The clinical side of contact lens provision historically has been in selecting the correct lens and lens material design for an individual patient. The fitter must be knowledgeable about ocular physiologic responses and be able to solve problems.
However, in certain areas of the contact lens practice, contact lens practitioners must also learn about the business through experience, through continuing education programs, from colleagues, and through studying other types of business.
In this chapter, we outline a dynamic approach to practice management for the contact lens practice. To succeed in the contact lens market, you should be knowledgeable about who the competitors are in your area and why they have or have not been successful.
There are many nontraditional channels via which the public can purchase lenses, such as mail order and mass merchandising. This is part of the competition for the professional contact lens fitter. Your practice focus should be on providing professional services based on your medical expertise. You should try to determine where your practice is located in the general milieu of other contact lens providers in the area. This relates to the specific city or specific region of the practice. Outline who the competitor is, how you can differentiate yourself and how you will succeed in a given market.
How to make patients happy
Making patients happy is good business, avoids negative comments or posted ratings harmful to your reputation and prevents litigious actions. The secret to making patients happy lies in good communication skills. This starts with an attitude of empathy, caring and making patients feel that they are important. This attitude is reflected not only by what the doctor but also the support staff say and do. The goal is to make the patient feel psychologically comfortable in the office. There are a number of ways in which this can be accomplished.
Minimize patient wait time
One of the key factors that affect a patient’s overall rating of a practitioner is the time spent in the reception area ( Fig. 17.1 ). When possible, support staff should begin promptly with history taking, measurements or contact lens instruction in advance of the appointment time with the practitioner. Waiting time is a major factor in patient dissatisfaction which increases dramatically if the wait period exceeds 30 minutes. Office schedules cannot always be controlled especially if there are unexpected emergencies to deal with. Doctors who are habitually behind schedule should take a close look at the bookings system and build in allowances for unexpected delays which snarl up the schedule. If delays are unavoidable, patients should be told why and how long the wait may be. This minimizes the patient’s aggravation and shows respect for their time. The patient should be offered a reappointment if it is more convenient. In addition, interesting diversions which include books, magazines, videos, TV with documentary or sports channels should be made available to pass the time. A play area for children with blocks and coloring books is welcomed by parents.
Make patients feel important
The first contact the patient has with a doctor’s office should be courteous, respectful, and personalized. Patients respond positively to being recognized—a nurse asking after a baby, the receptionist offering a preferred appointment time or the doctor inquiring after an ailing family member or recounting some details of an earlier conversation. It is also appropriate for practitioners to stand and shake hands when first greeting a patient. At the same time, consideration should be given to diverse cultural practices. In some cultures, a pleasant greeting is the accepted manner to welcome a patient and convey friendliness and concern. It is essential to communicate in a tone that is not patronizing. The patient should understand what the basic problem is and what is going to be done to correct it. The practitioner should take their cue from the patient as to the level of technical discussion—some prefer more and some less.
The importance of eye contact between practitioner and patient cannot be understated. And when more than one person is present, a respectful amount of attention is given to all. It is offensive to an older patient if the doctor directs advice exclusively to a younger person who is accompanying the patient. Patients are often reluctant to ask questions and it is better to be on the side of more rather than less information. Finally, the doctor should not make patients feel that he or she is too busy to listen to their problems and that they are not important. The patient always has the option to seek services elsewhere.
Create space for comfort
Surprisingly, small details, such as how the furniture is arranged, can make a difference in overall patient comfort. In a medical practice, a desk positioned between a patient and the doctor often represents a barrier to close communication. Positioning the chairs near each other creates an environment of comfort wherein problems and solutions can be discussed.
Respect a patient’s right to privacy
Any discussions with the doctor or support staff should be conducted in private. Other patients should not overhear privacy details relating to diagnosis, treatment, fees, and payment arrangements. Particular attention needs to be paid to the individual’s Health Insurance Portability and Accountability Act (HIPAA) provisions.
Look the part
Look professional. Patients expect a professional environment in which doctors and staff are dressed in appropriate attire. Some offices allow business attire whereas others adopt a uniform look that clearly differentiates the staff from patients. Unkempt staff reflect poorly on the practice.
Pay attention to detail
Unclean examining rooms make patients uneasy especially when materials from previous examinations are clearly visible. Disinfecting alcohol or chlorox swipes should be used on equipment and lens instruction surfaces after each patient to prevent contamination especially in lieu of SARS, H1N1, and COVID 19. Interruptions during an examination can be particularly annoying. A loud intercom system is disturbing and disruptive. Coat racks are a needed convenience in the waiting room. A pleasant décor created with plants, current magazines, and art prints offer a welcoming environment and a caring doctor. Washrooms should be wiped down and restocked once or twice daily.
Master communication skills
Conversation is an important factor in making or breaking the doctor–patient relationship. Here are a few tips.
Be upfront . Give information right at the beginning of the visit, not at the end.
Be creative . Use everyday language to explain what is wrong and how you are planning to correct it.
Be personal . Ask questions about the patients’ family and social life so that they feel that they have not been forgotten from one visit to the next. Make notes on charts about a patient’s interests and concerns for recall at future visits.
Be caring . A quiet professional tone conveys attentiveness.
Be prepared . If you have something that needs to be shared with a patient’s family, ask them to come in from the waiting room and share the information with them.
Solicit patient feedback . Confirm that what you have told the patient has been understood by asking the patient to relate the information back to you. This is particularly important when educating patients on care systems for contact lenses. Patients often leave the office without fully understanding all the steps involved with their contact lens care systems. Written information will reinforce the message. Personalized handouts are an important and effective means to confirm instructions, serve a quick reference for contacting the office and a means to refer friends.
Be human . Patients want human interaction and a practitioner who is supportive, empathetic, and caring.
Be fair in all matters of finance
Charge fairly for your professional services and do not overcharge. Be fair in refunding patients who prove to be unsuited to contact lens wear. A clear statement of fees and partial refund should be discussed and detailed on the chart. Have a written fee and refund policy on display. Always look at the situation from the standpoint of the patient. Maintain goodwill at all costs. By doing so you will help ensure a happy patient who will refer friends and family to the practice.
The preconceived information that a new patient has about contact lenses is often confusing and incorrect. The initial consultation should clear any misconceptions and answer all the questions. Handouts reinforce the answers to frequently asked questions and may answer other questions overlooked in the initial interview. Some of the pamphlets are available from manufacturers and from contact lens societies and others can be customized for your own practice. Handouts are a great practice builders. In addition, educational videos on lens handling and care of contact lenses reinforce the spoken and written word. Be prepared to answer questions from patients regarding online information and direct them to trusted sites. The ability to communicate face to face online with the patient is an added bonus.
It is most important that contact lens patients be adequately monitored after lens fitting. Contact lens patients require ongoing care as a means to maintain eye health. A number of satisfied lens wearers will simply forget to return for regular examinations. Complications can develop—a rigid lens may warp thus altering the corneal curvature and fit; a soft lens may become coated thereby changing the lens characteristics causing anorexia, vascular invasion and allergic reactions. Routine appointments are necessary to prevent problems.
The practitioner requests that patients return for regular follow-up and reschedules the patient with an appointment. This is the responsibility of the practitioner. And the patient’s responsibility is to return. In a busy practice, it is easy to overlook the drop-outs who do not return. Thus an effective recall system by either phone, mail, or email is most important. Addresses and phone numbers may change, but a little detective work may greatly aid in locating patients. This is detailed on the file and demonstrates the practitioner has attempted to provide proper care of the patient. We suggest that a patient agreement form be used outlining the minimum follow-up requirements.
A recall system can be set when all contact files are reviewed and those patients who have not returned, are duly notified. Some practices use the birthday cross-reference or date of initial fit thus spreading the load over the year. Other medical offices use a company that provides all office services off site; booking appointments—the practitioner is given a list of daily appointments, reminder phone calls, yearly insurance renewals, and replacement lenses.
Disposable contact lenses permit a system of follow up that is based on patients returning for their supply of additional lenses. It is important with disposable lenses that patients adhere to the prescribed replacement regimen and do not use the same lenses for too long in an attempt to save money. Computers can be invaluable in tracking patient contact lens replacement regimens.
A successful practice
Most professional offices cannot and do not advertise lenses at a discount price. Therefore they are not widely known or chosen because they are not the cheapest purveyors of lenses. The only advantages of going to the doctor are his or her superior skills and willingness to take a personal interest in the patient’s welfare. The following suggestions will help in achieving these aims:
Minimize answering machines during daytime office hours. Patients like to talk to a human being!
Be selective . Choose patients carefully. If a patient is contraindicated for contact lens wear, fully explain why this is so. The happy patient is your main source of advertisement.
Inform your patient . Information directly from the doctor and staff, along with office pamphlets, inform the patient about possible problems and complications of contact lens wear and how to prevent them. Ongoing communication through newsletters and mailings and emails helps reinforce this information.
Be thorough . Check tear film and lids and examine every facet of contact lens fitting so as to maximize your success rate.
Emphasize safety . Many patients think contact lenses are products like shoes or socks. A lens is a prosthetic medical device that requires expert supervision. In many countries, contact lenses are regulated by the government, and by law, require medical supervision.
Follow up . A follow-up service is essential. Many contact lens-induced problems are asymptomatic. The patient should be monitored carefully on an ongoing basis. The commercial way is to sell the contact lenses to the patient and then say good-bye. This should not be your way.
Offer personal service . Do special things for the patients, such as providing free starter kits, solutions, mailings, reminders, and so on.
Be current . Attend lectures and seminars and read journals to stay up to date on developments in the field.
Developing a business plan is essential. With pen and paper describe your practice, how long it has been in operation and the relevant legal structures. Check out available financing for promotion and advertising. A business plan should help you organize your goals, strategies, and activities. A well-devised business plan increases the chance of making the contact lens practice a profitable success. It will encourage you to commit to the endeavor. Consult with others who are knowledgeable in this field. The key points should also consider allocation of resources, staff, website, search engines and the important influence of social media.
Understanding your organization
Describe who your current patients are and with whom you would like to attract as patients. They may be from the general public or specific organizations, professions and businesses in your neighborhood. Develop your pricing strategy and your distribution methods. Ask yourself if you are promoting your contact lens practice effectively through a website and monitoring social comment. If you have companies or individuals that you would like to target, try to be placed on a “perk list” as a preferred business link. Knowing the key individuals in a business or practice to contact is important to the development and expansion of your practice. Actively consider how best your practice can thrive. You may decide to change contact lens vendors or even to relocate the practice to another part of the city or region.
Analyze the past 2 to 3 years of the balance sheet and income statement for the practice. In addition, it is a good idea to create some projections for cash flow. Monthly projections may be important if you are looking for financing from banks, and so on. These projections will serve as a basis for budgeting in the practice. There are many computer software packages for the business planning process. Most are inexpensive and useful.
Once you have a business plan, you can develop a marketing plan (see the following text).
Pricing policy in the contact lens practice
Two primary types of pricing policies are used in contact lens practices. One is a global fee encompassing all services provided to the patient. For example, practitioners can bundle lenses, care solutions, and follow-up care for disposable and frequent-replacement lenses for a set fee. The other pricing policy takes expenses into account by setting separate fees for examination, fitting, and services combined with retailing the contact lenses. This policy identifies specific costs to the patient.
When fitting custom contact lenses, such as rigid gas-permeable (RGP) lenses, toric soft lenses, and other special lenses, a specified exchange warranty should be obtained from the manufacturer if possible. No matter how skilled the fitter, small modifications of the lens base curve, diameter, power, and axis and refit changes are needed for a successful fit.
An exchange warranty for RGP and custom toric lenses, as well as the security of being able to reorder as needed, is well worth the additional initial expense. Having the ability to reorder lenses without additional charges is a boon to practitioner and patient alike and emphasizes to the patient the custom professional care provided by your office.
Practitioners should research prices for products and disposable lenses. You also may be able to participate in a buying group. It is well worth researching alternative sources for the average 15% to 30% price discount that can be obtained. The highest-quality laboratory should be used for custom lens orders regardless of price.
Packaging care solutions with lenses is becoming popular as a valuable added service. Many contact lens starter kits are available from the major lens manufacturers. Some contain a contact lens case, contact lens disinfection solution, protein remover, a daily cleaner, and buffered saline. Others consist of a contact lens case and an all-in-one solution. Perhaps dispensing more than one starter kit of the same care system is useful to patients to accustom them to proper compliance.
Careful controls are necessary not only in researching lens sources but also when purchasing contact lenses and supplies for dispensing to patients. A bookkeeping system must be in place to keep up with the charges as well as credits on lenses returned. Either a manual system or a simple computer program is required to track these orders and credits.
Maintaining your contact lens practice by following established business principles is essential to practice success. One such principle is the relationship between costs and gross sales. One rule of thumb is that the goods (contact lenses and care system) should amount to approximately 33% of gross sales. Salaries should amount to 25% and other costs should be approximately 17%. If the gross goes up, so too should the costs and vice versa. This leaves about 25% for profit and for future development and advertising. These ratios should be checked on a quarterly basis.
The fitter and some other staff may be encouraged by a performance bonus based on the contact lens practice revenue rather than salary increases.
It is important to track the financial performances of a contact lens department as a separate profit center. Revenue should be incorporated with all expenses in the balance sheet. The more details, the better is the ability to analyze the performance of the practice. There is a direct relationship of cost of goods, salaries, and advertising to the gross revenue.
Track sales and sales data on a computer. Identify which are the top-selling contact lenses annually. Track the turnover of your lenses. Identify whether you have a proper mix of contact lens products—disposable, bifocal, and extended wear—for your patient clientele. Use computers if possible. Goods that sit on the shelf often represent lost revenue, so it can be helpful to create an inventory of the most commonly prescribed contact lens products. Stocks of trial and diagnostic sets should be maintained because these can be dispensed in an emergency situation to the patient. Identify the percentages of new fits, refits, and replacements that are sold. Have service agreements in place for lens replacement programs.
Marketing is a very complex process that involves much more than paid advertising. Consider the following points:
How long is your database of patient records? Databases may be very important in marketing new products that become available from time to time.
What are the demographics and projected demographics for your market?
Review the marketing plan on a regular basis.
Where are you advertising? Think about dollars spent on advertisements in newspapers, radio, television, and in the Yellow Pages. Record the source of your new patients.
What is your best market?
What is the best advertising budget as a percentage of your gross? It can be anywhere from 2% to 25%.
Create an ongoing newsletter program and use email.
Manufacturers have been known to share costs for advertising a new product. Explore this with your vendors.
Improve public relations by community involvement in your area, such as soccer, basketball, giving talks in schools, and so on.
Develop a “thank-you” service to patients and to new fits. A handwritten thank-you letter might be suitable.
Have a recall system in place. Analyze your recall rate and percentage of returns.
Create a brochure for your practice for all new patients and shoppers.
Design a special appointment card to include telephone and fax numbers and email.
Send someone in personally as a mystery shopper to your competitors. See how you match up.
Consider a patient satisfaction survey.
Professionally design a website detailing all the services provided by your office. Inquiries by email should be handled promptly.
Review your internal marketing, staff, and ambience of your practice. Examine your external marketing (e.g., advertising, direct mail, etc.). Build up patient loyalty to your practice.
A system should be devised to track the number of calls received by phone shoppers about pricing. It is important that staff have adequate training on how to discuss prices with phone shoppers so as to maximize this source of new clients.
Actively participate in free trial lens programs offered by manufacturers. These may involve either new materials or new designs that become available. It may be more convenient to a busy patient to have replacement lenses received by mail or courier. This does not mean that the patient neglects to come in for a regular examination in your office. You could also provide a larger number of lenses, a 6-month supply to minimize office trips. It is important that you keep track of replacements and provide a reminder notice when due. This is another opportunity for the patient to contact your office.
Consider whether you should bundle lenses and lens care products in an annual package. Some practices establish an “annual bundling” in which they include instructions, follow-up visits, lenses, and lens care products for 1 year.
Solutions and contact lenses can be purchased directly from manufacturers and forwarded to the patient. In this way, the patient will know exactly in advance how much the yearly cost is for contact lens care.
It may be possible for you to offer the patient special payment plans, which may cement their relationship with your practice.
Advertising is a vital part of business planning. There are many ways to advertise. How do you differentiate your practice? Paper, television, and radio ads are expensive, require repeat ads for saturation, and are often beyond the means of a small practice. Websites are vital and effective in promoting special services in your practice. Professionally designed websites with search engines will ensure easy access by website browsers.
Advertising often can be shared with manufacturers, and you should take advantage of this. Direct mail is a powerful source of communication. Flyers can be attached to the local newspapers for special promotions. Newsletters, personally drafted or commercially available with your company name, provide the patient with information on new lenses and care systems. A quarterly email blast can be titled “ Update on Contact Lenses ” and is an inexpensive way to connect with your contact lens patients.
Remind all employees that patient loyalty is crucial and they are a major reason for that loyalty. You do not want patients to look elsewhere. Phone calls or emails should be used to remind patients of appointments or to reschedule.
Phone inquiries regarding prices and services should be answered by a knowledgeable staff member and followed with a mailed or emailed brochure. The brochures may highlight specific subjects, such as special lens designs, keratoconus, other disease processes and new available treatments.
Pleasant, efficient, and knowledgeable staff are vital to your practice success. Most will interact with prospective patients and the patient can either gain or lose practice loyalty. Support staff often interact more with patients than the contact lens fitter by answering the telephone, scheduling appointments, dealing with questions, recalling patients, ordering lenses, and many other services. This is a team effort.
Review goals and strategies with staff members regularly. Encourage teamwork in small, regularly scheduled staff meetings.
Try to encourage educational programs for the entire staff. The Contact Lens Society of America (CLSA), the Contact Lens Association of Ophthalmologists (CLAO) now officially renamed the Eye and Contact Lens Association (ECLA), and the International Joint Commission on Allied Health Personnel in Ophthalmology (IJCAHPO) offer good courses that will help staff increase their expertise and become more knowledgeable in managing patients. Employee training is an investment in the practice’s future. It is a good idea to have a staff development manual for the practice. This manual should be discussed annually with all staff members and updated and revised as needed.
Telephone answering is most important and is reviewed elsewhere in this textbook (see Chapter 6 ). All staff should have a 30- to 60-minute period every month to discuss areas of improvement.
The contact lens practice staff
In a practice that includes contact lenses, the practitioner involved in fitting lenses is extremely important. This person’s salary, along with other medical personnel, amounts to the most costly expense for an eye practice. Thus the practice must choose this individual with careful consideration. He or she must be well educated, innovative, and knowledgeable about contact lens products and lens fitting techniques. In addition, the practitioner must have the skills background and experience to successfully fit complicated cases. A professional practice will include corneal disorders, such as keratoconus and postsurgical patients. The contact lens fitter presents a caring professional manner so that a patient has confidence not only in the individual but also in the practice. The ophthalmologist relies upon the contact lens fitter’s ability to avoid or minimize complications of contact lenses and provide the best that modern care has to offer. Finally, this person must have excellent people skills coupled with patience and courtesy. In a practice that does not employ a contact lens specialist, the practitioner takes on this role.
In an efficient contact lens practice, each staff member should have specific responsibilities. The contact lens specialist is given the responsibility of fitting the contact lenses. Careful slit-lamp examination of the initial and subsequent fit, the adaptation process and any complications during wear should be the primary concern of the contact lens specialist or practitioner. Another staff member should have training to instruct patients in insertion and removal techniques, wearing schedules and lens care. Ordering initial and replacement lenses and lens-tracking activities should be delegated to staff to encourage maximum efficiency.
Purchasing lenses and care products for patients is the second most expensive office cost and needs to be handled efficiently to ensure profitability for the practice. The staff member who performs this task must be well trained, responsible and keep excellent records to keep costs to a minimum.
Office equipment and space
Fitting contact lenses requires basic equipment, such as the keratometer and lensmeter. Other useful equipment includes a Radiuscope to measure lenses and a corneal topography or pentacam unit to detect irregular corneas and aid in fitting. Video equipment is helpful for demonstrations during patient education and training. A specific area must be established in the office for handwashing and for patient training in lens insertion and removal. An area is also needed for storage of trial lenses, care solutions, and storage of a contact lens inventory. Supplies should be easily accessible.
Trial lens-fitting sets
In a practice, there is a need to have a selection of trial RGP lenses, soft toric design lenses, and soft disposable lenses. Traditionally, manufacturers simplified the fitting process by supplying a variety of trial lenses to determine fit, comfort, and vision. More than 25% of the population has astigmatism greater than 1.00 diopter that may require toric or RGP lenses. There can be charges associated with trial sets that are not minimal, especially if two or three trial sets of RGP and soft toric trials are required. Fitting of soft lenses and RGP lenses with trial lenses will suffice in most cases. A keratoconus or penetrating keratoplasty practice will need specialty keratoconus trial lens sets.
Contact lens inventory and ordering
The ability to fit and deliver suitable contact lenses on the same day is essential to building a successful practice. This requires a contact lens inventory and a system for reordering to keep the inventory current. Maintaining a contact lens inventory is helpful for patients that often desire instant service. By maintaining inventory of disposable lenses, patients can obtain replacement lenses on demand.
All practitioners maintain a small inventory of their favorite soft disposable lenses so that patients may leave with the lenses at their initial fitting and training. However, the growth of relatively inexpensive courier services allows rapid delivery of contact lenses from the manufacturer to a practice. One can receive initial or replacement contact lenses in 1 or 2 days. Patients are also pleased to know they can obtain lenses promptly either in person or by shipment. The cost of courier service could be borne by the individual who orders the lenses.
The ongoing cost of maintaining an inventory and ordering lenses should be of major concern to the contact lens practitioner. Replacements for inventory lenses must be ordered and bulk orders often will reduce shipping costs. Custom ordering, such as soft toric or RGP lenses will be needed for many patients on a per case basis. Inventory lenses should be kept in locked storage cabinets.
Ongoing care for contact lens patients is essential. Patients should be advised that regular checks are a valuable deterrent to contact lens problems and essential for ocular health. Consistent patient follow-up care over the years distinguishes your practice and builds loyalty.
Lid scrubs are useful for many individuals with meibomianitis, chalazions, and other inflammatory disorders of the eyelid. Many companies sell these in individual packages like hand wipes (e.g., Lid Care, Ocusoft, Ocusoft Plus, Systane, and Lid and Lash). These wipes are also recommended for removal of make-up. Patients are instructed to put a warm compress on the eyelids followed by a sterile scrub of the lash line. Patient loyalty is enhanced by providing starting samples of these products.