Article Date: 5/1/2009

The Proof is in the Practice
practice profile

The Proof is in the Practice

Lange Eye Care seeks and seizes opportunities to keep growing.

Phoenixville, Pa.

On a Saturday morning in April, Michael Lange, O.D., C.N.S, is reflecting on why his optometric practice in central Florida continues to grow despite the economy.

"It's hard work," he says. "This is literally the first day that I've had off in probably eight months."

But even that has a caveat:

"Not totally off because I had two talk shows this morning."

Those talk shows are part of the radio outreach fueling the growth of his 14-doctor, eight-location practice. The eighth office just opened this month, and no recession will deter his plans, he says. (See "Three Recession-Busting Strategies," below.)

A penchant for working 18-hour days and running a nutraceuticals business after hours — the C.N.S. is for certified nutritional specialist — sustain that business model. (See "Nutraceuticals Niche," below.)

The Lange Eye centerpiece

The Lange Eye Institute (one of the eight practices) is a multimillion dollar, 25,000-square-foot multispecialty center in The Villages, a city about 25 miles south of Ocala, Fla. It offers full ophthalmic and optical services along with a blood laboratory and LASIK center. Later this year, an ambulatory surgery center is due to open there.

Lange Eye Care has spawned a multitude of spin-offs: Fortifeye Vitamins, which makes and distributes nutraceuticals; Express Contacts and Express Sunglasses — discount distributors of those respective products — Parris Optics International, the group's own wholesale frame company; not to mention the live radio talk show "Ask The Doctor," which airs six days a week on seven stations throughout Florida and streams live on the Internet.

Along with their upscale look, the dispensaries at Lange Eye Care feature something for everyone, with frames that range in price from $39 to $2,000.

"The goal is to double our size in the next two years," says Wayne Keller, vice president of operations for Lange Eye Care and a 35-year optical industry executive.

He and Dr. Lange continue to find opportunities by acquiring practices at bargain prices and then implementing their business model. Their growth target is a triangle with Ocala in the middle, Gainesville at the apex, Orlando in the east and Tampa on the west Gulf coast — an area with 4.1 million people in 11 counties.

Strategic business approaches and long hours have enabled Dr. Lange to build this enterprise, he says. He displayed those qualities early in his career when he seized opportunities to first acquire a practice with no capital outlay, promote it via radio and then execute a calculated move to control his own phone line in a retail setting.

Three Recession-Busting Strategies
Despite the recession in central Florida, Dr. Lange keeps challenging conventional thinking to seize growth opportunities. Here are three examples:
Acquisitions. "We've tried to take advantage of this recession and do what we can to expand," he says. He acquired four practices, two for the patient files and equipment, two others "because I got such a great deal." Due to the economic downturn, equipment suppliers are also "giving great deals," he says.
Advertising. This is no time to pull back on advertising, Dr. Lange says. "We're doing more advertising now because the advertisers are giving us great deals, and nobody else is advertising," he says. "So, it's setting us apart [from other practices]." The practice offers a discount vision plan to those who don't have one, and "[we send] our own little economic stimulus letter to 10,000 patients with a $50 ‘Lange Buck’ toward optical goods," he says.
Merchandising. "We've done some things that I think will be helpful to people going through these difficult economic times," says practice Vice President Wayne Keller. Among them: The dispensary features "frames ranging from $39 to $2,000." The practice buys from a tight group of suppliers and uses volume to generate co-op dollars for advertising.

First Ocala, then …

Ocala, the epicenter of Lange Eye Care, is comprised of roughly 53,000 people. Surrounding Marion County has a population of about 303,000. The median age in Marion County is just above the Florida median of 39 years, which itself is the fifth oldest state.

Dr. Lange's first job was with a practice in New Orleans, but he decided in 1992 that he wanted to have his own practice. Through his research, he discovered Ocala had a large geriatric population and lacked optometrists. A local optometrist wanted to sell his practice, which consisted of the patient records and leased examination area in an OptiWorld. Dr. Lange offered to only assume the lease and let the doctor keep his records.

At Lange Eye Care, not only does the eye exam "dazzle" the patient, it brings home the message that an eye exam is preventative medicine.

"I had to pay [OptiWorld] a percentage of the action — there was no overhead," he says. "If I didn't make a dollar, I didn't pay them a dollar."

Among his first patients was then Ocala mayor "Country" Jim Kirk.

"Heck, I had so much time; he was one of three patients on the book that day," Dr. Lange remembers.

Mr. Kirk owned multiple radio stations around Florida and had his own call-in show. He invited Dr. Lange to be his guest one morning.

"I think we got seven or eight calls in 30 minutes," Dr. Lange recalls. ‘"Country’ Jim said, ‘ … if you want your own show, you got your own show.’"

Meanwhile, Lens-Crafters acquired Opti-World, Dr. Lange leased examination space in a second LensCrafters and then outgrew those leased spaces. Before he did, however, he executed another calculated business decision: " … I bought the phone lines and the phone numbers, and I advertised the phone numbers." The move allowed Dr. Lange to keep the numbers when he left to open his new practice. The result: On his first day in his new practice, Dr. Lange saw 47 patients.

Nutraceuticals Niche
Dr. Lange has spun off his interest in nutrition into a multi-million-dollar company called Fortifeye Vitamins. The company formulates and distributes supplements — and occupies him in the wee hours.
"I've always been into nutrition and health and believed in promoting vitamins to my patients," Dr. Lange says. "I saw the vitamins that were on the market just didn't have what I wanted. They had a lot of the dyes and synthetic nutrients, trans fats and only window dressing of nutrients that were good for you. Patients appreciate the O.D. taking the time to discuss nutrition with them, and this is a huge practice builder."
Now, Fortifeye Vitamins is in its fourth year. "I want to have science behind the nutraceuticals I develop," he adds. That science comes from the Lange Eye Institute blood lab, which has helped him tweak the formulas for Fortifeye Vitamins' Fortifeye Complete Plus, Mac Defense and Dry Eye Therapy supplements, he says. "We're getting closer to the fountain of youth," he says. "This is just the beginning."

The patient is No. 1

Lange Eye Care subscribes to a medical model for optometry, blends staff attitude and technology to "dazzle" patients and applies management and marketing principles to set the practice apart from the optical chains, Dr. Lange says. "We want to provide personal service to each and every patient and always go that extra mile," he explains.

That starts at the top.

"When you've got somebody who's always happy, always bubbly and always encouraging, like Dr. Lange is, the whole staff enjoys coming to work every day, making it no surprise why people like coming here," Mr. Keller says.

The experience is quite deliberate, Dr. Lange says.

"One of your best-trained employees has to be the person who answers the phone and greets people as they come in the front door," he says.

One supervisor hires, supervises and trains front-office staff in all branches. Dr. Lange lists the required qualities: "outgoing, proper etiquette, great personality and presentable."

Managing a far-flung staff

Having experienced upper-level managers is crucial, Dr. Lange says. He says that Mr. Keller and Tamie Lange, director of operations and Dr. Lange's wife, are a vital part of the business operations. Dr. Lange credits his wife for standing by him, working hard and making sacrifices, such as skipping family vacations and putting in 20-hour days that block any kind of social life, to help Lange Eye Care grow.

"On a day-to-day basis, we try to be as efficient as possible with confirming appointments and following up with no shows to make sure that the doctor's schedule stays as full as possible," Mr. Keller says.

Branch managers send technicians home if no-shows cause too much slack in the schedule.

"It's a constant process watching the hours to make sure we have enough staff but not too much staff at any given moment on any given day," he says.

Leaving branch managers unfettered is also part of the Lange Eye Care strategy, Mr. Keller says. Hiring and training is centralized under supervisors for each function: front office staff and technicians, for example.

"Purchasing is also centralized to allow us to create a product model for all locations and [for me to] use my contacts from the wholesale side to get us the best possible prices," Mr. Keller says. "This also allows the branch managers more time to do the day-to-day tasks without so many interruptions."

Some of Dr. Lange's employees have been with him since 1993. He provides a retirement plan, health insurance and performance-based bonuses divided among all employees, but eschews large commissions for the optical staff.

"When you put people on commission, a lot of times it looks like they're trying to push the sale," he says. "I don't want that perception. We just pay them very well, higher than industry standard."

The medical model

During the examination itself, diagnostic technology is integral. The practice frequently uses spectral domain optical coherence tomography, optic nerve fiber layer imaging, digital anterior and posterior segment photography, A- and B-scans, visual field testing and corneal topography.

"That's why patients pay $150 for an eye exam at our facility; because they've been dazzled and wowed by our technology," Dr. Lange explains. "… We try to bring home [to patients] that an eye exam is preventative medicine."

Although not linked to an electronic records system, computers in each exam lane display images and reports to aid in patient education.

"When a patient has glaucoma and you show him an optic nerve with glaucoma and then show him his own optic nerve, that drives home the message of how important treatment and compliance [to our recommendations] are," Dr. Lange says.

Providing nutritional consultation takes the medical model for optometry to the next level, Dr. Lange says. He formulates the nutraceuticals for Fortifeye Vitamins. The Lange Eye Institute blood lab provides testing to monitor patients' blood chemistries, such as antioxidant levels. These intracellular blood tests help Dr. Lange develop new nutraceuticals.

The eight Lange Eye Care centers, which total 65,000 square feet, keep long hours: 8 a.m. to 6 p.m. or 9 a.m. to 7 p.m. Monday through Friday. Two locations are open all day Saturday, with the Gainesville office open Sunday from noon to 5 p.m. That's 369 hours of operation a week combined.

"We do a lot of business early morning and later evenings," Dr. Lange says. "It allows the busy business professional a time to come when they are not working."

Eleven optometrists and three ophthalmologists comprise the team of doctors.

"It is a great symbiotic relationship," says Dr. Lange. "…Our optometrists are the primary eyecare providers that determine the appropriate treatment and when a referral to our M.D.s is necessary."

Having staff ophthalmologists is another lesson Dr. Lange learned early on.

"A lot of ophthalmologists would try to retain patients once referred to them …" he says. "[Today], all they do is surgery; our O.D.s take care of the rest."

His staff M.D.s cover a broad range of subspecialties: cataract and refractive surgeries, oculoplastics, cornea, retina, glaucoma and neuro-ophthalmology. Three in-house LASIK centers also help retain patients.

These M.D.s will do more when the in-house ambulatory surgery center opens at the Lange Eye Institute. Patients will have not only one stop for eye care, optical and nutritional blood testing, but also ocular surgery and even face lifts, Dr. Lange says. "Everything under one roof," he says. As if he would have it any other way. OM

Mr. Kirkner is a medical editor and writer in suburban Philadelphia.

Optometric Management, Issue: May 2009