FIX THIS PRACTICE
Fees for Service
Why you should charge your
patients for the services they receive.
By Richard S. Kattouf, O.D.
Q. I've been in
private practice for 26 years. I see many contact lens patients
who wear both soft and rigid gas permeable lenses.
When contact lens wearers come for
yearly examinations, we check them with their contact lenses in
and then remove the lenses to perform the comprehensive eye
examination. This results in a great deal of chair time and
I know some O.D.s who charge for
this extra exam and others who do a separate exam with the
contact lenses in place. Our problem is that we've "trained"
our patients to expect us to do the whole thing for one fee and
in one office visit.
Do you have advice on how to
fairly charge contact lens patients for exams?
Merle Berry, O.D.
via the Internet
A. Our profession
has placed itself in a difficult position by hiding profits in
materials rather than charging a fee for services. In the days
before fixed fee vision programs, it wasn't difficult to keep the
net income of a practice in proper ratio to the gross income.
The number-one reason doctors seek
my consulting services is their low net profits despite having a
large number of patients. Other factors that have made it
difficult to garner profit from materials are the price of
advertising, competition from mail-order lens companies (which
patients perceive to be less expensive than an exam with their O.D)
and corporate expansion into vision care.
I've noticed that most O.D.s
charge contact lens wearers and non-contact lens wearers the same
fee for a comprehensive eye exam. The following is a sample
scenario in which this might occur:
- Patient (new)
-- Lori (age 43). Having trouble reading -- no desire to
wear contact lenses.
- Patient (former,
home from college) -- Diane (Lori's
daughter, age 20). Wearing contact lenses -- due for
Let's evaluate the professional
services required for each patient (see table).
Obviously, other tests you may
perform would be standard for mother and daughter (e.g., extended
ophthalmoscopy, retinal photography, blood pressure, etc.). Here,
most O.D.s would charge their standard comprehensive fee to both
|LORI (43), (NEW)
||DIANE (20), (FORMER)
||spectacle refraction plus contact lens overrefraction
||biomicroscopy w/contact lenses biomicroscopy w/o
contact lenses plus fluorescein evaluation
|standard consultation or summary regarding eye helth
||consultation (summary) on eye health, spectacle
prescription, contact lens prescription, contact lens
wearing time, contact lens hygiene and corneal condition
How to make a profit
What services should patients be
responsible for paying in your practice? Where should you make
your profit? The answer? Time, skill and knowledge -- not just
If your standard exam fee is $60,
charge Diane $95 because you'll spend more time, skill and
knowledge on her than on her mother.
O.D.s who charge a different fee
with their standard exam still aren't usually making enough to
Many of my O.D. clients lose
income on every contact lens patient because they don't
adequately charge for their services.
It's important for independent O.D.s
to know what corporate and commercial practices charge or don't
charge. I'm not suggesting you try to match these fees. Educate
your patients as to what services you and your staff provide and
how they differ from the "quickie" evaluations many
I teach my clients methods to
change their fee structure without irritating patients and
causing consequent erosion. This is a huge change in O.D.
behavior because many don a passive attitude about fees.
You can't thrive financially on
profits from materials alone -- concentrate on fees for service.
Act your role
Medicare classifies us as
optometric physicians. We've won most legal battles at state
levels. We're regarded as "real" doctors, so let's
charge fees like real doctors.
Dr. Kattouf is in private
practice in Warren, Ohio, and he's president and founder of two
management and consulting companies. If you'd like Dr. Kattouf to
address an issue you have with your practice, call (800) 745-EYES
or e-mail firstname.lastname@example.org.
Optometric Management, Issue: January 2001