issue is becoming very common throughout the country. The mentality of the patient (consumer) is to ask or look for a “deal.” It’s interesting that many other health-care professionals would never consider extending professional courtesy to the general patient.

Optometry has a history of being a “product-based” profession. This history and an increase in commercial optometry practices are partly to blame for the discount dilemma. Many O.D.s are to blame as well for enabling their patients to seek discounts by caving in to these requests.

A client of mine has a specialty practice limited to pediatrics, developmental vision and brain-trauma patients. Dr. Harriett (name changed) doesn’t accept any vision or medical insurances. His office bills the insurance companies as a service to the patients, but all services are private pay. The fees for a therapy program range as high as $4,500.

Prior to Dr. Harriett retaining my services, he had three payment plans, two of which allowed patients to make monthly payments. This doctor’s accounts receivable (AR) were out of control. When you enable the patient to pay per visit or per month, you put the patient in control of the program.

Other alternatives

I advised Dr. Harriet to only offer services on a per-case basis, giving patients two options: pay the fee in full or borrow the money through care credit, a service that helps patients who have medical needs not covered by insurance (www.carecredit.com). This change in policy eliminated the high AR, raised net income and cash flow.

I composed an in-house script for his staff, should any patient ask for discounts, which explained the following points:

• The office’s fee structure is reasonable for specialized services.

• If our office reduced the fee, it would be necessary to downgrade the professional services, which could result in unfavorable results.

• In order for our office to continue to render the best staff, facility, instrumentation and services, it’s not possible to lower the fee.

• If our office extends a courtesy to any patient, there will be a “snowball” effect with any of that patient’s referrals expecting similar savings.

Put it in writing

In my experience, the root cause of these problems is a lack of defined collection policies. Write them down in your policy manual, discuss them with the entire staff, and have all your employees sign the policy to indicate they fully understand it. The only exceptions to the policy is a short, pre-submitted list of patients who you have determined will receive the courtesy. The entire organization shares in the responsibility of the collection policies. You have heard me scold you in the past: Charge what you’re worth. Stop practicing in fear of the patient, and don’t be shy about fees!


DR. KATTOUF IS PRESIDENT AND FOUNDER OF TWO MANAGEMENT AND CONSULTING COMPANIES. FOR INFORMATION, CALL (800) 745-EYES, OR E-MAIL HIM AT ADVANCEDEYECARE@HOTMAIL.COM. THE INFORMATION IN THIS COLUMN IS BASED ON ACTUAL CONSULTING FILES.



Optometric Management, Issue: April 2007