It's obvious that I'm bullish on scribes, but the benefits of using them in contact lens practice are so profound that you really must consider adding the technique to your office routine.
Efficiency is as good as raising fees
There are two very important factors in your contact lens profitability: your fees and your time. I assume you have already set your fees as high as you can, given market conditions, but most practices I see are still very inefficient when it comes to contact lens fitting. If you can reduce the chair time and doctor time needed to fit a patient, you will have more appointment slots available for other patients and your revenue will increase.
Most optometrists are still fitting contact lenses the same way they were taught in school and have not made a significant change in office procedures for many years. Yet, contact lens technology has changed markedly along with managed care trends and competition for contact lens product sales. We must adapt our practices to the new market conditions to remain viable.
Analyze your fitting philosophy
We really should think of contact lenses differently than we did in the old days. Consider these traditional ideas.
Most ECPs only discuss contact lenses if the patient asks about them or is already wearing them. This causes your practice to miss many good candidates. This approach can often be traced to the fact that the appointment given to the patient only allows enough time for an eye exam and to begin a discussion of contact lenses would throw the office off schedule. What a shame! Is your scheduling process holding back your revenue production?
Patients today are more impressed with services and products that are easy and quick than they are with those that are complex. If you think you are impressing patients by making the contact lens fitting process appear to be so advanced and complex that it requires much more time and effort, I would think again. That's old school. Today's consumer is more impressed with a practice that fits the new contacts that are super-easy! Of course, it's how you fit them that makes the difference.
Scribes can change your fitting process
Let's take a look at typical contact lens procedures in use today. Let's assume a patient is in for a comprehensive eye exam and has an interest in contact lenses – either a new fit or a significant refit. The doctor usually performs the following steps and the amount of time really adds up.
After the eye exam, the doctor talks about contact lenses with an overview about the types of lenses, the risks and complications, the fitting and follow-up process and the fees.
After deciding on the lens design and brand, the doctor goes into the CL inventory room and searches for trial lenses with the correct parameters.
Upon returning to the exam room, the doctor opens the lens package, removes the lens, rinses it with saline and inserts it for the patient. After waiting for the lens to settle, it may need to be removed and reinserted if there is any discomfort. This is repeated for the other eye. More waiting is needed.
The fitting procedure may vary, but usually the doctor takes monocular visual acuity with the contacts and may take near acuity as well. An over-refraction is performed. A slit lamp exam is performed and the fit is evaluated. One or both trial lenses may be changed based on test results.
The steps described above can easily take more than 15 minutes – possibly 30 minutes. That is enough doctor time to conduct another comprehensive eye exam! If we consider that the average gross revenue produced per exam is about $350, it is very expensive to fit contacts this way! The cost of a missed opportunity is very real.
Let's look at the process in my model using a scribing technician:
After the eye exam, the doctor enthusiastically recommends contact lenses and encourages the patient to simply try on a pair.
The doctor tells the technician/scribe what brand of lenses to insert and the doctor leaves the room to see another patient.
The technician gets the trial lenses and follows the steps outlined above to insert the contacts.
Depending on your state law, the technician takes visual acuity and may perform a spherical over-refraction with the phoroptor. An over-refraction without cylinder testing is quite easy, but if you would rather not have the tech use the phoroptor, she can also take the patient into the pretest room and do an auto-refraction with the lenses in place.
The technician discusses lens types, lens handling and hygiene, follow-up visits and fees.
The doctor pops back in and checks the fit of the contacts with the slit lamp. The lenses are dispensed if possible.
Total doctor time: about three minutes.
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.