CONTACT LENS FEES
Developing Contact Lens Fee Structures
A Medical Model
Learn how to structure your contact lens fees to boost profitability in your practice.
By Walter L. Choate, OD, FAAO
Maintaining profitability in today's contact lens practice has become a serious challenge because many patients view contact lenses as commodity items, not medical devices, and standards of care related to contact lens patients continue to be poorly defined. Over the past 20 years, our practice has become consultative in nature. More and more of the patients who seek care from us require specialty contact lenses. That has led us to view our contact lens fee structures in much the same manner as our medical eyecare services.
Applying the Medical Model to Contact Lens Fees
Medical services are billed to third-party insurance carriers according to time required, complexity of the decision-making process and relative risk factors. You can develop contact lens fees using exactly the same model that was developed for medical eye care, with four to five levels of care applied using the same type of thinking.
We quote contact lens fees with four components:
1. Medical eye exam and visual analysis
2. Contact lens evaluation
3. Prescribed follow-up care
4. Contact lens materials
The care that we provide in the evaluation and follow-up is billed to the patient according to estimated chair time needed and according to the difficulty of the fit and complexity of managing the patient after the fit. In our practice, we have five levels of complexity for the evaluation and follow-up care. Table 1 illustrates how this works with the simplest return patient who is happy and wearing a two-week disposable daily wear lens, how it works for a routine continuous wear fit and also how it works with a difficult keratoconus or post-graft fit. The fees quoted are not our fees. This is just for example purposes. Your fees should reflect the market in which you practice. (Base fees upon the quality ophthalmology and optometry practices)
Pre-paid Plans In most cases, when a patient elects to pay for follow-up care by the visit, that patient will typically not return often enough to benefit from problem-solving of minor issues such as minor late afternoon dryness or trace bulbar conjunctival injection. These frequently seen entities prompt many patients to discontinue contact lens wear after one to two years. Industry surveys support this. Pre-paid care plans encourage patients to come in more frequently, and these patients tend to stay with the practice and continue wearing their lenses.
Be careful to differentiate medical conditions that may not be contact lens-related and bill accordingly.
Other Fee Structures
Contact Lens Spectrum recently requested fee schedules from two well-known contact lens practitioners. One practitioner submitted the following fee schedule that is similar to the fee structure we use at our practice. His contact lens fee system has three elements:
2. Contact lens fitting and follow up care (12 months)
3. Contact lens materials
The examination portion is coded as a Brief Office Visit (99203=$90 or 99213=$69), and the practitioner adds a contact lens exam fee of $79.
This contact lens fitting and follow-up care fee is similar to ours in that it has five levels, depending upon the complexity of the case. The five price levels are $149, $199, $249, $299 and $349.
The contact lens material fee varies depending upon the lens material used.
With this fee structure, a typical new patient fee for normal soft disposable lenses would be $90 (eye exam) + $79 (contact lens exam) + $199 (contact lens fitting and follow-up) + $50 (contact lens materials) = $418.
A rigid bifocal case for a new patient would be $90+$79+$299+$250 = $718.
As you can see, the total fee with this practitioner's fee structure will vary depending upon if it is an existing patient or a new patient, the complexity of the case (expertise and time) and the contact lens materials used.
Table 2 shows some of the professional fees for another successful practitioner. This fee structure does not include material costs. It contains three elements:
2. Follow-up visits
3. Insertion and removal training
In this fee structure, the fitting includes:
- Analyzing spectacle prescription
- Measurement of corneal curvature (K readings or topography
- Discussion of lens types
- Diagnostic fitting (if necessary)
- Design of initial lens
Follow-up exams include:
- History of symptoms
- wearing time and lens care use
- Evaluation of visual acuity with lenses
- Lens to cornea relationship evaluation including
- K readings
- Discussion of any changes in lens design
- Wearing time or lens care product use
- Lens design changes, if indicated
Application and Removal Training Includes:
- Demonstration of application and removal techniques and lens care product use
- Discussion of "Do's and "Don'ts"
- Discussion of wearing schedule and need for follow-up visits
- Provision of initial lenses and lens care product
- Scheduling of initial follow-up visit
This practitioner's office also offers a planned replacement lens program. The annual package of this program includes contact lenses, fitting, application and removal training, initial solutions, fresh packs and office visits. Table 3 shows the price breakdown for the lenses in this program.
There are probably as many fee schedules for contact lens professional fees and materials as there are practitioners. Mode of practice, location and philosophy of practice are just a few variables that influence these fees.
Most professionals charge a strict hourly fee for what they do, with good attorneys pricing themselves up to $350 per hour. For contact lens practices to return to profitability, a serious refocusing on the value of quality time needs to take place. The trick is to price one's time for these services at a level reasonable for the level of time commitment and complexity. As one practice management guru once put it "Do not cost account every visit, but do not take ownership of your patient's eyes either!"
Contact Lens Spectrum, Issue: March 2003