Ways to Gain and Retain Lens Patients
By focusing on care and services, you show your patients that lenses aren't really a commodity.
By Glenn S. Corbin, OD
To gain and retain contact lens patients in today's competitive market is very challenging. Patients, or "consumers," have a variety of options for purchasing lenses: private practices, commercial practices, Internet vendors, etc. Most want convenience as well as quality. Unfortunately, the "service" aspect of contact lens prescribing and of wearing contact lenses has been so severely downplayed for the sake of competitive material fees, that the public has forgotten that they also need to consider appropriate fitting characteristics and eye health issues.
Contact lenses have become a commodity. "How much do contact lenses cost?" is often the first question that a potential contact lens patient, or parent, asks. The burden is now great to educate the public (our patients) about the potential risks of poorly fit or misused contact lenses so that the importance of "care" again weighs on the minds of our patients. As practitioners we also should be more concerned with what we offer our contact lens patients with regard to service and appropriately align our fees to be commensurate with that care. This approach allows us to establish material fees that are very competitive with most alternative suppliers. Our patients will want to "shop" for the best care rather than the best price.
The Contact Lens Market
A recent report indicates that there are more than 30 million contact lens wearers in the U.S. marketplace. The bad news is, of that figure, 10 percent are lost to lens wear each year. The good news is that we have a 10 percent increase in new contact lens wearers each year. So we have a relatively flat market. Not an encouraging number when we're trying to grow our practices and increase our income. We need to analyze the reasons why we lose contact lens patients and look at creative ways to retain them.
Why Do We Lose Contact Lens Patients?
I believe that discomfort from dry eye-related issues is the number one cause of contact lens failure and dropout. Anyone who isn't completely comfortable with the feel of their lenses during their required or desired wearing schedule will consider alternatives to contact lenses. Treat dry eye aggressively before fitting or refitting these patients. Dry eye is a medical diagnosis and you can bill services to the patient's medical insurance. Many of today's dry eye treatments allow us to enhance patient comfort and contact lens wearing time.
I would rank "less than optimal vision" as the next leading cause of dropout. I list this second because some people will accept slight visual compromise for the convenience of a comfortable contact lens. I hear this often with the opaque lens wearers who will admit to some image blur from the opaque iris, yet they're comfortable and willing to accept visual compromise for the sake of the color change. Also some monovision contact lens wearers will be comfortable and accept slight visual compromise at distance and/or near for the convenience of the lenses.
Consider multifocal, toric, aspheric and new aberration-correcting lens designs to address visually compromised patients. Remember that dry eye and allergies can cause visual compromise and instability for contact lens wearers, reinforcing the need to treat these conditions aggressively.
We need to strive to exceed contact lens patients' expectations so they don't leave our practices because we were unsuccessful in prescribing clear, comfortable, healthy lenses.
We must convince our successful "simpler cases" that they need our services and should purchase their materials from us. The easiest patients to satisfy are those who were unsuccessful elsewhere when the resources were available to make them successful contact lens wearers. These are the cases that make us look good and garner word-of-mouth referrals.
Never take your patients for granted and assume they'll always return to you if they aren't totally satisfied. Through comprehensive patient education, use of state-of-the-art technology and excellent clinical skills, you can nurture patient loyalty.
Some Housekeeping Ideas
Along with my partners, Robert Copeland, OD, and Darren Rich, OD, I follow a practice philosophy that assumes the patient knows nothing about contact lens prescribing, care, follow up or risk. In recent years, as the contact lens material market has evolved, we've maintained a dynamic approach to contact lens care. We've eliminated stocking lens supplies in the office to save inventory cost. I've always viewed this as if I were leaving cash sitting idle in a cabinet, not a potential cost savings. We almost always had leftover boxes that we would need to trade in or take as a loss. With the advent of disposable and frequent replacement lenses, every patient leaves the office with a fresh pair of lenses and doesn't require their full supply on the day of the exam. Banking supplies for cost savings makes sense if the savings are significant and if you'll use the entire bank of boxes without compromising your usual prescribing routine. We inventory many trial lens sets in every power available so we can provide efficient diagnostic visits and limit return visits for patient convenience.
We have some high quality lens materials that are branded and some that are private label. I've read articles and encountered controversial opinions on the subject of "private labeling." Think about when a patient continuously sees his contact lens brand on billboards and in price ads. It can create a cognitive discord, and the patient may pursue contact lens purchases from an alternative supplier. The saying, "out of sight, out of mind" does hold true for brands that have less price marketing in the public eye. I prescribe many premium lenses which I price competitively, and these tend not to be priced below market from alternative suppliers.
Lens rebates offered by the manufacturers are a tremendous asset to us. They don't affect our income, but allow us to offer our patients a rebate on their materials. Rebates also require a year's supply of lenses and a current exam.
How Do We Do It?
Our professional fees align with the high level of care and service we provide. To substantiate higher professional fees, you must offer contact lens patients much more in diagnostic services than what you offer non-contact lens patients. Establish fees commensurate with the testing, time and expertise required to manage the case. To save staff time, limit patient discord and get the patient "on board" from the start, discuss fees up front and spell it out in a brochure or handout before committing to additional services. Patients don't want surprises after the fact and neither do we. For example, a simple spherical daily wear monthly fitting is less complicated and time consuming than a toric, multifocal or GP case. Your fees for the diagnostic work-up and anticipated follow-up care must compensate you appropriately.
Discuss the time and required visits for the diagnostic phase, insertion and removal/care visit and follow up as well as potential risks. Offer a three-month diagnostic period during which a patient can return the product (only) for a refund if he isn't fully satisfied with the result. This will give the patient a high level of confidence to proceed with the evaluation. Never refund the professional fees. You deserve compensation for services you've already provided.
For new patients, include corneal topography, lid eversion, diagnostic lens evaluation(s) with over-refraction, biomicroscopy to evaluate lens fit and a consultation to review the patient's lifestyle needs, refractive and eye health findings.
Tailor the replacement schedule to best suit each patient's lifestyle. Emphasize that there are short-term risks and long-term risks associated with contact lens wear and that appropriately prescribed lenses and follow-up care will serve to reduce some of those risks. I emphasize that contact lenses are safe, but abuse, misuse or unavoidable factors can place the wearer at increased risk for sight threatening problems. Be sure to have a 24/7 answering service and a doctor on call to address the occasional contact lens-related red eye or removal issue that can frighten a new wearer. This is a good selling point for the practice to gain patients' confidence as well as to reduce your risk of malpractice.
For established patients, repeat all the diagnostic testing yearly. Continuously update your exam equipment and procedures so the "routine" exam for your patient doesn't become stale. It's amazing how aware patients are of even subtle changes in our pre-test instrumentation. Years ago when we transitioned from NCT to Tonopen as our screening tool, our patients immediately recognized and commented on the change.
On entrance, we test the established patient's acuity with lenses on, perform an over-refraction and assess the lens fit prior to lens removal. We remove the lenses and obtain corneal topography, along with all of the preliminary tests for a comprehensive exam. Use a Wratten filter when performing biomicroscopy with fluorescein to more accurately detect subtle staining.
After the exam, review your patient's results and consider a new material for the patient. In our practice we embrace the philosophy "If it ain't broke, break it." In other words, offer new products often. Suppose the same patient returns every year, gets the same exam and lenses without a problem. In reality, if he maintains good comfort, vision and eye health, you've done a great job. But the patient's reality is, "Dr. X does the same thing every year. Why do I need to see him every year if he isn't innovative and I never have a problem?"
Fortunately, the new contact lens law helps protect our patients (and us) by requiring a yearly examination prior to lens replacement. This creates a great opportunity for us to see established and new patients who've purchased through alternative suppliers ad nauseum without updating their professional care. We're happy to see these patients and provide their contact lens prescription for them to fill elsewhere because our professional fees are appropriate for the services we provide. When we discuss our lens material fees, they most often purchase through our practice. We price our lenses more competitively for a yearly supply to avoid six-month or smaller purchases. This is where rebates assist us as well, requiring the annual exam and annual material purchase to be valid. We offer direct ship and next day air if required by our patients.
One way to encourage loyal patients is to exercise control over their care. Patients really want professional advice and expect it from their practitioner.
Select the care system you feel is most compatible with a patient's lens material and/or will be easy for compliance. Don't just hand patients a product and assume that they will re-purchase the same product when they need a refill. Explain the importance of lens care and the risks of lens/solution incompatibility such as those that may be associated with the newer silicone hydrogel lenses.
Remember, you may start prescribing a specific material then change course if the patient experiences problems on follow up. We select a multipurpose solution that's compatible with all lens materials and has superior wetting ability and convenience. This reduces unnecessary solution-related complications and chair time. Never underestimate the potential for lens-solution compatibility issues that can plague patient comfort and success. Don't simply hand out care products. Issue an OTC prescription to emphasize the importance of compliance.
Patients tend to migrate toward generic products when we don't emphasize to continue using the product prescribed at dispensing. Generic solution systems often don't contain the more current chemical formulations found in the branded products. Consider that some generic companies may choose to market contact lens material sales directly through care product inserts and promotions. These same companies don't assist with professional educational programs. Prescribe care products from companies that support our profession.
Offer eyewear discounts to your contact lens patients to encourage them to maintain emergency eyewear and stylish sunwear. Explain that their contact lens annual program (with material purchase) includes free replacement of torn lenses, a service not offered by alternative suppliers. Also, if they encounter a lens problem during the year that requires a material change, you can exchange their product as needed, a service not available with alternative material purchasing.
Focus on Service
Patients will appreciate your professionalism if you play an active role in all aspects of contact lens care. Contact lenses are medical devices. The more "commercial" you make contact lenses out to be, the less likely that patients will feel compelled to return to you for future services and/or materials. Care about your patients and be sure to educate them so they know that you care. That's what differentiates a healthcare professional from a product retailer.
We don't work for free and, as long as you can substantiate your fees, don't underrate your education and abilities by cost cutting your services. Unfortunately the insurance companies have already degraded the value of health care today, and we don't need to further that cause. Be sure that you can provide quality care, get fair reimbursement and not rely on contact lens material profit to support your practice. Remember that the majority of what you provide for your contact lens patients is service related.
Competing in today's healthcare and contact lens market presents many challenges and opportunities. Practicing optometry lets us enhance the quality of life for patients through vision care and medical eye health services. Seize the opportunity for every patient encounter and use your valuable skills to help your patients. At the same time, enjoy the fruits of your work. CLS
Dr. Corbin is in private group practice in Reading, PA. He is an adjunct instructor at the Pennsylvania College of Optometry and lectures nationally.