Todays O.D. may think that prescribing lenses and selling eyeglasses is pretty ho-hum business compared to the exciting world of disease management. However, optometrists who turn their back on their dispensary may be turning off their patients and, in turn, losing a critical source of income.
With the emphasis on therapeutics and disease, there has been a de-emphasis on the optical, says optometrist Bob Cole of
However, as optometrists are increasingly moving away from optical as their main focus of interest, many ophthalmologists are recognizing it as a new avenue to increase their bottom line. We need to get over the idea that optical is beneath us and realize that, in fact, we are the experts, Dr. Cole says.
The Trend Toward Disease Management
Today, there is a huge tendency to focus on diagnosis and treatment of disease, often to the detriment of optical, according to
Optometrists have increasingly become the primary eye care doctors as a result of new legislation that has increased their scope of practice. Optometric colleges are also contributing to this trend by encouraging the growth of disease management in their curriculum, says optometrist Jason R. Miller, MBA, of
Optical dispensing has a low status starting in optometry school. Doctors want to examine eyes and treat eye conditions, not sell products; and they dont like the public perception that they sell products, Dr. Gailmard says.
Getting tips on how to maintain a healthy dispensary may seem as unnecessary as re-learning the ABCs, but this is critical for any practice. Dr. Cole chuckles as he recalls the lesson he learned about the importance of a dispensary while taking a practice management course he initially thought was beneath him. Dr. Cole told the instructor that he typically wrote a prescription for eyeglasses, gave it to the patient, and then told the patient to see the optician. The instructor asked, When you hand the patient the prescription, can you be sure the patient can get the quality and price outside of the office?
While O.D.s are turning more toward disease management, there is also a trend of M.D.s turning their focus to optical to boost their practice, Dr. Cole says. While we are letting it go, organized ophthalmology is embracing it.
Traditionally, ophthalmology stayed away from optical, but over the past five years theres a growing interest. Courses at ophthalmology meetings now focus on how to start a dispensary and how to better manage one. In addition, consultants are suggesting that M.D.s ramp up their dispensary to boost their bottom line. As surgical fees continue to be cut, it is rare to find an ophthalmology practice today without a dispensary, Dr. Cole says.
While many ophthalmologists are beefing up their opticals, many optometrists are continuing to decrease the amount of square footage to optical in their practices.
Office space is always limited, so when O.D.s design their floor plans, their true priorities are revealed and, generally, it favors more exam rooms, more special testing areas, more billing and administrative offices and a larger waiting area, Dr. Gailmard says. In the end, the optical dispensary gets whats left. And, once space allocation is determined and the rooms are built out, it is not easily changed. To be truly successful, the optical must be impressive and compelling. That is dependent on sufficient space, excellent inventory and beautiful display furnishings, Dr. Gailmard says.
Finding a Balance
Satisfying a patients vision and a patients medical needs are of equal importance, and a successful practice needs to have a comfortable balance between the two, Dr. Miller says. Optometrists who dont put much emphasis on optical are missing out on a significant source of revenue.
The optical is what separates a good net income from a great one in optometry, Dr. Gailmard says. Primary care alone does not generate huge fees. Optometrists are so pleased to find that medical insurance plans pay much better fees than vision plans they think that is the key to maximum revenue.
Treating eye disease produces revenue through office visits and special testing, but the fees for those services are not large dollar amounts. Fees are limited because most O.D.s see a large percentage of healthy eyes for routine care. Even if an O.D. specializes in eye disease, he or she does not generally perform surgery, so the revenue is good, but not great, Dr. Gailmard says. The key to great revenue production is to provide both primary care and a great optical.
While O.D.s may think that disease management is the area of optometry with all the bells and whistles, patients still think optical is just as important. Patients dont view eyeglasses as trivial objects, but complex devices that are vital to good vision, Dr. Gailmard says. To make medical and optical co-exist successfully, the doctor simply has to be interested in both and talk about both, he says.
Optometrists can delegate the actual work of optical dispensing, but they should remain very active in the management of that segment of their practice. Its important to make a significant investment in the physical space, the inventory, the optical lab and an excellent staff, Dr. Gailmard says.
Part of maintaining a comfortable balance is through delegation, with preliminary testing and dispensary management, Dr. Miller says. In the last few minutes of an eye exam, Dr. Miller reviews a form with his patients and recommends the specific lenses and coatings. That form is passed on to the dispensary staff and, typically, these recommendations are followed through. Through delegation, you can perform a more comprehensive eye exam, satisfying both the patients vision and medical needs, he says.
Whats Important to Patients
When a patient gives a report card to an optometric practice, the dispensary is a significant part of that grade, Dr. Miller says.
A great optical department with a large selection of attractive frames, beautiful dcor, a skilled and attentive staff of opticians, and fast service offers a powerful competitive advantage over other optometric offices, Dr. Gailmard says. Word-of-mouth referral is the largest source of new patients for O.D.s, and people often refer when theyre happy with their glasses.
Im perfectly happy with that reason for referral, Dr. Gailmard says. Lets face it, the public does not understand the technical aspects of the eye exam, but they do understand eyeglasses. The exam is over in a half hour, but the glasses are with them every day for a long time.
Glasses are a natural for stimulating referrals, Dr. Gailmard says. The first thing a friend is going to say is did you get new glasses? Theyre on the patients face; people cant help but talk about them. What the patient says about the optical dispensary, if anything, is completely up to the optometrist.
Optometrists should still have an active role in recommending optics, which can control quality and cost. If we write a prescription and the patient goes his way, the patient may wind up with a pair of expensive glasses that are not good quality, Dr. Cole says.
In addition, not talking to patients about dispensary needs may be detrimental to the patient-doctor relationship. If a patient needs sports eye wear and the optometrist doesnt recommend it, the patient may wonder why, Dr. Cole says.
Patients also like the idea of one-stop shopping and knowing that total eye care is delivered in your practice. Patients spend hundreds of dollars on a pair of glasses, and they are always going to need a new pair in the not-too-distant future.
It seems obvious that patient loyalty to the optical department of a practice is extremely valuable, yet I think many O.D.s are pretty complacent about it, Dr. Gailmard says. If you picture the optical area of an average optometrists office anywhere in the
Benchmarks for Optical
Dr. Gailmard suggests that optometrists use a 50% benchmark on how much optical should bring into their practice based on practice gross revenue being broken down into optical and everything else. Many O.D.s are very proud when their practice breaks the mold and produces 70% from professional services and 30% from optical. But Im not so sure if thats because they are doing great with services or if its because they are just mediocre in optical. In the practices Ive observed, its usually the latter.
Dr. Gailmard says hes happier if the optical produces 55% or 60% of total revenue. The highest grossing practices hes seen are that wayand they do a great deal of medical eye care. In analyzing the mix of services and products, we should remember that professional services require the doctors time, while optical sales do not.
While the expanding scope of practice has created a greater interest for optometrists to focus on disease management, todays O.D. should not forget about the optical side of practice. This is critical for the satisfaction of the patient and the practices bottom line.
"Optometry is still the undisputed leader in the field of refraction and optical dispensing, but the retail work and ophthalmology would like to increase its market share," Dr. Gailmard says. "Optometrists must stay active and interested in optical or risk losing a valuable competitive advantage in the marketplace."
