A Contact Lens Staff for
Today and Tomorrow

BY R. A. KOETTING, O. D., F. A. A. O.
SEPT. 1996

How can you maintain your high standards of care while operating cost-effectively? Count on your professional staff to keep the practice running smoothly.

Building a productive optometric support staff calls for choosing the right personalities in the first place. Once you've done that, what else will it take to keep your contact lens practice out in front in the marketplace? Survival under the influence of third party payers will take more than a pleasant smile.

As more of your patients enroll in managed care plans, the net profit per patient will decrease accordingly until it becomes painfully obvious that you're working harder just to maintain the same bottom line. Cutting service might seem logical at first, but patients soon perceive when they're being short-changed. You can't afford to eliminate important tests and procedures, but why try to do it all yourself?

GET MORE DONE WITHOUT DOING MORE

Show every patient that you care even though you're spending less time with them. Delegating tasks to a competent technician assures every patient a thorough examination and gives you more time to develop a closer relationship with the person in your chair.

Some of the most time-consuming tasks are part of a contact lens examination. Always have an assistant place and remove diagnostic contact lenses. Autokeratometry and even videokeratography have been perfected to the point where any knowledgeable layperson can produce reliable results. Tear flow and break-up time measurements are more complex but not beyond the scope of a qualified technician.

While your assistant handles some of these tasks, you can talk with patients to establish rapport. Of course, you'll look at fields and assess test results, observe positioning after lenses have settled, and verify that all significant measurements have been recorded. However, there's no need for you to be present during every step of a routine examination.

EDUCATE BEFORE YOU DELEGATE

To make delegation effective in your office, staff development must be a top priority. Encourage your employees to enroll in the courses offered at major eyecare meetings. Take advantage of some resources we tend to take for granted, such as company reps who can teach inventory control techniques and effective ordering. Subscribe to contact lens publications and clip or highlight articles for study. At staff meetings, encourage your assistants to report on what they've learned.

INSTRUCTIONS ARE IMPORTANT

We seldom give enough thought to instructing patients in the care and handling of their contact lenses. Because so many people have worn them at some time in the past, this part of the contact lens visit is sometimes overlooked until a patient returns with the message, "These lenses are just too much trouble."

Helping people distinguishes your practice from the price houses and mail-order providers. Allow time for adequate patient training during routine appointments. Your technician can't give thorough instructions between fielding phone calls, writing receipts and showing frames. And there's no justification for using your own time that way.

PHONE CALLS CAN GET YOU DOWN

Keep your hands off the telephone! Every office should have a clear policy describing phone techniques for emergencies. In fact, a few sessions on handling emergency calls should be mandatory in every office. Your office staff should take all problems as seriously as the callers do. They must avoid drawing conclusions too quickly and follow a standard form for telephone triage. This precaution will save time in addition to providing some legal protection.

Skilled assistants are the ideal protectors of professional time, but award this authority with caution. Don't let patients think your assistant is blocking the door. Fee-for-service has been wounded, but it's certainly not dead. Many people will bypass their panel providers to see doctors whom they know are interested in their well-being. Be sure you're one of them!

SELLING UP

The good news about third party payment is that it enables people to receive eye care that they might normally put off or avoid altogether. The better news is that patients who have vision plans may have more discretionary income available to upgrade. Tinted lenses, spare lenses and disposables may now be within their budgets.

'Selling up' involves a lot more than suggesting a second pair of eyeglasses. Alert your staff to opportunities such as the following:

"Contact lens service isn't covered under your plan, Mr. Jones, but I know how much you'd like a pair for tennis and you've already saved about half the cost."

"While you're here, Jennifer, why not see how you would look with green eyes? Your company has already paid for the examination so it probably won't cost as much as you think."

Patients come to us not because they have to, but because they want to. They're looking for advice and guidance. Believe it or not, they're glad when your assistant asks, "How about an extra pair of contact lenses just for the fun of changing the color of your eyes?"

When patients feel that they've received some special service, such feelings go a lot farther towards bonding them to your practice than any managed care provider list.

KEEPING THE PATIENTS YOU HAVE

People really don't like to see two different eye doctors, so if you're no longer on a certain panel, your staff must make patients feel that you have something worth coming back for. Would your staff make the most of this opportunity?

"I'm really embarrassed to see the doctor because I don't come to your office anymore."

"I'm sorry to hear that. Is something wrong?"

"Oh, no, we're covered by a new plan and he's not on the panel."

"Well I can certainly understand that, but how about your contact lenses?"

"As a matter of fact, they aren't covered and our new doctor charges extra....."

"When can we set the appointment?"

KNOW THE SYSTEM

Today's contact lens assistant must be computer-literate. Every member of your staff should be familiar with CPT 4 codes and know how to handle HCFA 1500 forms. They should also be adept at securing payment from everyone else.

Make sure your staff knows how to complete claim forms so that patients receive the maximum reimbursement promptly. Remember that third parties speak only medical terminology and be sure diagnosis relates to procedures.

What can the hospitals and the big HMOs do for patients that you can't do? Very little, but it's up to your staff to tell them so. Prepare a script and be sure that technicians know how to explain each instrument and test. Role-play and ask questions until they're comfortable with their replies. See that they take plenty of time, but not your time. Provide brochures and show educational video tapes in your reception area to reinforce patient learning.

MAIL-ORDER CONTACT LENSES

Don't lose out to mail-order. Be sure every person in your office really understands that as an eyecare professional, you are much more conscientious than a mail-order house. And, not only that, the services you and your staff provide are faster and more economical. Develop standard replies to the most-asked questions and rehearse them with your staff. Here are a few suggestions:

"You are most welcome to your contact lens specifications, but be sure you don't order them after the expiration date, and always check the date on the container when you receive them."

"You should also come back to our office so we can verify that you have the correct prescription and that your lenses fit properly."

"Incidentally, it might be wise to add up all the charges for mail-order. A patient told me that mail-order actually cost him more than lenses from us."

PAMPER PEOPLE

Self indulgence is in. People want personal attention as they never have before. See that your staff keeps a "you deserve it" attitude and always recommends the finest. Disposable contact lenses, for example, cost only a little more, assure better health and save time. Try this:

"I know your health plan doesn't provide for new contact lenses, but you will certainly enjoy wearing them. You deserve it!"

Assistants must empathize with patients and try to understand their needs. Communication improves exponentially when staff members wear contact lenses. And that's only the beginning. People don't mind paying for express shipping or courier service when they need a replacement lens, and they become genuinely appreciative when someone says, " I know, that happened to me."

STAYING OUT IN FRONT

Meeting and coping with the challenges of the '90s isn't going to mean much if you're not planning for them. You'll have a head start with pre-set appointments. Although calling patients after an absence of a year or two can be modestly productive, having an assistant schedule the next visit while a patient is still in the office is three times more effective.

Be sure your staff understands and can explain service policies. These contracts have traditionally offered some real or perceived savings as a means of tying patients to a practice. Many doctors have developed a relatively inexpensive agreement that covers those services and materials that are excluded from most vision plans.

RECOGNIZING OPPORTUNITIES

Americans are seriously involved in a form of age denial called down-aging. From facelifts and hair coloring to Nordic Tracks and vitamins, we are obsessed with holding onto youth. What better way than with contact lenses?

Although the number of people over age 65 continues to grow, fewer than two percent are likely to wear contact lenses. Statistics prove that at least a third of us would be happy with monovision if someone gave us a chance to try.

PRK or any other surgery that promises to improve a person's looks appeals to everyone, although relatively few people have actually made the commitment. Nevertheless, refractive surgery is here to stay and it must become a part of every viable practice. Comanagement groups are springing up all over the country and your participation shows an awareness of the latest vision correction techniques available, even for patients who want to continue wearing contact lenses.

Discuss refractive surgery and participate in comanagement if you wish, but be certain that your staff understands all the alternatives available today such as extended wear RGPs, orthokeratology and newer, safer soft lens materials.

Educational seminars have become popular in the comanagement practices of those who don't actually perform refractive surgery. Some reports estimate that up to 70 percent of the people who attend them opt for contact lenses. Could one of your assistants conduct such a seminar? Probably so, and with more credibility than a doctor who might appear to have a conflict of interest.

In these challenging times, just keeping busy is not good enough. It will take a dedicated, well-trained staff to put your contact lens practice out front and keep it there! CLS

EVALUATE STAFFING NEEDS
& SPACE REQUIREMENTS

Hire staff based upon the size of your office. Statistics show that one optometrist can keep up to nine assistants busy.

Be sure you have enough rooms to keep technicians fully occupied and enough "holding area" so that no one ties up an examining room while pupils dilate or new lenses settle. Study your floor plan and consider a new location if you're unable to use your space efficiently.

DRESS FOR SUCCESS

Although it may sound snobbish in the face of today's trend towards dressing down, your staff has to look professional and worth the price of your service. That means good quality career apparel. Looking better than the competition means technicians should not wear scrubs or athletic shoes.

SCHEDULING: NOT NECESSARILY
'BY THE BOOK'

Take a hard look at your schedule. Booking appointments efficiently begins with a realistic appraisal of doctor and assistant time. Scheduling appointments in the half-hour increments of a standard appointment book is not necessarily the most effective way to use your time.

Identify all the tasks you can delegate, and then calculate the average number of minutes you'll need to complete an examination. In determining the total time a patient will be in your office, remember to add about 30 minutes to your assistant's time to allow for the tasks you delegate. Patients may be on the premises a little longer, but you'll find you're using your time more efficiently.