Surviving Into The 21st Century:
A Roundtable Discussion

NOV. 1996

Managed care, laser refractive surgery, primary eye care -- these are more than just meaningless buzzwords in the profession today. Here 's how a group of contact lens practitioners are facing the challenges of change.

Contact Lens Spectrum: What are the trends now and in the next five years that are important to contact lens practice?

Dr. Dubow: Contact lenses have to be part of the primary care treatment of the patient now and forever in optometry. I believe that in three to five years, most optometrists will turn back to contact lenses, especially specialty lenses, as a primary care option.

Dr. Grohe: We'll see an increase in requests for contact lens prescriptions, especially with more lenses available over the Internet. Also, we'll need to maintain a perception of accessibility by having a beeper and a 24-hour answering service.

Managed care from a contact lens perspective means marginalized care. As contact lens profitability decreases over the next five years, we may need to shift our focus more towards eyeglasses and therapeutics. Our practices must run leaner and meaner.

WHAT INFLUENCES YOUR BOTTOM LINE?

Contact Lens Spectrum: What's the most significant trend, right now, that influences your profitability? What do you do to maintain contact lens profitability?

Dr. Abramson: In spectacles, there are various levels of quality in both lenses and frames, but in contact lenses, especially standard spherical lenses, the public perceives that a lens is a lens is a lens. We have an opportunity in specialty lenses though, and we've advanced our patients to planned replacement lenses and new products.

Dr. Snyder: Spectacles inherently require servicing and customizing. I would challenge that our contact lenses need that same type of ongoing service. The mark-up in materials is much less than it used to be. It may actually be more profitable for me to give patients an 800 number than to inventory spherical lenses.

Dr. Grohe: Forget about mark-ups on contact lenses. Those days are gone. The best thing to do is to charge cost plus postage. All our other fees should represent the cost for our services, both clinical and consulting. Within the next five or 10 years, distribution of contact lenses will be out of our hands except for specialty lenses. Patients who buy their lenses via the Internet are getting legitimate lenses that work. So patients who do well won't come back to the office.

Patrick Caroline: Also, lenses today are safer and require less care. Most eyes are going to be just fine. Basically, patients will come in to have us check their prescription maybe once a year. How much can we charge for an eye exam?

Dr. Dubow: I don't think that profit in materials is very important to a practice. We can make more by selling our services properly, taking care of patients' eye health and eye care than by trying to mark up materials. How do you do that in a managed care environment where they're telling you to cut your fees?

MASTERING MANAGED CARE

Contact Lens Spectrum: Is it your experience that patients whose managed care plans cover contact lenses, which may be one-fourth of the patients, are not willing to pay for more than the plan provides?

Dr. Eiden: I believe there are patients out there who are still willing to pay for excellence in service, quality and expertise.

Dr. Snyder: We should continue to focus on the high-end patient who wants more comprehensive health care and who will accept the cost if we explain why we're providing it. We shouldn't change all of our policies to accommodate those patients who come in and say "my plan only covers $90 so that's all I'm going to spend."

Dr. Abramson: Contact lenses, especially spherical lenses, have been reduced to a commodity and patients are shopping for price. If you realize that, then you'll emphasize the quality of care and the efficiency of your office. Patients who are in managed care plans come in with various expectations. It's important to determine the patient's expectations as soon as possible in the examination and adjust accordingly.

Contact Lens Spectrum: How do you deal with the patient who is programmed to think that because his managed care plan only pays a certain fixed fee, then he can't go beyond that?

Dr. Schnider: Our job is to make sure our patients un-derstand why they need our services. At some point we have to decide we know better than the managed care companies. The plan is providing coverage for the lowest common denominator, which is not always best for every patient.

We should be concerned about losing patients and not necessarily about losing lens profit. We need to remember that we're not selling contact lenses, we're not fitting contact lenses, we're caring for our patients' refractive needs.

Dr. Snyder: I discuss my patients' needs with them and together we develop a plan. You have to understand your patients, what their immediate needs are and what their long-range plans are.

Contact lenses will continue to be a strong portion of our practices because we've never had it so good in the way of products. We have a wonderful opportunity here if we can stick to our game plan. If we start lowering our prices like some people did to compete with commercial optometry, it will run us right out of business. Do what you do best but do it better and do it more efficiently.

Dr. Grohe: It's difficult to start talking about additional costs beyond what the managed care plan pays. Who decides what's right for the patient? The doctor or some insurance company or bureaucrat? I think third party managed care has taken that role from us. Unless we make it a priority to regain control and to insist on appropriate reimbursement, we're going to run into difficulties.

Dr. Studebaker: You don't have to participate in every plan that comes down the road. I think the plan that you have to participate in is the plan that's interested in the same thing your practice is interested in -- outcomes.

Dr. Dubow: It's a matter of attitude and confidence. It's a matter of not letting the loud, noisy, complaining patients drive what you do with the rest of your practice and the rest of your patients.

MAINTAIN MARKETING MOMENTUM

Contact Lens Spectrum: What are some of the strategies you use to market your practice?

Dr. Eiden: First, we let people know that we really appreciate them. We send welcome cards to new patients and thank-you cards to the people who referred them.

Second, we let people know what we're doing, the credentials we have. Our newsletter includes a section about our academic and research activities. We use our reception room bulletin board to post information about our recent lectures and presentations. Communicate with your referral sources -- ophthalmologists and other health care providers -- about your professional activities. One effective practice-builder is to send a thorough follow-up letter to the professional who sent you a patient. In our area, we've not only gotten a lot of referrals from pediatricians but we've also gotten the pediatricians as patients.

Dr. Abramson: We use a computerized preappoint-ment reminder system. I tell each patient when and why I want him back, and if he doesn't come back, we're on the phone to find out why. That gives us feedback on why someone might have left the practice, whether it's insurance, cost, staff, whatever.

Dr. Schnider: Patients are looking for value. To stay in the forefront, we're going to have to work harder to make patients excited about what we have to offer.

Dr. Dubow: We need to be consistent in our internal marketing, and it's really important that our staff are intimately involved. A patient can have the best experience nine-tenths of the way through a practice, but if one-tenth is sour, he may not come back.

When it comes to external marketing, plan and execute a very well-organized campaign to make the community aware of your practice.

HOW YOUR STAFF FITS IN

Contact Lens Spectrum: What about staff and staff training as we approach the year 2000?

Dr. Grohe: I'd be dead in the water if I didn't have great support staff. Without them, I wouldn't be able to see the number of patients I do. If nothing else, managed care will compel us to delegate more procedures and tests to staff so we can see more patients.

Dr. Snyder: One reason my patients are so happy and so dedicated to my practice is my staff. One of the most difficult scheduling challenges is to provide a comprehensive eye exam to contact lens patients in a limited amount of time.

Quality staff can be a real key, not only to the success of the practice but to the future of contact lens practice. With a layer of well-trained staff as a parallel practice, my daily schedule for comprehensive eye exams can proceed as planned. By assigning the contact lens-related tasks to my staff, I have a separate profit center up and running every day. Not only is it very efficient, but it impresses patients and brings more referrals.

Dr. Abramson: My patients spend more time with my staff than they do with me. So, if they don't have a good experience with staff, then I'm going to lose patients. My practice works because I hand-picked my staff and I have the quality personnel that I want in my practice. I think the emphasis should be on continued training for staff at different levels.

Patrick Caroline: Where will this trained staff come from within optometry? Ophthalmology has established a very efficient technician training program. There are now 13,000 certified ophthalmic assistants and technicians. Perhaps academic optometry should take a more active role in training paraoptometric personnel.

Dr. Dubow: The time is right for new programs to provide us with the trained personnel that we need.

NICHE MARKETS

Contact Lens Spectrum: How do planned replace-ment and specialty lenses fit into contact lens practice for the year 2000? How can the industry help in those areas?

Dr. Grohe: Specialty lenses represent stable patients who will stay with your practice. These patients understand the commitment it takes to fit their lenses. They comprise a strong and loyal patient base. Patients who wear lenses that are replaced frequently are more likely to look elsewhere for their lenses.

Dr. Schnider: There are obvious and proven advan-tages to regular replacement. We've always been concerned about reproducibility and I think many companies have addressed that. Our job is to tailor the best lenses to each patient's eyes. There are many patients who value and benefit from frequent replacement. The challenges are to find the right interval, to explain the replacement schedule so patients don't think you're ripping them off, and to make sure they know you're monitoring them because that's what we do best.

Dr. Abramson: We have tremendous opportunities in the niche markets to maintain a quality base with baby boomers in presbyopia, as well as refractive surgery options.

Dr. Grohe: In a managed care environment, though, the last type of case you would want to fit is a bifocal contact lens because of the extra chair time and laboratory costs. While there may be liberal exchange and warranty policies, we still can go through a number of lenses, come up with a result that the patient may not want and then have to deal with the issue of refunds. Why do we refund? No other health care professional gives refunds. It seems that patients who invest a lot of time believe that they should get something back if they don't end up with a pair of lenses they can wear. Refunds are an unfortunate but necessary part of contact lens care if you're going to work with bifocal lens patients.

LASER REFRACTIVE SURGERY

Contact Lens Spectrum: Do you believe refractive surgery, primarily PRK, is a threat or an opportunity?

Dr. Dubow: PRK is a huge opportunity. It will drive patients into our practices, and those of us who are promoting ourselves as eyecare specialists will benefit. We can certainly offer a refractive surgical option, but studies show that the majority of patients are not going to choose surgery. That leaves a huge population of people who are saying I want something different. We have the skills, we have the materials, we have the staff and the equipment to provide them with something different -- contact lenses. There may be a new material, a new design, a new solution that they haven't tried, or it may be that we can offer better training, better care, better follow-up today.

Dr. Snyder: Every day I have someone in my chair who asks about PRK. That's my cue to educate the patient. Even when patients decide to have surgery, I'll refer them and retain them as patients.

Dr. Grohe: It's a short-term challenge, a long-term gain. The short-term challenge is to develop an effective method to explain comanagement to patients. The long-term gain is that it will bring a lot of patients into the office.

CONCLUSION

Contact Lens Spectrum: What one key thing will help ensure success in the year 2000? Success is not just a healthy bottom line. It's something that works for patients and for industry too.

Dr. Schnider: My short answer is just have fun. Main-tain zeal and enthusiasm.

Dr. Eiden: Keep improving academically so people will continue to want to pay to see us.

Dr. Studebaker: I'd sum it up in one word, commun-ication. Communicate your enthusiasm. And support your profession.

Dr. Abramson: Deliver quality health care through user-friendly services and an efficient staff. Stay at the top of the profession with the highest level of health care techniques, so that we can continue to solve patients' problems.

Dr. Grohe: Be flexible to change.

Dr. Snyder: Continue to do what we do best and not give up ground on the services we provide. CLS

This roundtable was sponsored by CooperVision, Rochester, N.Y.

This roundtable was chaired by Contact Lens Spectrum Editor Joseph T. Barr, O.D., M.S., and included: Clark Abramson, O.D., Patrick Caroline, C.O.T., Burt Dubow, O.D., Barry Eiden, O.D., Robert Grohe, O.D., Cristina Schnider, O.D., Chris Snyder, O.D., and Joseph Studebaker, O.D.