A common theme throughout a range of presentations in the commercial and business stream of last month’s British Contact Lens Association conference was the nurture of a medically based relationship between patient and practitioner,.
US speakers Dr Jack Shaeffer and Dr Kirk Smick presenting in the Global Contact Lens Forum, a partnership with Vision Expo, said following the medical model was the only sustainable way forward for eye care. ‘The best way to retain your patient is to know what is happening clinically,’ said Dr Shaeffer. The duo said all the three big drivers of dropout – cost, compliance and convenience – could be addressed through strong clinical care. This should combine prescribing the best lenses and solutions and sensibly funded, regular care to head off problems before they arose. ‘The faster and stronger you get in the clinical model the better you will retain patients,’ he said.
Having those skills also drove the business side, said Dr Smick. ‘My practice is a referral practice. Other practices send me patients because they can’t, [or won’t] deal with them. They lose that patient and they become my patient.’
Dr Shaeffer said it was important to remember that most patients were non-compliant, so understanding that misuse and solving it was crucial. ‘People use water because they have run out of solution or use drinking glasses because they have forgotten their lens case. The incidence of AK is not going down.’ You might think these things are uncommon, but, he said: ‘If it’s in your chair, it ain’t rare.’
A better approach, he said, was managing the patient so they did comply. Common issues such as failure to replace lenses on time could be tackled head on. ‘That is a disease caused by us by not being diligent with our patients,’ he added. ‘A lot of people are buying daily lenses and re-using them and that is absolutely the worst thing you can do. In our office [practice] any patient that does not come in every six months to replace their lenses will not remain a patient. Anyone who misuses extended wear will not be kept on as a patient. Be tough with them, they will respect you.’
A similarly tough approach also needed to be taken on solutions – don’t let them shop around. ‘We prescribe solutions not suggest,’ Dr Shaeffer said. ‘Knowing what solution they are using makes problem-solving easier.’ He suggested replacing two-weekly lenses on a weekly basis.
[CaptionComponent="446"]High value route
Despite the financial and regulatory differences between the US and the UK, Dr Shaeffer urged practitioners to take a medical, high value route. Make the decision to charge and expect to lose half of your patients. In the US Walmart had half of the market and would fit and supply contact lenses for $60 against a fit-only charge of $300 in a medical practice such as Dr Shaeffer’s.
Underpinning the idea of a medical approach the pair described a litany of lid, conjunctival, and margin issues from chalazion to Demodex which had the audience valuing the idea of clinical care. Dr Shaeffer urged practitioners to think clinically first and to blame the contact lens only when everything else had been ruled out. If it required drugs you could not prescribe, become friendly with someone who could. ‘The first thing you should do if you are using the medical model is to wear rubber gloves. What does the patient think when they see you putting on a pair of rubber gloves? He’s a doctor.’
Chairing the session, optometrist Anna Sulley shared the findings of a survey which highlighted the need for good record-keeping, to understand patients’ behaviour, and close follow-up in the early days of wear.
The study of new wearers, conducted this year, recruited 38 practices but only 29 sites could take part because they simply didn’t have the data the study required. The study looked at what people had been fitted with, when and why they dropped out. Of the sample, a third were over 45 per cent, showing the potential for new fits, while the group as a whole were fitted with a range of lens types.
In the study 42 per cent of reported dropouts were in the first two months. ‘If patients are going to lapse, a large number will be early on. They need a lot of hand-holding in those first two months,’ said Sulley. Record-keeping showed that vision, not comfort, was often the reason for dropouts. Sometimes the practitioner just doesn’t know why the patient dropped out. The reality was difficult to pin down, Sulley surmised. ‘ECPs perhaps concentrate too much on vision and that’s why that reason is given on patient cards.’
Analysis of records showed that demographics didn’t play a big role in dropout while toric wearers proved to be successful. Age was a major factor in early dropout, ‘The older you are the less likely you are to stay in contact lenses,’ said Sulley who suggested multifocal wear could be the issue. Those requiring low powers also tended to drop out more.
Reasons for dropout were less easy to ascertain because of the record base. Comfort was reported as a reason by just 17 per cent. An ‘alarming’ 32 per cent of records reported no reason. If vision was the issue, toric or multifocal contact lenses might be the answer, said Sulley, but in reality 70 per cent of patients were not offered an alternative choice of lens when they dropped out.
Offer the best first
Supporting Sulley was Simon Donne, who suggested a lack of practitioner proactivity meant many customers wanted to wear contact lenses but were not currently wearing them. He suggested there were a number of things practices could do such as always recommend optimal products first. ‘The reason my patient retention is so high is because I always offer the best product first,’ he said. ‘Give them a selection of options. You wouldn’t wear one pair of shoes for everything so why should you wear the same pair of glasses or contact lenses for everything? We can empower them, give them the option of when they wear glasses and when they wear contact lenses,’ he said.
Always manage expectations and tell them there are options if their current product was not right. Warn early presbyopes of what was going to happen and when it did they would turn to you to sort it out, he said. Bundle solutions up with lenses, don’t let them go to the supermarket and buy the cheapest one. Donne also saw new patients more often in the early days of wear. He used the Johnson & Johnson Lenspal app and made an appointment with the patient one month into wear. ‘Record-keeping is also important, so you know what is going on.’ Finally see contact lens patients every six months, direct debits and home delivery were also great for patient retention.
‘If you communicate with the patient regularly they will feel comfortable coming in and talking to you about any issues they have.’
Josie Barlow, clinical and customer service adviser at Ultravision, argued that fitting the 20 per cent of patients who weren’t suitable for soft contact lenses with custom lenses was a profitable option for practitioners. ‘We can provide your patient with any parameter they require. It’s more profitable fitting specialist contact lenses.’ She said there was no need for additional chair time or extra readings and patients couldn’t buy the same product from the internet.
Ross Grant, consultant and chair of the Sunday session, reminded delegates of some of the business basics. He said everyone in the practice should be aware of just how much the practice needed to turn over each week to cover the fixed costs and make a profit. Offers should also be well thought through. ‘Offering a 10 per cent discount means you have to sell 25 per cent more.’
Spectacles may appear more profitable and offer more cash up front, but over time contact lenses, with a smaller margin, may yield more profit. Turning over stock with a lower margin more quickly would allow you to achieve a better return on investment. Contact lens wearers would also buy spectacles anyway. He also pointed to the London Business School study. ‘A contact lens wearer brings in 2.5 times more in sales and 1.5 times more in profit than a glasses wearer.’
Grant also raised the recurring theme of patient retention. Finding a new patient could cost up to 22 times that of holding on to an existing one. The true cost of a patient walking out of the door wasn’t just the product they didn’t buy that day but the products they wouldn’t buy for years to come too.
Pricing strategy
Contact lens optician Andy Pearce discussed the topic of pricing: ‘You have to have a pricing strategy which clearly separates professional fees and products.’ Achieving this brought the practitioner and the patient closer, built trust and boosted retention. Echoing Drs Shaeffer and Smick he said that meant offering specialist medical advice that would help them. Patients were prepared to pay for service they valued and loyal patients would not shop around for cheaper prices. ‘If you are in pain you will pay anything to have that pain taken away.’
On pricing, he said understand what you charge and know how you compare on price with the internet. Be comfortable with what you charge and be able to explain the level of pricing to the patient. ‘Being cheaper doesn’t mean your prices are less, you just explain them in a different way.’ That means showing the patient that an online price doesn’t include any examination, fitting or aftercare.
‘A successful pricing strategy is all about examinations and aftercare.’ He said this element of work was underrated by opticians. ‘Each one is an opportunity to demonstrate why the patient is loyal.’ But, he warned: ‘If you are going to charge for your professional services you have to devote time to do it properly.’ That may well mean investing in new equipment. ‘People don’t expect to get quality care free-of-charge.’
A typical example would be for a twice-yearly aftercare costing £60, or £10 a month. Matching prices on the internet became easy as contact lens mark-up was irrelevant once you started charging for professional time. The final question, he posed, was whether to devise your own patient membership programme or use a third party plan.
This was the topic of Plymouth practitioner Peter Noakes and Philip Everett-Lyons. They explained the benefits of patient membership programmes (PMPs)set against an environment which saw the internet and supermarkets constantly reducing the cost of contact lenses and solutions. They advocated the use of established PMPs. These, they argued, took on the administrative burden and price-setting issues and allowed the practice to concentrate on optometry.
On a basic level, a PMP ring-fenced fees and boosted loyalty, said Noakes. There were also added benefits. Securing regular payments from patients smoothed out cash flow and allowed the practice to concentrate on care and reward loyal patients if necessary. PMPs offered flexibility and a whole range of service levels could be included. Other benefits included increasing dispensing values and frequency of return visits.
Most immediately, underpinning the cost of professional services allowed the practice to compete with internet prices. ‘You have done all of the hard work and these guys [the internet] are taking it away from you,’ he concluded.