Making the Specialty Pay
Serving low vision patients lets you both help people and
BETHANY FISHBEIN, O.D.
If you ask doctors why they
practice low vision, you'll probably get answers like "helping people," "serving
the community" or "providing a service that no one else does." Very few will
answer "to make money." In fact, when I ask doctors why they don't practice low
vision, the answer I most frequently hear is, "I can't do it and be profitable."
And indeed, this seems to be what optometry
schools teach � even professors of the subject perpetuate the myth that low
vision practice should be a charitable endeavor, or at best, a labor of love.
I beg to differ
I truly enjoy practicing low vision; I couldn't
do it if I didn't like it. There are days when I love it. I love the feeling of
helping people accomplish something they had written-off as impossible � seeing
someone read a newspaper for the first time in many years, or giving a visually
impaired student the tools to help her through college. Do I consider it charity
work? Absolutely not.
One of the reasons that low vision is such an
enjoyable specialty for me is that it combines the reward of helping people who
truly need it with the reward of financial success. In setting up a low vision
practice, or adding a low vision specialty to an existing practice, follow these
steps to maximize both the personal and financial rewards that come from
providing this care.
See low vision patients during non-profitable
Because you are providing a more specialized
level of care and are presumably not in competition with all of the other
doctors in your town, you have more flexibility in choosing when to provide low
If your Saturday morning hours are typically
filled with a parade of Prada-wearing presbyopes, then scheduling low vision
patients is neither practical nor profitable. However, if your Tuesday mornings
are so slow that you are sitting around surfing E-Bay for Star Trek
paraphernalia (or worse, considering adding a low-paying vision plan just to
give yourself something to do!), this may be a perfect time to see low vision
Even if you have yet to see a low vision patient,
schedule "Low Vision Evaluation" slots during slow times in your schedule, and
try to block low vision patients together during those times. Even if you only
see two low vision patients in a month, see them both on the same day. It lets
you and your staff get in to the low vision mindset and set up your equipment.
Buy the right stuff
Doctors starting out in low vision often feel
they need to get every piece of low vision apparatus before seeing their first
patient. I hear from doctors who tell me they've met with a company rep, spent
$15,000 on a "starter kit" of low vision equipment and ask me, "now what?"
While you do need to have enough equipment to
serve a wide range of patients, you don't need everything all at once. If you
make a huge financial investment in special equipment, it will be harder for
your low vision practice to become profitable. Speak with your colleagues who
practice low vision and ask which devices they use most frequently � the old,
"If you were practicing on a desert island and could only have five low vision
aids, which would you pick?"
You can get a good variety of low vision aids
(from basic magnifiers to high-tech equipment) for under $5,000. Be aware of the
devices that you aren't buying, though, so if you see a patient who needs
something you don't have, you can order it. You will add to your equipment
arsenal as you see more low vision patients, learn what their needs are and
develop your own "desert island survival kit" of low vision aids.
Marketing your specialty
Low vision practice is easy to market � in many
areas, doctors are just looking for someone to whom they can refer patients. You
just need to tell them you're available. Here are some ways to let them know:
► Register with your state's association for the blind � many have a
certification process that allows you to become a member doctor. The association
will refer its clients to you for services.
► Send a letter to area retina specialists, ophthalmologists, and optometrists,
announcing the addition of low vision services to your practice. Follow-up with
a phone call or a meeting to share your enthusiasm for low vision care and
generate additional referrals. Send letters or newsletters every few months to
mention new low vision technology, share a particularly good case, or just to
remind the doctors that you exist.
► Each time you see a patient, send a letter back to the referring doctor. It
lets everyone know what you have done for the patient, and again serves as a
little reminder of your existence. If a patient compliments you profusely, ask
him or her to please let the referring doctor know that he or she is happy with
► If you have the opportunity to go in to your referring doctors' offices, speak
with their office staff as well. Many patients may not tell the doctor that they
are having trouble reading, but will mention it to one of the nurses, or as they
check out at the reception desk. If the staff is empowered to give your card to
patients, it creates additional opportunities for referrals.
Good relationships with several referring doctors
may be all you need to create a steady flow of low vision patients into your
► You can generate additional low vision business by marketing directly to
patients, to gerontologists and primary care doctors and through senior health
centers and nurses.
► Low vision is a specialty that lends itself naturally to media, so keep that
in mind for your marketing strategy. If you have a particularly interesting
patient who you're able to help with a specific goal, contact your local
newspaper or TV stations � "Doctor helps legally blind patient read again!"
makes a great human interest story. If your name and practice information are
listed, such media attention can generate free publicity and a tremendous number
In a low vision practice, you are providing
specialized care that requires additional knowledge, equipment and time. Charge
fairly for your services and products � but do charge! Manufacturers of low
vision products will tell you what the average retail price is in your area. If
you find patients who truly need charity care and you wish to provide it, then
do so, but set your fees based on the assumption that most of your patients will
pay for them. Here are some additional tips:
► Don't be tempted to try a loaner program, where you provide patients with a
free "loaner device" for a period of time while they decide if they want to
purchase the aid. While a nice idea in theory, this is a logistical nightmare in
practice. Many low vision patients are elderly with multiple health problems and
rely on outside transportation to get to your office. Even if they are
successful with the device, it's not easy for them to get back for multiple
visits, and if they already have the device in their hands (for free!), they
have little motivation to return and finalize the process.
If the device isn't useful to them, it may get
lost or broken ... or in the worst case, the patient becomes ill (or dies!) and
your staff has the task of calling the family to get the device back, or asking
them to pay for something that wasn't useful to begin with. Managing a loaner
program can easily become an unpleasant and unnecessary full-time job for a
staff person. Not managing your loaner program is a surefire way to lose money
by giving away your inventory!
► Once you are seeing low vision patients consistently, stock some of your
frequently-used devices to allow the patient to leave with his (purchased) aid
immediately after the visit. This increases patient success and decreases work
for your staff.
► Be goal-specific. Ask the patient what his or her goals are, and know that
often there is not one device that meets all of the patient's needs. If multiple
devices are necessary, then prescribe multiple devices, making sure the patient
understands the benefits and limitations of each.
► Don't watch patients' pocketbooks. If your child, spouse, or parent needed a
vision aid, you would want the best possible solution, regardless of cost. Your
patients expect the same care.
Utilize technology. In my low vision training at a VA Center, high-tech devices
like CCTVs were used only as a last resort. In real-life practice, patients come
to you for the best and easiest solution � in many cases, this requires a higher
tech product. Utilizing multiple aids when necessary, and providing the best,
highest-tech devices will result in better help to the patient and more profit
What not to do
I speak to a lot of doctors who see low vision
patients and choose not to make money in the process. These doctors accept
insurance payment for services, often waiving co-payments or non- covered
refraction fees. Many also provide vision aids at their wholesale cost, ignoring
shipping charges, administrative time, etc.
These same doctors often complain about their low
vision practices, saying it's so much work (and not really fun). The end result
is that they lose enthusiasm for their low vision practice, or may stop seeing
low vision patients all together. Their knowledge and inventory go to waste, and
the patients in their area need to look elsewhere for care. This serves neither
the doctor nor the low vision patients.
Low vision is an important service to provide in
a community. It also can � and should � be an important profit center for your
practice. Doctors who make money while providing low vision care will enjoy this
specialty and actively seek out more patients. If more doctors practiced low
vision, more patients would have access to low vision services, which is a
benefit to patients and doctors alike.
Dr. Fishbein and her husband,
Jonathan Fishbein, O.D., have a private optometric practice. They are also
directors of the Low Vision Center at Robert Wood Johnson. In addition, Dr.
Fishbein is the Director of Low Vision Consulting Services for The Power
Practice, in Hawthorne, N.J.
Optometric Management, Issue: November 2006