Article

THE SUM OF THE PARTS OF A SPECIALTY LENS PRACTICE

Tips on how you can create and develop a contact lens specialty practice.

These days, private practice is faced with a number of challenges, some of which are new and many of which have been present for some time. The proliferation of third-party systems (both vision plans and medical insurance) necessitates that we look closely at our office efficiencies to maintain profitability. In addition, the conversion to electronic health records (EHRs), and all of the regulation that goes along with it, has tried our patience and caused us to jump through many time-consuming hoops that may appear silly and superfluous. Through it all, hope is not lost.

As we consider ways to manage these challenges, it is important to remember our roots. It was Newton K. Wesley, OD, MD, ScD, PhD, and George Jessen, OD, who helped to popularize contact lenses back in the 1950s by traveling the country and educating practitioners as well as the public. And, at that time, the only available contact lenses were rigid lenses made of polymethyl methacrylate (PMMA). Robert Morrison, OD, introduced hydroxyethyl methacrylate (HEMA) spin casting to the United States and thus the birth of soft contact lenses. John DeCarle, OD, introduced the first extended wear soft lenses in the United Kingdom, and Donald Korb, OD, enlightened us all about giant papillary conjunctivitis (GPC) as a complication of soft lens wear. Of course, Dr. Korb continues to perform fabulous work in the area of ocular surface disease and how it relates to contact lens wear.

A 2012 Survey of Optometric Practice by the American Optometric Association (AOA) stated that, in the average optometric practice, approximately one-third of the revenue is provided by medical insurers (evenly divided between private insurance and government reimbursements), approximately one-third by vision insurance plans, and approximately one-third by private pay.1 We also know that under many insurance plans, contact lenses are covered to a lesser extent (or not at all) compared to other eyecare products and services. As a result, contact lenses offer us an opportunity to regain some control of our practice profitability.

With this in mind, it is perplexing that contact lenses have resulted in such modest growth over the years. Yes, it is true that contact lenses are now about a $2.5 billion industry in the United States,2 but you would think it should be even more by now.

After all, contact lenses are now available to correct virtually every vision defect and in every desired wearing schedule. New technology has also allowed for improved comfort, better vision, and easier care. The key is to educate our patients about contact lenses and the benefits of these devices.

Unfortunately, as it pertains to new contact lens wearers, it seems that patients have to ask far too often rather than being provided contact lenses as an option by their eyecare provider. Too often, practitioners make excuses such as “I can make more profit selling a pair of glasses,” or “Contact lenses take too much chair time,” or “I want to concentrate on medical eye care only.” Well, I believe that practicing medical eye care is a great way to supplement your practice, but it takes more.

So, it’s time to get serious about making your practice more conducive to contact lens care. Consider every spectacle wearer as a potential contact lens wearer, and always mention this option. Have a positive attitude toward contact lenses, and be willing to wear them yourself. Have your staff do the same, if possible.

Most importantly, don’t take the “stretch sock” (one-size-fits-all) philosophy. Welcome the most difficult cases to your practice, including astigmats, presbyopes, and keratoconus, post-transplant, post-refractive surgery, and dry eye patients. Additionally, consider ways of setting you and your practice apart and differentiating your practice from the competition. Following are 10 suggestions to consider when making your practice a contact lens specialty practice.

1. ESTABLISH YOURSELF AS A SPECIALIST

We have all heard that it is very difficult to be all things to all people. Practicing full scope optometry is great, but to build a contact lens specialty practice, patients (and others) need to perceive you as a contact lens authority. Of course, before you can look and act the part, you need to be the part.

Learn as much as you can about contact lenses, including therapeutic and medically necessary fitting. Become comfortable in managing all aspects of anterior segment disease that may influence contact lens success, such as ocular surface and lid disease. If you are still in school, you should strongly consider a cornea and contact lens residency.

Once you are comfortable and confident, it is time to get the word out. This entails becoming involved in your local community through various service clubs, religious groups, and school organizations. Offer to speak and share your knowledge and expertise. Also, consider calling on other professionals in your area. If you are willing to tackle difficult contact lens cases, you should tell other eyecare practitioners in your area. This is especially true of cornea specialists who may not offer contact lens care in their practices or centers, yet see many contact lens candidates. In addition, get the word out to school nurses and pediatricians.

Establishing yourself as a specialist also means networking professionally. Become involved in the AOA Contact Lens and Cornea Section, the American Academy of Optometry Section on Cornea, Contact Lenses and Refractive Technologies, and the numerous other contact lens organizations. These national organizations are a great way to meet others who have common interests and can help you expand your knowledge and grow your practice. Don’t forget the local and regional organizations or chapters as well. Also, consider publishing articles on various aspects of contact lens care as a way of getting your name out in the profession.

You will need to invest in your practice in the areas that are conducive to building a contact lens practice. Having the necessary equipment beyond the basics is key. Instrumentation such as a corneal topographer, pachymeter, optical coherence tomographer (OCT), endothelial cell analyzer, radiuscope, and GP modification equipment are all worth considering. It is also important to have an expansive array of diagnostic contact lenses available—both GP and soft—including specialty designs. Inventorying contact lenses for dispensing is expensive, but also a great way to set your practice apart.

2. PUBLIC AND PATIENT RELATIONS

Public relations (PR) is nothing more than news or information that gets published or circulated in the media that affects your relationship with patients, your community, and your staff. This information can build awareness of your brand with your current and future patients by creating a “third-party” endorsement by the media. You may be able to manage a PR effort on your own in some instances, but seeking professional advice is never a bad idea. A firm may be hired on retainer to develop a long-term PR strategy, or you can simply use it on a per project basis. One of the keys to success is to define what you have to offer to the niche that you want to reach.

Patient relations concentrates more on internal marketing approaches and is designed to take advantage of the fact that, in most practices, the vast majority of new patients come to your practice based upon the recommendation of existing patients. Obviously, the more satisfied those patients are, the more likely they are to refer friends and family.

In many ways, effective patient relations involve nothing more than applying the Golden Rule to patient care. It also helps to pay attention to detail in every aspect of your practice. Following are just a few of the “little things” we have done to help try to exceed patient expectations. This in no way is an exhaustive list, but it gives you an idea of the types of approaches you can try.

Call patients by name. It seems obvious and silly, but everyone wants to feel comfortable in your office. We have a place in our EHR patient charts that allows us to record each patient’s preferred name (Bob versus Robert) and proper phonetic pronunciation, where applicable. Our technicians are also instructed to approach patients in our reception room prior to addressing them and to not call their name from across the room. For this reason, we also place photographs in the chart for ease of recognition.

Record information. We record personal comments about patients in a special area of the chart that is not part of their medical record. This might include information such as how many children they have or where they are taking an upcoming vacation. This allows us to have future conversations with patients and makes them feel more special and at home.

Give a warm welcome. Send every new patient a welcome note. You should also send thank you notes if a patient refers someone new to your office.

Call patients back. Check on patients if there is some potentially unresolved issue or if they have undergone a recent procedure. For example, do a phone follow up for a patient experiencing a contact lens vision problem for which you have made some sort of change or a patient in the early stages of adapting to corneal reshaping. This call does not need to involve practitioner time, as it can be handled by other staff members. However, it can be a very effective way to let patients know you care.

Provide snacks. We hope our patients don’t spend too much time in our reception room. But, while they are there, we serve refreshments (such as drinks and cookies) to help make their time in our office more relaxing and enjoyable.

Two words: Great staff. Perhaps the most important thing you can do to build quality patient relations is to hire and train exceptional staff members. It goes without saying that your staff is an extension of you and can make or break a patient’s perception of your practice.

3. ADVERTISING

These days, advertising comes in many forms and can be an excellent way of promoting your contact lens specialty practice. There is broadcast media (e.g., radio and television), websites, email communication, text communication, and social media (e.g., Facebook, Twitter, etc.). Although perhaps less popular than previously, print media is still a viable option as well. This can include newspapers, magazines, programs, and billboards. Other avenues to consider are direct mail, sponsorships, and the local telephone directory.

As with public relations, the key to successful advertising is to target your market and then market to your target. In other words, know who you are trying to reach, and develop a campaign to reach that group. You should be able to measure the response and adjust if necessary.

There are a few things to remember when it comes to advertising. Advertising cannot: 1) Help you sell where a need is absent (think: selling parkas in Miami Beach); 2) Reach someone who is out of the market (someone who just bought a new car is likely going to ignore any advertisements for new cars); or 3) Satisfy your patients. Advertising may get them to your office, but satisfying them must be done once they get there.

4. HOLD OPEN HOUSES

Holding an open house during the evening can help to make patients aware of the services you provide or new contact lens developments that you offer. Perhaps you are working with a new multifocal lens, or perhaps you recently remodeled or opened a new location and simply want to show it off. You also might consider hosting a reception for the local Chamber of Commerce or other local organization.

5. HOLD SEMINARS

Similar to an open house, holding a seminar is a great way to invite existing or prospective patients into your office. This has worked well for years with talks about refractive surgery. You can consider discussing corneal reshaping or myopia control.

Include a formal presentation by the eyecare practitioner, and be sure to save time for questions or discussion. Serve refreshments and have staff on hand to help and even to schedule appointments.

6. PATIENT MAILINGS

Direct patient communication continues to be an excellent way to make your patients aware of new developments in your practice and in the contact lens field. These communications may be subject-specific (a new contact lens technology) or in the form of a newsletter covering a number of topics. These days, this does not need to be done via “snail mail”—though it still may—but it can be done via email or text.

7. IN-OFFICE COMMUNICATION MATERIALS

Another form of internal marketing involves educating your patients by various means while they are in your office. Again, the most important aspect for this is a well-trained staff, but there are a number of supplemental materials that may be used to support and reinforce your message.

In-office pamphlets and brochures may be very helpful (Figure 1). In addition, they are easy and affordable to customize; templates are available that let you write them on your own to clarify the message you want to deliver. This further allows you to build your own brand and concentrate on areas that are important to your office. If you’d rather not do it yourself, there are a myriad of pamphlets already available from the industry, the AOA, or other sources.

Figure 1. In-office pamphlets and brochures are easy to customize to portray your practice’s message.

In-office videos and closed circuit loops are another fine way of educating your patients as they spend time in your office. There are several eyecare-specific media companies that can help you with this. Ideally, patients calling your office are not placed on hold for prolonged periods, but quality on-hold messages can be educational and can encourage some questions as patients are waiting to have their needs addressed. Other items such as in-room computers and tablets, schematic models, and drawing boards are inexpensive and offer additional ways to educate patients.

8. CLINICAL STUDIES

Perhaps there is no better way of projecting yourself as a contact lens specialist than to become involved in clinical trials for new contact lens materials and solutions. Participating in clinical trials elevates your level of expertise in the eyes of patients and the community. In many instances, it also provides you access to the latest advancements and developments in the contact lens field before others have the opportunity to try them.

However, you cannot just simply decide that you are going to participate in studies and instantly be part of one. This requires networking and involvement with industry and colleagues. Again, I emphasize the importance of becoming involved professionally.

If you are fortunate enough to get your foot in the door, the next step is to do a great job so you will be asked again. This involves designating a staff member on whom you can count and who is very detailed oriented as study coordinator. And, if you become involved in clinical trials, you want to communicate this to your patients regardless of whether or not they participate.

9. CONVENIENCE AND SERVICE

Having a contact lens specialty practice requires providing a level of service and convenience beyond that of your competition. In this “I want it now” era, you must offer flexible and convenient hours, which might need to include evenings and weekends. You also must be available 24 hours per day for emergency calls; fortunately, these do not occur very often.

And, it is imperative to make it easy for patients to replace their contact lenses or order additional supplies if you are going to compete with alternative sources of distribution. This may include allowing patients to order lenses by phone, online, and/or via email request; then, make the lenses available via mail, courier, or even drive-up window.

10. ESTABLISH A CONTACT LENS FEE SYSTEM BASED ON SERVICE

Building a contact lens specialty practice will provide you with little benefit if you cannot find ways of making it profitable. To do this, you should take the approach that you are providing a sophisticated service and not merely dispensing a product.

For many years, and for many reasons, contact lenses have become trivialized and commoditized in the eyes of many of the public. It is our job to re-educate these individuals regarding the importance of professional care to the success of any contact lens wearer. It all starts with the attitude that it is the professional’s skill and expertise that makes a patient successful with contact lenses, not the result of any specific brand of contact lens.

When I was a student at the Illinois College of Optometry many years ago, I attended a practice management lecture by my then future mentor, Robert A. Koetting, OD. He posed the question: “What would you charge if contact lenses were free”? Thirty-five years ago, that question was quite thought-provoking.

With that in mind, there are three considerations in developing a contact lens fee system and structure that are successful. First, how do you handle a new wearer? Second, how do you manage an ongoing wearer? Third, how are we to be compensated for the costs to dispense product in our office?

All new patients must start with a comprehensive eye examination, but we must also include a contact lens examination. That second examination consists of tests and measurements specific to determining candidacy for contact lens wear as well as diagnostic lens evaluation. Too many times, practitioners do not differentiate between these two exams and do not charge a separate fee.

In addition, all new contact lens patients require instruction on appropriate lens care and handling. Historically, the contact lens dropout rate among patients is about 16% per year3,4, and many times it is due to difficulty and frustration in handling lenses. Recognizing this in our practice, each new patient receives one-on-one instruction on application and removal as well as proper lens care techniques. We charge a separate fee for this service as well, as we are devoting significant staff time to the process. We also provide a three-month supply of recommended solutions and emphasize the importance of continuing with those particular products.

Finally, in our practice, we charge a fitting fee, which includes the initial contact lenses (or supply as in the case of soft lenses) and all follow-up care related to the adaptation to the lenses. The fitting fee is broken down into four categories (Standard, Complex, Special, and Custom), with variable fees depending on the complexity of the individual case; the fee is not necessarily based on the type or brand of lenses being used.

For example, most spherical daily wear fittings would be considered Standard. Conditions such as astigmatism and presbyopia, or fitting lenses for extended wear, would all add a level of complexity, and a higher fee would apply. We base these fees on the anticipated time and materials we would expect, including the number of expected return visits. Developing the amount to charge will depend on your particular practice situation and overhead.

In the event that a patient is unsuccessful for some reason, the fitting fee may be fully or partially refunded, depending on when the patient discontinues lens use. The examination fees, as well as the instruction fee, are non-refundable, as these represent time and services that we have already provided to the patient.

Once a patient is successful, the next consideration is what will occur in year two and beyond. Although many practitioners will tell you that service agreements are no longer a good option, our experience has been quite the opposite. We charge the patient an upfront annual fee that covers all contact lens-related office visits for one year and provides an in-office discount on contact lens replacements and eye wear (Figure 2). In this way, patients are tied to our practice for a full year, and they are a captive audience when it comes to replacement lenses and eyeglasses. As a result, not only are patients tied in to the practice, but it is a source of ongoing cash flow. The use of service agreements may be affected by insurance plans, so understanding each plan must be factored in prior to issuing the service agreement.

Figure 2. Service agreements tie patients to your practice for at least one year.

We mail service agreement renewal notices 30 days prior to the expiration date and then again at the expiration date. If we have still not heard back from the patient, a third notice is mailed 30 days after the expiration date.

Finally, as mentioned, if we are going to dispense contact lenses in our office, we must be aware of our costs. Remember, this cost is not simply what we paid for the lenses, but includes other factors as well. If a product is inventoried, there may be staff time associated with checking the order in and placing it into inventory. Once you determine what your costs are, you should set your fee so that you can be fair to the patient while still maintaining competitiveness.

Once again, the entire idea with a fee structure such as I’ve outlined is to de-emphasize the materials and place the emphasis on the professional service and care that we provide. This will elevate your stature in the eyes of patients and hopefully help them understand the importance of quality contact lens care.

CONCLUSION

Contact lenses continue to be a popular mode of vision correction with patients and offer practitioners an immense opportunity to significantly grow their practices. The biggest hurdle is to embrace the concept and be willing to make the changes necessary to achieve this success. I hope the 10 steps that I’ve discussed above can help you to develop or enhance your contact lens specialty practice. CLS

REFERENCES

  1. American Optometric Association. Survey of Optometric Practice. 2012 Nov.
  2. Nichols JJ. Contact Lenses 2016. Contact Lens Spectrum. 2016 Jan;32:22-25, 27, 29, 55.
  3. Rumpakis JM. New data on contact lens dropouts. Rev Optom. 2010 Jan;147:37-42.
  4. Evans VE, Carnt NA, Naduvilath TJ, Holden BA. Factors associated with drop out from silicone hydrogel contact lens daily wear. Invest Ophthalmol Vis Sci. 2008 May;49:4839.