How the Lenses You Choose Affect Your Bottom Line

BY EDWARD S. BENNETT, O.D., M.S. ED., WAYNE R. GILMORE & MARK SIEFKES

Does your contact lens preference affect your profit and growth potential? We surveyed RGP specialists and general eyecare practitioners to find out.

Retrospective studies conducted at a large group practice that specializes in contact lenses have shown that prescribing RGPs rather than soft contact lenses has a greater positive impact on patient retention, referrals and practice income. But a more important question may be whether these effects are generalized into typical practices. Our survey attempted to answer this question.

SURVEY PARTICIPANTS

We surveyed two groups of practitioners. One group, members of the Rigid Gas Permeable Lens Institute Advisory Committee, prescribe RGPs for approximately 40 percent of their patients and are generally considered RGP specialists.

We also selected a group of 200 general eyecare practitioners at random from The Blue Book of Optometrists. Twenty-four RGP specialists and 62 general practitioners responded to our survey.

WHAT THEY PRESCRIBE & WHY

When asked to cite the best reasons to prescribe soft and rigid lenses, there were obvious differences between the RGP specialists and the general practitioners (Table 1). Both groups cited clarity of vision as the best reason to select an RGP lens. But the general practitioners were much more likely than the specialists to choose RGPs to fulfill special prescription needs. Interestingly, the third most common reason for selecting a rigid lens over a soft lens among the general practitioners was that the patient was already wearing RGPs or preferred that modality. This reason was negligible among specialists. The RGP specialists were most likely to fit soft lenses when comfort was an issue; the general practitioners cited comfort followed by sports applications.

When asked who their typical soft lens candidates are, the RGP specialists listed athletes, infants and children, and part-time wearers. General practitioners named athletes and infants in an equal number, followed by teens.

Who are the best candidates for RGPs? The specialists listed presbyopes and astigmats equally, followed by progressive myopes/myopic teen-agers. The general practitioners listed presbyopes and astigmats, with progressive myopes a distant third (Table 2).

TAKING MAIL-ORDER OUT OF THE EQUATION

Many practitioners blame mail-order for a general reduction in their contact lens income. Because fewer than one percent of the contact lenses ordered by mail are RGPs, some postulate that practitioners who prescribe more rigid lenses will experience less practice erosion due to alternative suppliers.

When asked if mail-order influences their choice of lens modality, most of the practitioners from each group said no. But when asked if mail-order affects patient retention, proportionally more of the general practitioners than the RGP specialists said yes (31 of 50 vs. 11 of 22). Two out of three of the RGP specialists believe that mail-order has affected their practice profits compared to more than four out of five of the general practitioners.

BIFOCALS AND OTHER PROFIT CENTERS

In terms of profitability, three out of four of the RGP specialists believe rigid lenses contribute more to the bottom line, as opposed to four out of every 10 general practitioners. And almost all the RGP specialists (22 of 24) feel that RGP patients are more loyal to the practice than soft lens patients. Forty-six of 57 general practitioners agree. The RGP specialists also believe that RGP patients are more likely to refer to the practice.

Not surprisingly, the rigid lens specialists derive more income from bifocal contact lenses than do the general practitioners. Almost all of the bifocals the RGP specialists prescribe are rigid, as compared to about 60 percent of those prescribed by the general practitioners.

Some speculate that prescribing rigid lenses -- particularly specialty lenses -- is a hedge against managed care losses. Only one in three of the RGP specialists say that managed care has reduced their contact lens profits, compared to more than half the general practitioners.

FITTING PREFERENCES

Twice as many general practitioners as specialists use empirical fitting methods (20 of 58 vs. 4 of 24). Fifteen of 24 RGP specialists use diagnostic fitting exclusively, although many indicated that improved contact lens design software for computerized corneal topographers might persuade them to change to empirical fitting methods.

THE IMPACT OF SERVICE AGREEMENTS
& ANCILLARY SALES

According to the general practitioners, soft lens wearers purchase more service agreements than RGP patients. However, nine of 24 RGP specialists and 11 of 54 general practitioners report that their practices no longer offer service agreements.

Of the practitioners we surveyed, more RGP specialists than general practitioners sell contact lens solutions (79% vs. 58%), and the specialists are also more likely to believe that RGP solutions contribute more to practice income than do soft lens solutions.

ADDING VALUE WITH IN-OFFICE MODIFICATION

Almost all the RGP specialists we polled (21 of 24) modify lenses in their offices, compared to only about half the general practitioners. Those who modify are realistic about the benefits. Three out of four say modification does not contribute significantly to practice income, but note that the benefits are not necessarily monetary. All the RGP specialists say that in-office modification is a value-added service that contributes to patient retention. Only 24 of the general practitioners agree.

THE BOTTOM LINE

Although further study with larger and equal subject samples would be beneficial, the results of this survey show that RGP specialists believe that fitting rigid lenses benefits the health of their practices. Rigid lens specialists tend to fit RGP lenses to a greater variety of patient types than do general practitioners, who fit RGPs most often when the patient is already wearing them or has a history of rigid lens wear.

RGPs provide greater profits, keep patients with the practice and generate more referrals than do soft lenses. Although some of the necessary ancillary services such as in-office modification are not profit producers, they substantially increase patient loyalty. CLS

Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis School of Optometry, and executive director of the RGP Lens Institute. Wayne Gilmore and Mark Siefkes are fourth year optometry students at UMSL School of Optometry.

References are available upon request from the editors. To receive references via fax, call (800) 239-4684 and request document #29.