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The business model for a typical optical practice revolves around a loss-leading eye examination followed by the sale of spectacles, hopefully to maintain practice profitability. This is a potentially very fragile business model, especially in an economic downturn with an ever-growing number of cheap spectacle suppliers.
A well-considered, professional fee-based contact lens scheme can overcome all these issues to ensure the desired profit is achieved from chair-time, as well as the sale of spectacles and contact lenses. This article will address some of the business and practice management concerns relating to the supply of contact lenses and provides some practical suggestions for growing your contact lens business.
Concern
Contact lenses are less profitable than spectacles.
Facts
For those who fit lenses reactively, ie only to those who ask for them, this could well be the case. It could also be true for practices that do not have a transparent, professional fee-based charging scheme. However, many studies, including those by the London Business School on behalf of the Association of Contact Lens Manufacturers,1 have shown that in both the medium and long term, contact lens wearers are more loyal and profitable than the average spectacle wearer.
In a recent study, Atkins and colleagues2 offered potential lens wearers the opportunity to try contact lenses prior to spectacle dispensing so that they could see what they looked like in various fashion frames. A matched control group was not offered this facility. The contact lens wear trial was well received by subjects who generally reported a very positive experience. One third of subjects proceeded to purchase contact lenses, versus only 5 per cent of control subjects. Furthermore, those who trialled contact lenses ended up spending 32 per cent more money than the control group.
The authors recommended that practitioners consider offering contact lenses to all suitable patients who are proceeding to spectacle dispensing to optimise the dispensing process and to provide an opportunity to try CLs.
The Optician/ACLM research survey 20093 shows the average optometrist spends only 15 per cent of their total patient time on contact lens work, which is at the centre of the problem. Research among independent practices by Myers La Roche4 shows that the top quarter of successful practices spend an average of 26 per cent of their time on contact lenses, and this results in a significantly larger percentage of new business, a larger percentage of private patients, greater sales per person and a far higher conversion rate.
Multiples must view the fitting of contact lenses as a profitable or beneficial activity, otherwise why would contact lens practitioners working in multiples account for nearly three times as many new fittings compared with the average independent? The actual figures are 5.65 per multiple practitioner per week versus 1.98 new fittings per independent practitioner.3 Interestingly, those working in multiples were also more likely to have fitted some specialist lens types, such as RGPs, torics and soft bifocal/multifocals, than their independent counterparts.
Concern
CL patients are likely to be lost to the internet.
Facts
Practices have found that if they charge a higher price for contact lenses, including an element subsidising clinical time for aftercare, this is likely to be true, especially when no explanation is provided regarding the amount included towards chair-time. This issue can be ameliorated by charging a monthly or annual professional fee to purely cover chair-time and regular eye examinations, at a realistic rate.
Product, in terms of lenses, solutions and spectacles, can then be supplied for much lower prices than before, often as low as internet suppliers (who account for just 6.2 per cent of contact lens value sales: GfK, December 2008). It would be highly unlikely that these patients buy from the internet, as they would gain very little. However, if they did, but continued to pay the monthly or annual professional fee, the practice would still benefit.
There are other advantages to both patient and practice since this approach has been shown anecdotally to encourage more purchases of spectacles of equal or higher value than before, and greater compliance with aftercare schedules. Much has been published about setting up these schemes previously. Support materials are available online.5
Concern
There's no incentive to fit CLs in my practice.
Facts
The LBS study1 demonstrated quite effectively how much more the typical contact lens wearer is likely to spend compared with a spectacle wearer over a similar period. It is also worth considering that nowadays, unlike 20 years ago, the typical contact lens wearer is a spectacle wearer too. Contact lenses are not instead of spectacles, but a lifestyle alternative for times when spectacles may not be so practical, or even just for a change.
Before contact lenses were as easy to fit or convenient to wear for just some of the time it was almost impossible to get a typical contact lens wearer to update their spectacles. Today's contact lens wearer is often interested in having the most fashionable spectacles as well, and not just one pair either.
For some practitioners, personal financial incentives to fit contact lenses may also be an issue since practice incentive schemes may not be geared towards encouraging staff to recommend contact lenses. The Optician/ACLM research found that optometrists, in particular, lack financial incentive to fit contact lenses.6 Given the benefits to the practice of a proactive approach to recommendation, incentives for new fittings may be worth considering.
Career benefits are another factor for the employed practitioner to consider. In a difficult job market, having contact lens skills and a qualification on your CV may well be an advantage when seeking work, especially for more recently qualified practitioners with fewer years of experience in practice behind them. For DOs, becoming a CLO can also be stepping stone to further qualifications or to a career in optometry, while for optometrists contact lens work may lead to an interest in therapeutic practice.
The personal satisfaction to be gained from fitting contact lenses should not be neglected either. Contact lens practice can be very interesting and exacting, and introduces more variety into the working day. The relationship with the contact lens patient is often more personal and long-lasting than with the spectacle wearer. This often leads to greater job satisfaction.
Concern
Patients are unlikely to want CLs during an economic downturn.
Facts
If someone needs contact lenses to pursue a sport, hobby or lifestyle and they are confident their optician is providing a total package for eyewear and eye care which is great value, allowing costs to be spread throughout the year, it is unlikely they would want to change. Of course, those who feel they are paying more than they need to may be inclined to shop around to seek more cost-effective alternatives.
It has been reported in previous recessions that personal expenditure on healthcare does not reduce as much as other more discretionary spend. Those who know they are paying a 'professional fee' for their eye care, which enables them to benefit from low-priced lenses, are more likely to remain loyal.
Concern
CLs will not appeal to my older patients, who are the majority of my patients.
Facts
Many independent practice owners wish their practices appealed more effectively to a younger age range. Some report their practices are 'dying with their patients'. Not that there is anything wrong with a business that appeals to an older age group as long as it replaces the patients it is losing at a greater rate than it loses them it can still grow as a business.
There are two important points to consider. One is that if a practice promotes contact lenses effectively, it is more likely to attract younger, more active patients. Several contact lens manufacturers are currently highlighting the opportunity to fit more children and teens with contact lenses. Secondly, with a great selection of options for presbyopes, in materials designed to retain moisture and remain comfortable for longer, there has never been a better time to promote contact lenses to all age groups. Multifocal lenses or modified monovision could soon be a secret weapon on the bowling green!
It would be unwise to assume that your presbyopic patients do not have the type of active lifestyles that would benefit from contact lens wear. Today's 'silver surfers' have some surprising hobbies and pastimes, often with exacting visual requirements, which you are unlikely to discover if you don't ask!
Concern
CL wearers do not spend as much on spectacles.
Facts
Companies that run eye care payment plan schemes report that patients who pay a monthly fee for their eye care, and benefit from a substantial discount off their eyewear, spend an equivalent or greater amount than they did before they were entitled to a discount. If this is extended to a contact lens scheme, it is easy to see that if a new contact lens wearer spent the same on spectacles, plus the monthly fees and contact lenses, as well as solutions, sunglasses, etc the practice will be a great deal better off than before. However, contact lens wearers will need reminding about the benefits they are entitled to, ensuring they make the most of these and the practice gains its full potential.
Concern
It is a waste of my chair-time as an optometrist to teach new wearers how to handle their lenses.
Facts
When the volume of contact lens wearers increases it will soon become apparent that it is not an effective use of the optometrist's or contact lens optician's time to teach all new wearers how to handle lenses. The best solution is for an optical assistant or receptionist to be trained to undertake this task. They will usually become more motivated and act as a 'practice champion' for contact lenses, encouraging more new wearers over time. This training can often be supplied by one of the major contact lens companies.
Concern
I don't have the time to discuss CLs during an eye examination.
Facts
Discussion about contact lenses as a vision correction and lifestyle option should not be exclusive to the optometrist. In fact, all practice staff should understand enough about the freedom afforded by contact lenses and the main options available. This will allow contact lenses to be discussed from the point of first contact through to the collection of new spectacles. Support staff can freely discuss lenses in general as an option with those waiting for eye examination.
If a pre-exam questionnaire is used to understand each patient's visual lifestyle needs, the question 'Have you considered contact lenses?' could be included. Open questions should also be asked regarding hobbies, interests and lifestyle.
Concern
Aftercare appointments take up too much time.
Facts
Good appointment scheduling is important to ensure that chair-time is optimised. However, with many wearing disposable lenses on a part-time basis, an annual aftercare assessment appointment for 20 minutes is considered sufficient by many practitioners. The important factor here, from the business point of view, is not to worry about the time required, as long as a suitable fee is being charged to cover the time utilised.
Time for aftercare appointments should never be considered a waste, especially if they are described as an annual assessment, to determine whether the lens type used is still best for the wearer, his or her eyes and lifestyle, when compared with all the lens types available. When wearers come expectantly for their aftercare appointment, there will be a more positive atmosphere if they know there is the possibility of being offered a 'latest technology' lens option.
Concern
I'm not confident enough to fit many CLs.
Facts
One of the main findings from the Optician/ACLM research3 was that almost nine out of 10 practitioners who fit contact lenses say their fitting skills could be improved. OOs, in particular, showed a lack of confidence in their skills.
The UK provides access to some of the best post-qualification training and development for fitting contact lenses in the world. These range from roadshows by individual lens manufacturers, to the annual BCLA Clinical Conference and in-practice training from specialists working for the industry. There has never been a better time to gain confidence and knowledge in contact lens fitting.
Equally, it should be remembered that contact lenses have never been so versatile and easy to fit. The latest materials and lens designs have benefited from large research and development budgets funded by major corporations in the industry to ensure that lenses are safer, more predictable and easier to fit than ever. This includes lenses designed to correct astigmatism and presbyopia too.
For practitioners wishing to progress their contact lens fitting skills, there are still the challenges afforded by RGPs, which tend not to be the most popular everyday option, although they are gaining popularity for those opting for orthokeratology. This is turning some otherwise ordinary independent practices into 'specialist' contact lens practices, as word spreads. Just consider the local press coverage you could gain by talking about contact lenses that you sleep in, but take out during the day when you want to see!
Conclusions
Contact lens fitting has many benefits from the business, career development and personal point of view, as well as offering clinical benefits to wearers.
Practices that make a concerted effort to grow their contact lens business do end up performing better with a more loyal patient database. However, it must be remembered that this is only likely if a great value scheme is available for contact lens wearers to join. This type of professional fee-based scheme can also be the basis for an eye care payment plan for spectacle wearers in due course.
Whether you are an employed practitioner or a practice owner, it's worth reviewing your contact lens fitting and recommendation habits to make sure that you, your practice and your patients all benefit from contact lenses. ?
References
- Ritson M. Which patients are more profitable? CL Spectrum, March 2006.
- Atkins NP, Morgan SL and Morgan PB. Enhancing the approach to selecting eyewear (EASE): a multi-centre, practice-based study into the effect of applying contact lenses prior to spectacle dispensing. Cont Lens Anterior Eye, 200932:3 103-7.
- Ewbank A. Who fits contact lenses? Part 1.Optician, 2009237:6200 12-17.
- Myers La Roche. Market Intelligence Summary. August 2008.
- http://www.cibavisionacademy.co.uk/business_fee_based_pricing.shtml.
- Ewbank A. Who fits contact lenses? Part 2. Optician, 2009237:6203 16-21.
? Martin Russ is a director and practice development consultant at TMR