The Global Contact Lens Forum is a new event under a joint partnership agreement between International Vision Expo and the British Contact Lens Association. The first GCLF was held at the Javits Center in New York, immediately prior to Vision Expo East. In June, the event crosses the Atlantic to become part of the BCLA’s Clinical Conference in Birmingham.
The New York version provided two days of continuing education and business lectures compiled by the Vision Expo Conference Advisory Board and BCLA. The programme featured presenters from the US and UK, along with keynote speaker Professor Lyndon Jones from Canada.
As Kirk Smick, board chairman, explained: ‘The BCLA Clinical Conference is the most respected contact lens meeting on the globe, and Vision Expo is leading the field in practice management trends and business strategies. It’s the perfect collision of scientific education and business content.’
The aim was for US speakers to share their experiences of handling the many changes in contact lens practice. ‘Online ordering, managed care, corporate practice habits and major discounting have forced us to look more closely at our professional services rather than profit from materials directly,’ he said.
Dr Smick will be one of two US speakers travelling to Birmingham in June, along with Alabama OD Jack Schaeffer. Running on the Friday and Saturday morning (June 6-7), the GCLF is among several new elements to the BCLA programme.
A Commercial & Business track will run throughout the four days of the conference, including a practical ‘toolbox’ session on the Sunday led by optical consultant and trainer Ross Grant. Marketing and practice management will also be covered in Sunday’s Development & Maintenance track.
In New York, the BCLA’s conference programme coordinator Nick Rumney and past president Shelly Bansal joined the line-up of US contact lens specialists, many of whom have not presented at UK meetings. Differences in style of presentation as well as business methods made for an interesting contrast.
GCLF worked best when it delivered new insights and perspective on issues common to both countries, although often expressed in very different language. There was little reticence about talking money at this conference, and although the level of clinical practice and use of technology was impressive, it was business management tips that were most useful to take away.
New products yet to come to the UK, renewed emphasis on the importance of solution recommendation in the US market where generics dominate, and the relatively slow uptake of daily disposability in US prescribing meant there was plenty to learn from each other. There was also much discussion of the Affordable Care Act health reforms (‘Obamacare’) which take effect this year.
Money talks
Getting down to business, Seattle OD David Kading examined the value of contact lens patients. The average practice increased its contact lens wearer base by 2.5 per cent each year. Using a model of $305 yearly revenue per patient, the difference in total revenue between ‘laggards’ (-2.5 per cent net growth in wearers per year) and ‘best in class’ (+10 per cent) widened over time to more than $633,000 cumulatively over six years.
Prescribing only spectacles brought in total revenue of $876 per patient, compared to $1,678 for a contact lens patient (+91 per cent), over the same six-year timeframe. ‘Select lenses that are profitable, and benefit the patient too,’ said Kading, adding that daily disposable lenses were not only the healthiest option but also the most profitable.
For Shelly Bansal, who has 52 optical outlets within a 15 square mile area around his Middlesex practice, acquiring patients was all about communication, whether through external or internal tools, or via the eye care professional and team. Tips for acquiring new patients included making contact lenses more visible in the practice, which could increase sales by up to 20 per cent. Awareness of offering contact lenses rose from 44 per cent to 95 per cent when he installed iVue and captiv8 in-store video display, and unsolicited enquiries also increased.
Bansal’s top three tools for retaining patients were to focus on product, communication and pricing. Bundling lenses and solutions, offering upgrades and free trials at every visit, six-monthly check-ups and contacting patients in the first 48 hours of lens wear were among his suggestions.
Advice on pricing was to split fees and charges, have patients pay monthly and offer them a package of discounts on other eye care products. Monthly direct debit or credit card payments were a concept unfamiliar to US doctors. In Bansal’s practice, which has 40 per cent of its turnover in contact lenses, the equivalent of $50,000 per month was through direct debit.
Down the drain
According to Oregon OD John Rumpakis, contact lens dropouts were ‘money down the drain and ignoring them can hurt your business’. Yet a straw poll of the audience of 160 revealed only one delegate actually measured dropout from their patient base. Common misconceptions and assumptions were:
? My practice doesn’t have any dropouts
? That’s not my responsibility
? Discomfort with contact lenses is usual
? My patients can’t afford new technology
? Generic solutions are much cheaper.
Rumpakis estimated the value to the average business of a single contact lens patient over their lifetime at $47,678. The lifetime economic potential for eliminating dropout from the business was as much as $1.8m.
Dropout was preventable, he said. But doctors often underestimated the role of lens care in contact lens comfort, failed to actively recommend a specific solution or treat lenses and solutions as a system, and tended to focus on ‘what’ rather than ‘why’ in their patient recommendations.
Asking the right questions at aftercare was key to preventing dropout, such as:
? What are you using to take care of your contact lenses?
? Do your contact lenses do what you’d like them to do?
? Are your contact lenses a hassle?
? If you could change one thing about your contact lenses what would that be?
Tools of the trade
Brooklyn-based OD Justin Bazan is the guru of social media in optometry. His philosophy is that ‘people like to do business with people they like’. ‘Your business has a persona. You have the ability to interact through social media, and to build and develop relationships. Your posts should be friendly, helpful or fun,’ he said.
Bazan used Facebook to build loyalty, acquire new business and engage with (and sell products to) patients, pin posting items he wanted to highlight. All the major contact lens companies had social media sites that could provide a source of content. His office also has its own YouTube channel (www.youtube.com/user/parkslopeeye) of curated content on topics of interest.
Useful tips included converting online suppliers’ prescription verification requests into sales with set protocols, such as emailing the patient with: ‘We’re part of the community and we’d appreciate your support because we’re a local business. If we’re close on price please consider us.’
Email reminders went out to patients whose prescription had expired or who failed to collect their annual supplies, giving reasons for coming in and the opportunity to book an appointment online. Each patient received an automated reminder prior to lens supply running out. Acuminder also allowed patients to reorder and to schedule their own appointment.
Ohio OD Mile Brujic talked about four technologies that could enrich practice, whether from the patient’s or business’s perspective: scleral lenses for irregular corneas, better on-eye assessment of multifocal lenses, recommending contemporary solutions and using new materials such as water-gradient lenses.
Nick Rumney had his own ‘tools of the trade’ in his Hereford practice. These were centre distance soft multifocals for myopia control; tear osmolarity testing with the TearLab device (part of a £140 dry eye evaluation, including up to two follow-ups); infra-red meibomography, using instruments such as the Topcon BG-4M and Oculus Keratograph 5M; and anterior OCT for recording clinical information.
Technology could make life easier but it posed a few questions too. ‘There’s nothing new under the sun but we can measure it now – and put it on the internet,’ he said.
Throwaway debate
A three-way debate on contact lens replacement frequency threw up some interesting trends in prescribing. Sauflon has just launched in the US, which will increase the options for SiH daily disposables. Alcon recently extended its portfolio of Focus Dailies AquaComfort Plus lenses. B+L’s new Ultra SiH containing PVP is a monthly lens and there are reports that a new weekly lens will soon enter the market.
Only about 20 per cent of lenses currently prescribed in the US are daily disposables, but two years ago David Kading decided to make his practice exclusively single-use. In 2013, he fitted 65 per cent of his lenses in this modality and by the end of this year that figure would reach 85 per cent. ‘If we don’t target these things we’re never going to be able to move the needle,’ he said.
Case contamination was one of the principal clinical reasons for prescribing daily disposables. There was still no guidance on case replacement frequency although at least three monthly seemed to be the recommendation. In the US, solution packs do not usually contain a case as they do in the UK.
Among the prime targets for daily disposables were previous dropouts, a theme echoed by other speakers. Occasional use, ‘for moments when you still want to wear contacts’, was an attractive and economical option for this group, said Kading.
Shelly Bansal argued that there was no single modality that was best for all patients and would keep them in lenses for life. There were still comfort and cost issues with some daily disposables and parameters were limited. ‘One day they will be the best product but until then we have to fit the best available,’ he said. Bansal made the case for two-weekly replacement over monthlies for comfort reasons and to avoid ‘extreme stretching’ of replacement interval.
According to Jack Schaeffer, doctors and patients preferred a monthly schedule, which was easiest to remember and most cost-effective. Schaeffer’s prescribing decisions, fee structures and aftercare frequency were tailored to the individual and based on risk. Children, for instance, might use monthly lenses but on a two-week replacement schedule, two-weekly lenses replaced weekly, or daily disposables, with check-ups every six months. He invited delegates to ‘join the medical model contact lens revolution’ and take back control of their patients.
In a keynote address, Lyndon Jones was back on more familiar ground with a comprehensive review of contact lens comfort and an update on new products. His advice was to take a multi-pronged approach and think about the material, the solution and the patient’s eye health. With most patients, this approach would enhance comfort. To elicit symptoms, ask patients to grade their comfort in the morning and at the end of the day, and record how many hours of discomfort they experienced.
Delivering on service
A session on how patients receive their lenses revealed more differences between the US and UK. Shelly Bansal explained the principle of bundling lenses and solutions together which led to better patient control, compliance and stock control, and improved profitability. Patients were routinely seen every six months and product was shipped directly to patients in three-monthly supplies.
Minnesota OD Jason Jedlicka was also an advocate of direct-to-patient shipping but supplied most lenses annually, priced lenses per box and offered bulk discounts, free shipping and rebate coupons as incentives. ‘When patients buy less than a year’s supply from us it’s about a 50:50 bet that they’re going to come back and get the other six months’ from us later. We’re better off taking a mark-up on a year’s supply that may not be double that of a six months’ supply but we’re getting it all upfront.’
Patients either wanted their lenses immediately, wanted the most convenient method of supply or wanted the best value. It was not necessarily more convenient to pick up a year’s worth of product from the practice and 4 per cent of lenses ordered in his practice were never collected. As with internet shopping, patients were willing to wait for a product if they were getting a better price. Value was not just about cost but the whole package of professional care.
In terms of transaction costs, the most cost-effective way to get lenses to patients was to have them order via your website and for distributors to ship rather than sending out from the office. Offer next-day or two-day delivery for an extra charge.
In the top 25 per cent of US practices, about 30 per cent of their orders were annual supply directly shipped to patients. In less successful practices that figure was more like 10 per cent, he said.
Alan Glazier practises in Washington DC and is founder of ODs on Facebook. ‘Omnichannels’ was the term for different ways to order product, via fax, phone, email, Facebook etc. When patients told him they were going to get their contact elsewhere, he challenged them with: ‘Why would you do that? Here’s what we offer…’. Prescribing familiar ‘mom and pop brands’, keeping in line with prices online and using social proof, such as ‘Most of our other patients buy their lenses here’, were among other useful tips.
Glazier ended with a mention for Alcon’s uniform minimum suggested pricing strategy in the US which he described as ‘a game changer’. B+L had a similar policy for its Ultra lens, he said. Opinion was divided on whether this move was welcome or not – just one of many topics likely to stimulate debate when GCLF comes to the UK next month.
[CaptionComponent="190"]Refreshing approach
Optometrist Somari Biehler (pictured) of Chiltern Opticians in Great Missenden, Buckinghamshire attends Vision Expo East every year to buy products for her practice and attend its CE programme. ‘Because I was coming to Vision Expo, I thought it would be good to do the Global Contact Lens Forum too, and see what they say about contact lenses in the US. You can always learn from them, and they can learn from us.
‘The CE programme does have a contact lens stream, which is very good. But I just thought I’d try this – I specialise in contact lenses and it’s a big part of my business.’
So what did she think of GCLF? ‘It’s been really good. It has a lot of experts in one room and there’s always more than one view in each session, which brings more variety. The content was also good – the future of contact lenses talk was really interesting.
‘US practitioners seem to be more aggressive about fees and it’s refreshing to hear that you just have to charge for what you do. We sometimes have a “sorry but I’ve got to charge you” attitude. It was good to hear from Shelly that a direct debit system works since we use a similar system. It motivates me to go back and make it bigger and better.
‘There were a few interesting points about solutions and how you combine them with lenses, and whether you ship the lenses direct to patients or let them pick them up. Our feeling is we have more control over our patients when they come in to the practice. But patients whose lenses were shipped to their home address seemed to be as compliant.’
On the clinical side, a presentation on the dry eye drug Restasis, which is not yet available in the UK, was of interest. ‘It’s nice to know we’re not behind on lenses – it seems like we’ve got the same lenses available.’
Would Biehler come again to GCLF or be more inclined to attend the BCLA event? ‘Because I come to Vision Expo every year I’d come here again, although I’m disappointed that I haven’t been able to claim CET points this time. I would recommend colleagues to go to the BCLA if these speakers are there.’
[CaptionComponent="191"]Different perspective
The Global Contact Lens Forum was the first event under the agreement between Vision Expo and BCLA, and Nick Rumney is coordinating the programme for his first BCLA Clinical Conference. What were his impressions of the New York event?
‘It exceeded my expectations. We’d been led to believe that contact lens education wasn’t popular in the US but we couldn’t have been more wrong. They have similar issues to us, worse in some aspects, especially with regard to managed care and insurance companies that make the NHS look generous.’
The GCLF in Birmingham would be different from the other business sessions at BCLA, in tackling therapeutics alongside practice management issues: ‘We’ll look at how therapeutically trained optometrists in the US have utilised independent prescribing as a USP in looking after their patients. The major focus will be on patient retention rather than business planning per se.
‘The message will be that therapeutics are mainstream, not niche, and that it’s a competitive advantage to have independent prescribing on offer. It means it’s much easier to justify higher examination fees or monthly payments that are chair time related, even to patients who are determined to seek every bargain under the internet sun! And it’s about time we treated our own contact lens patients when they need it, rather than referring them on.
‘GCLF offers a different perspective on the world and BCLA is an international conference. Britain and British optometry doesn’t have all the answers although we might help pose some questions.’
Visit www.bcla.org for more details of the BCLA Clinical Conference and Exhibition. The New York GCLF was sponsored by Alcon, Allergan, SynergEyes and Vistakon