Let’s move on through a typical patient experience in your office to the next point of contact. After the eye exam we usually provide some form of treatment, so let’s focus on contact lenses this week and we’ll cover other therapies in the future.
The treatment and management of contact lens patients has changed a great deal in the past 20+ years. It is important that we keep our clinical procedures up to date to meet the needs of patients today.
Ask yourself this: How often do you bring up the topic of contact lenses to a patient in your chair who did not ask about them and is not currently wearing them? Most optometrists will answer rarely or never. Why is a mystery to me. It means there is something wrong with our process if we rarely recommend a treatment modality. Do we not make enough profit? Is it too time consuming and we have so many patients we simply can’t find the time to do the work? Do we not believe in the effectiveness of the product? Do we not have many patients who love the product? Obviously, none of these things are true and I pose them only to make a point: let’s think about the procedure and pricing in your practice and change it so you will actually feel good about bringing up the topic!
Review Your Resources
In addition to providing a pleasant experience in the office for the contact lens patient, we also need to be mindful of profitability. One way to do this is to spend less time in the fitting process. This strategy works well because patients want everything faster today and basic disposable lenses are easier to fit and healthier than ever before. Increase your profitability by reducing chair time and doctor time for simple cases. Resist the urge to make contact lenses a bit more complicated, maybe to justify your professional fee. Patients are more impressed if you make the fitting process fast and simple.
I want to recognize that many optometrists are specialists in more advanced contact lens designs, including scleral lenses, keratoconus designs, ortho-k, hybrid lenses, multifocal, toric and more. These lens designs are far more complex than routine disposable lenses and professional fees will reflect the additional skill and time required to prescribe them. But basic contact lenses can be fit extremely easily today and much of the process can be delegated to a clinical technician working under OD supervision.
Contact lens products are becoming increasingly competitive on price and most optometrists in private practice are seeing some percentage of patients buying their lenses online or from other discounters. Be sure to charge enough for your initial fitting services and for ongoing yearly corneal health evaluations. By moving more of the profit into the professional fees, we can keep the markup on the product low and be very price competitive with most vendors.
Review Your Financial Investment
Every OD has a slit lamp, phoroptor and some form of keratometer. The major contact lens manufacturers will supply free diagnostic lenses to practices that sell the product. So no additional investment is required to fit contact lenses, but I recommend that you buy a corneal topographer as soon as possible. Having your technician perform topography on every contact lens fit and on every annual CL evaluation, justifies a higher fee while providing a wow factor for the patient. Some practices also invest in specular microscopy and endothelial cell counts.
Review Your Process
New contact lens fittings can be very efficient if you have a technician/scribe working with you. This is one of many benefits of scribes, in addition to handling the recording of data in the EHR system. Here is one scenario that could make contact lenses easier to fit and will help you greatly increase your practice.
At the end of the eye exam, tell the patient he is a good candidate for contact lenses and ask if he has considered them (or relate this to the case history). With enthusiasm and confidence, the doctor says to the patient: “We have a breakthrough contact lens design that is so comfortable, most people tell me they can’t even feel it. I’d love to see what you think – do you have a few minutes and are you willing to try it?” Don’t talk about fees yet. Don’t talk about risks or problems. Don’t talk about wearing schedules. Let the try-on be a free screening. You might say: “After we put the lenses on, you can still look at glasses in the optical and we still need to dilate your pupils and check your retinal health, so it won’t really take any more time. If you don’t like it we will just take the lenses off and forget it”.
If the patient agrees to the free try-on (most will), just tell your scribe what lenses to put on. The doctor moves on to see another patient and the tech takes over. If you are thinking you can’t do this because your staff is too busy, maybe you need more staff. Don’t be too busy to make more money. The tech finds the correct trial lenses, washes her hands, opens the lens packs, and inserts the lenses for the patient. Don’t waste time trying to teach a new wearer to insert the lenses. After the lenses are on, the tech takes acuity and over-refracts with the phoroptor (spheres only) or with an autorefractor. The tech proceeds with whatever the case calls for (frame selection or the patient can wait in the reception room). At some point in this process, the tech explains the contact lens fees, keeping it as simple as possible. The patient is returned to an exam room and the doctor completes the exam, checks the contact lens fit and decisions are made to proceed with contact lenses or not.
One more factor to consider in your contact lens fitting process: recommend and prescribe the best. Try to avoid giving patient choices of different types of lenses and wearing schedules. Try to avoid thinking about how much the products cost and how to save the patient money. Your mission statement is probably not to offer the cheapest eye care in your area. Your mission may be to provide the best eye care. Stay true to that. Tell patients that you are prescribing daily disposable lenses for them. If they ask about price, mention the savings on lens care products and any rebates that exist, but recommend going with daily disposables.
In addition to training your techs to assist with the fitting of contact lenses, here are some other points to cover:
It is helpful for staff to mention the contact lens evaluation fee to established patients when they schedule their annual appointments, even if they don’t ask. This vastly reduces complaints about the evaluation fee at the front desk.
Assume patients want a full year supply and provide a discount of the usual per box price.
Be sure staff understand contact lens rebates and that they quote the rebate when discussing prices.
Some practices have a nice supply of quality sunglasses purchased at lower cost and they tell patients that they can select a free sunglass with the purchase of a full year supply.
Be sure to mention to patients who want to buy lenses elsewhere that emergency replacement lenses are only available from your office with product purchase.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.