3 Reasons You Need an Office Manager

Human Resources, Managing Others, Talent Acquisition

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Does your practice have an office manager? You might want to consider hiring one. Here are the key benefits of an office manager, including points to help you decide if hiring one is right for your practice.

Recently we read an article that got our attention by making the following three statements about office management: (1) “One of the biggest costs in any business—medical or not—is employee incompetence,” (2) “Management is a learned skill,” and (3)” ‘Evidence-based management’ is as similarly important as ‘evidence-based medicine.’”

Let’s explore these three thoughts further.

Employee Incompetence
Employee incompetence is a common problem in many practices. We’ve all heard and seen things when walking through the practice that makes us wince. We thought staff was trained appropriately, but obviously, based on what we saw or heard, there’s a problem somewhere.

The most common drivers of incompetence are: laziness, poor communication (just because you’ve said something doesn’t mean the other person understood), lack of people skills and lack of training. So, who in the practice is addressing these drivers of incompetence?

Is the doctor the best person to handle these drivers? Not always. Often the doctor has a very distorted view of what is happening in the office. The doctor spends the majority of their office time in the examination rooms in back of the office.

A staff member bringing to the doctor a problem occurring in the front of the office often gives the doctor a perception of the problem which may not be an accurate description of what is really going on. It is the perception of that staff member. Other staff members may have different perceptions. If there is no office manager, the doctor must investigate to get an accurate understanding before making a decision. That takes time. Time that the doctor could be spending on patient care, or time the doctor has to add on top of patient care.

An office manager – one with time dedicated to management – is the best person to address the drivers of incompetence. The office manager is going to have the best understanding of what is going on in the office with both patients and staff. Rather than being reactive, a good office manager is proactive in handling the four drivers of incompetence because the office manager is managing in real-time, versus the doctor, who will hear about what happened in past-time.

Management Is a Learned Skill
One of the core tenets of any successful person is the drive to always become better. There is always something new that can be learned that enables you to do your job better. But some staff members (and some doctors) have plateaued. Learning has stopped. Performance improvement has plateaued. The office manager is no different.

Here’s a core question that needs answered: Have you provided targeted, effective and ongoing training for your office manager? In many practices the office manager is given the title, but no, or little, training on how to do the job. When this happens, beware the Peter Principle. “According to the Peter principle, employees continue to be promoted as long as they perform well in their roles; as a result, they rise to their level of incompetence: the point at which they fail to do a good job.”

The antidote to the Peter Principle is training. Even the office manager needs training. Training on how to do their job. Training on how to manage people. Training on how to move the practice forward.

Let’s make a list of what we want the office manager to accomplish, so we can see what training is needed.
Starting with the big picture, there are two primary things that we want from the office manager. They are to ensure the smooth functioning of the practice and to help grow the practice.

To ensure the smooth functioning of the practice, the office manager needs to manage at least these things:
1) Find, hire, train and fire staff and vendors
2) Keep and enforce office policies
3) Ensure that expenses remain as low as possible
4) Handle problems with staff and patients
5) Make and implement day-to-day decisions
6) Allocate resources, decide staff schedules and vacations
7) Supervise and manage employees in a fair and consistent manner

To help grow the practice, the office manager needs to manage at least these things:
1) Inspire staff members to perform better
2) Look for ways to improve the practice
3) Report to leadership
4) Plan with leadership
5) Implement the leadership plan

So, how does the office manager get the skill-sets necessary to ensure the smooth functioning of the practice, and to help us grow the practice? Training. This is not a one-and-done. Training is an ongoing activity, so the office manager is doing the job better and better. We need to make sure that we invest in training for our office managers.

Evidence-Based Management
In the 1990s, we began to hear about evidence-based medicine. Now the concept of “evidence-based” has expanded to include other disciplines, including business management.

“The starting point for evidence-based management is that management decisions should be based on a combination of critical thinking and the best available evidence. And by ‘evidence,’ we mean information, facts or data supporting (or contradicting) a claim, assumption or hypothesis. Evidence may come from scientific research, but internal business information, and even professional experience, can count as ‘evidence’.”

We believe that practice management rule number one is measure to manage. There are three things about a practice that need measured: (1) how are we doing now compared to last year, (2) how are we doing compared to other like-sized practices, and (3) how are we doing compared to our goals. This information is available in the office practice management software and from reports from vendors in our profession.

With a little work you can establish reporting systems that gather this information for you, or you can purchase dashboard management software that can do this for you.

Training your office manager on how to read the numerical evidence, and how to use an evidence-based management approach, maximizes the performance of your office manager. When done properly, this approach enables the office manager to do the job in such a way as to ensure the smooth functioning of the practice and to help grow the practice.

References
i. http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-feature-articles/do-you-really-need-office-man?page=full
ii. http://work.chron.com/causes-incompetence-workplace-2947.html
iii. http://whatis.techtarget.com/definition/Peter-principle
iv. https://www.cebma.org/faq/evidence-based-management/

 

MARK WRIGHT, OD, FCOVD

Dr. Wright is the founding partner of a nine-partner, three-location full-scope optometric practice. As CEO of Pathways to Success, an internet-based practice management firm, he works with practices of all sizes. He is faculty coordinator for Ohio State’s leading practice management program.

CAROLE BURNS, OD, FCOVD

Dr. Burns is the senior partner of a nine-doctor full-scope optometric practice that she built with her husband, Dr. Wright. She is also the COO of a state-wide nursing care optometry practice. Dr. Burns lectures nationally on practice management and staffing issues. Dr. Burns authored the Specialty Practice section of the textbook, Business Aspects of Optometry.

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Aesthetic Optometry: 6 Pointers for Making It Part of Your Practice

Differentiation | Business Strategy, Practice, Resources

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The medical eyecare and refractive services you provide safeguard patient vision and improve quality of life. Sometimes, though, patients want something more–to look as good as they see. Aesthetic optometry, which offers cosmetic improvements to the eye area, offers practices a chance to provide patients with an additional, in-demand service.

I define aesthetic optometry as the art of prescribing to enhance the health, appearance and performance of the ocular surface and adnexa.

As optometrists, we need to own that we are the experts on everything in the eye and eyelid area. That means having an informed opinion and scientifically based advice about the safety of procedures and products patients are using on and around the eyes. The value of an eye exam cannot be limited to the numeric outcome of a refraction. With the advent of online refractive services, it’s more important than ever to offer comprehensive ocular care where our patients can easily perceive the value of coming in for an in-person eye exam.

Men and women both are seeking treatments to improve the appearance of their eyes and eyelid skin. Cosmetic Botox usage around the eyes has increased by 41 percent since 2011, and 10 percent of all Botox users are men (it’s gotten so popular it’s been dubbed “Brotox”). Our patients are seeking ocular aesthetic procedures at higher rates than ever before, and we need to make sure as eye doctors that we are seen as a vital part of that care plan.

Tie Aesthetic Treatments Into What You Already Do
Sometimes aesthetic optometry can tie easily into services you already provide, such as for dry eye.

As a dry eye specialist, offering ocular aesthetics is a natural extension of what our office does to improve the ocular surface. We recommend preservative-free tea tree oil lid cleansers for makeup removal and fighting blepharitis as a safer alternative to formaldehyde-containing baby shampoo that was a mainstay of generations past.

A go-to product in our clinic is We Love Eyes by Dr Tanya Gill. It’s made a huge difference for many of our patients with chronic eczematous dermatitis that were sensitive to the preservative-laden cleansers or soaps they were previously using. Baby shampoo is a huge dry eye offender, but many of our patients have been told to use this by previous eye doctors, so it’s important for us to recommend a product alternative that is non-toxic. There is no perfect mascara, but we discuss the chemicals in these products that should be avoided, and also make recommendations for more gentle options for the ocular surface. While we don’t retail mascaras or makeup products, it would definitely be an option for a doctor to look into if they found a product with ingredients they could really stand behind.

We currently offer Lipiflow treatment for protecting and preserving the meibomian glands in patients who have suffered damage. Discussing the risks of meibomian gland disease with prostaglandin-based cosmetic products like Latisse, or over-the-counter lash growth serums, is a big focus in our clinic, and we offer free meibomian gland imaging at every comprehensive exam to help find patients using these cosmetic products who are at risk of developing permanent dry eye disease.

Another great option, depending on the scope of practice laws in your state, would be to offer intense pulsed light (IPL) treatments for ocular aesthetics. These pulsed-light treatments improve the appearance of lid margin hyperemia by coagulating telangiectasia around the ocular adnexa, and have the added boost of improving dry eye signs and symptoms.

Treat Aesthetic Optometry as a Science
The key to elevating ocular aesthetics as a true specialty to put beside dry eye or glaucoma care is to treat it as a science. At Triangle Visions Optometry, the way we practice ocular aesthetics overlaps very much with our dry eye specialty. When we are treating dry eye, addressing the cosmetic products and procedures our patients use, and the side effects they may cause, is an essential foundation building block to their dry eye treatment. We can’t ignore the impact of aesthetics on our dry eye outcomes, so adding that specialty to our practice was essential to our patient care outcomes.

As a specialty contact lens fitter, I often tell other doctors I have to be a dry eye specialist, too, to get the contact lens outcomes my patients expect and deserve. They won’t see their best, or get the best contact lens comfort and performance, without me addressing any underlying dry eye issues. The same is true in our ocular aesthetic specialty. If I treat their dry eye, but ignore the ocular surface offenders they are using on a regular basis, am I really fully treating the issue? In my opinion, it’s impossible to separate specializing in dry eye care from also specializing in ocular aesthetics.

Little Investment Required
Offering ocular aesthetics as a specialty can be done with minimal-to-no investment. All it takes is familiarizing yourself with the chemical risks associated with common cosmetic and facial products, and the treatments available. As a part of routine eye exams, we get asked by patients on a regular basis questions like, “what can I do about my under-eye circles” or “what mascara would be better for sensitive eyes?” Ocular aesthetics is specializing in solving these common patient issues and questions.

If you choose to retail products in your office, it can be another additional revenue source. Currently we retail HydroEyes supplements for improving dry eye and meibomian gland function. MGD and dry eye is a major side effect of ocular cosmetics and cosmetic treatments like eyelash growth seurms, eyelash perming, botox injections or retinol wrinkle creams. As a Vision Source member, our cost is around $15 per bottle, and we are able to retail it for $33 per bottle for a great return. We also retail Bruder masks for improving meibomian gland function for patients who are diagnosed with issues during the exam. We discuss the importance of makeup removal, lid hygiene with a safe cleansing product, and then heating the glands nightly to reduce the negative impact of products like eyeliner and mascara that can promote meibomian gland dysfunction.

We offer Lipiflow treatments, as well, for patients with nonexpressing glands due to meibomian gland dysfunction. This treatment is FDA-approved for preserving and protecting meibomian gland function, and at this time, not covered by medical insurance. As a cash-pay treatment, it is a revenue-builder for both our dry eye clinic, and by extension, our ocular aesthetics specialty, since treating meibomian gland dysfunction is an important part of treating side effects of cosmetic products and procedures and solving underlying causes of common ocular aesthteic issues like chronic redness.

Educate Yourself
If you want to jump-start learning more about the most common ocular surface irritants in cosmetic products, check out Vampires on the Vanity by ophthalmologist, Laura Periman, MD, and become a member of the collaborative OD/MD community on the Ocular Surface Facebook forum OSDocs.

In addition, Advanced Ocular Care has done an excellent job featuring articles from the leading ocular aesthetic and anti-aging eyecare specialists around the country. Bridgitte Shen Lee, OD, Leslie O’Dell, OD, and Whitney Hauser, OD, are optometrist-thought leaders in the field. Any article or course offered by any of them always gets my immediate attention to expand my knowledge on the topic.

Educate Your Staff
It is essential to have all of your staff familiar with any product you retail or service you provide. They are spending a lot of face time with patients, and they are likely to field questions or hear buzzword complaints or issues that should trigger a discussion of what you offer in the office. It’s always a slam dunk for enrolling a patient in my treatment plan when I have a patient sitting in my chair who has already heard from another staff member about how I can help them. Whether it is my technician recognizing dry eye symptoms during the work up, and seeing tell-tale meibomian gland atrophy on their imaging, or my front-desk staff documenting pertinent complaints she heard when the patient scheduled the appointment, any time a patient is primed to know I can help, they are much more receptive to the treatments and solutions I recommend during the exam.

Have the Conversation with Patients
We have adapted several aspects of our exam flow at Triangle Visions Optometry to investigate both dry eye and ocular aesthetics issues. It starts with our technicians asking questions during the exam work-up: we ask about common dry eye symptoms like fluctuating vision, redness and watering. We ask about the medications our patients take and any cosmetic treatments (even over-the-counter) they use. I want to know anything my patients are putting around their eyes, including wrinkle creams, lash growth serums, eye drops and soaps.

During the slit lamp exam I’m not only checking for normal signs ocular surface disease like punctate keratitis, lid hyperemia, and meibomian gland dysfunction, but I’m also observing for any tell-tale signs of ocular aesthetics issues. Are they tight-lining their eyelids? Wearing false lashes? Do they have mascara debris in their conjunctiva or on their contact lens surface? These are all conversation starters to delve into ocular aesthetics treatments and solutions. We also screen every patient with meibomian gland imaging, and if any evidence of gland atrophy is seen, we thoroughly dig into all possible offenders, including cosmetic products and treatments, and start the discussion about treating the glands with ocular surface approved lid hygiene, Bruder heat masks and Lipiflow, if needed.

Displaying the products you offer is great to start a conversation. We have our HydroEyes supplements and information about dry eye and ocular aesthetics right at the checkout counter, and many times asymptomatic patients will pick up the bottle and say, “Oh my sister might need this” or “I should tell my friend about this.” It’s a great way to get more patients scheduled, offering additional conversation-starters about how you can help patients both look and feel their best.

 

JENNIFER LYERLY, OD

Jennifer Lyerly, OD, is an associate at Triangle Visions Optometry in Cary, N.C. To contact her: jelyerly@gmail.com

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The Art and Science of Successful Hiring

Human Resources, Talent Acquisition

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Successful hiring is a bit of an art. But experts say “Never put the Art before the Science” in order to improve your success rate.

If you’re like me, you have hired a good number of people over the years. And you have likely had your share of surprises and revelations along the way. A few have likely been pleasant, where people have shown unexpected qualities that have contributed to your business, and a few have led to, well, disappointment.

Statistically speaking, if you are “getting it right” even half the time, you are beating the odds. Research in larger corporations suggests that only 20% of hires are an unqualified success, where both the new hire and the manager who hired them rate it a “great decision” after six months.

That represents an 80% failure rate.

What that costs an organization is a topic for another day, but it does beg the question: what are we missing?

“Fit” is the Key

If you dig further into the research, you discover that nearly 9 times out of 10, the reason for the failure has nothing to do with the person’s competence or their skill level. It is directly attributable to their ‘fit’.

If you think of it in terms of the hiring process itself, people are admitted into conversation with an organization on the basis of what they know (skills, qualifications and experience, as expressed in the résumé); while the overwhelming reason for failure is who they are as individuals – their core attitudes, traits, standards etc.

In fact, academic research bears this out. Research over several decades at the University of Manchester into the relative validity of various predictors of job performance shows clearly that the items contained in the résumé have a far lower predictive value than the individual’s core traits and how they process and use information.

Further research into the concept of “fit” reveals that there are actually four critical aspects of fit to consider:

  • Fit with the Manager – this is perhaps the most critical chemistry to get right. Do the two share similar standards, and is the manager’s natural style going to bring the best out of the new employee?
  • Fit with the Job – to what extent does the role draw from the person’s natural strengths and interests, rather than asking them to spend their day doing things they will never be better than “adequate” at?
  • Fit with Co-Workers (and Customers) – again, is this aspect of the “chemistry” right? Does the employee genuinely like and respect the people they spend their day with, and do they feel liked and respected in return? This one seems like a particularly soft factor, but the quality of the “social fabric”, so to speak, is the aspect of fit that correlates most strongly with team productivity. Where relationships are strong and positive, the team will overcome any adversity.
  • Fit with the Practice – can the individual see how what they do contributes to overall success, and does that success matter to them? Do the organization’s values and mission resonate with them?

Science can accurately predict someone’s likely fit, or compatibility, in an environment. There are new platforms that are designed specifically to help organizations screen candidates for fit in the reality that would be awaiting them on their arrival.

The big mistake most organizations make is in relying on conventional techniques to crunch through a stack of résumés (or the old “A pile, B pile, and C pile” technique which I used for most of my career), then do phone screens and interviews, and then administer an assessment with the shortlist.

This method relies on the factors with the lowest predictive (read: nearly meaningless) value in the front end, then investing in science to screen a shortlist that might as well have been assembled by a random-number generator.

When you look at it that way, it’s absurd.

Far better in my opinion is to let the science do the heavy lifting up front by screening ALL your applicants for their likely fit in your open position; then, once you have identified the best people—those likely most compatible—at this point you can check their résumés to make sure their knowledge, technical skills and experience is in the right ballpark and take them through the interview process.

There’s room for both Art and Science in hiring. Using them in the right sequence will yield you a better, more consistent outcome.

 

JAN G. VAN DER HOOP

Jan is the co-founder and president of Fit First Technologies, a company that applies its predictive analytics to the task of matching people to roles. Those algorithms drive platforms such as TalentSorter, FitFirstJobs and Eyeployment.com, which are relied upon by organizations to screen high volumes of candidates for “fit” in their open positions.

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Get Staff Buy-In with a Team Huddle

Human Resources, Managing Others

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As mentioned in our October article (“By the Numbers: Make Better Decisions”), Optometrists as business owners need to set goals for their business year and make plans to attain them. There are three key success factors in ensuring your plan achieves your goals. Number one: monitor progress frequently. Number two: get buy-in from staff. Number three: strong leadership.

Set Goals with Input from Staff

The beginning of the year is a great time to make goals! We recommend setting aside time during office hours for a staff meeting that is dedicated to this agenda item alone. Start by communicating some of the goals you have in mind for the office. Goals can be anything from a Gross Revenue target, to how many patients you see a day, to reducing wait times. Ideally, allow the team the opportunity to help shape the goals and offer suggestions on how to attain them. Their contribution is what will lead to a higher probability of success.

To keep “eyes on the prize,” consistent reinforcement and updates are crucial. The most effective way is to have regular monthly or weekly staff meeting and a daily huddle. Big retailers do this well. Every day, the team gathers for ten minutes before the doors open and they discuss that day’s goals and targets. The huddle will look different from office to office depending on the goals.

For instance, here is what the huddles could look like for three different types of goals:

  • Goal – Increase the Monthly Number of Patients Seen
    Give a daily update on how many new patients and full exams you saw yesterday and the plan for today. Specify how many recalls need to get done and by who. Talk about what Google or Facebook ads will be running today. Ask the front desk staff how many parents/caregivers they will ask to book an appointment, and when they last had an eye exam.
  • Goal – To Increase Gross Revenue
    Give a daily update on what gross revenue was achieved yesterday and the plan for today to hit that target. Each member of the team should outline what they are going to do today to contribute to the daily revenue target.
  • Goal – Reducing Wait Times
    Give a daily update on the wait time yesterday and the plan for today. Each team member should outline what they are going to do to help the doctor stay on time.

Some offices print out a day-sheet beforehand and make notes that the rest of the team will review. Ideally, each team member would come prepared having reviewed each patient for the day. This type of planning provides two benefits. One: the staff can plan out who needs to be in which department and when. Two: staff will have a list of goals to accomplish for the day, which contributes to greater employee satisfaction.

Staff Looks to the Practice Owner for Leadership
Strong leadership is of utmost importance. The practice owner needs to make the team huddle a part of the work day and insist that all members of the team participate. The owner should lead the team huddle, emphasizing the information that is most important and asking clarifying questions when team members are sharing information.

Finally, the intent of the team huddle is to build energy. Therefore, keep the meeting short. Fifteen minutes is the maximum length of time it should take, five minutes is ideal.

Be sure to end the huddle on a high note. “We’ve got this! Let’s give every patient today the best experience possible.” Sincere encouragement goes a long way!

 

KELLY HRYCUSKO

is the co-founder and managing partner of Simple Innovative Management Ideas (SIMI) Inc. and expert Practice Management contributor for Optik magazine. She can be reached at info@simiinc.com.

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Plan How You Shop for New Office Space

Finance|Wealth, Office Design & Renovation, Practice, Real Estate, Resources

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Shopping for office space is like shopping for a house. It is easy to get distracted by first impressions. A beautiful, bright space is tempting, but will renting or purchasing the space give your practice what you need to grow? My practice recently made a move to a new space. Here is how I connected my strategic goals for my practice to the new space we found.

Match Patient Volume to Space

Our old space had distinct limitations. It was less than 900 square feet, far too small for the more than 3,000 patients we see each year. We also lacked prominent street-front views of the office, so people could not see us from the road. Including the doctor that I bought the practice from, we had been in that space for over 30 years, and still people in the neighborhood did not know we were there. We were only attracting one demographic, and we wanted to have a more diverse population of patients.

The well-trafficked corner in West Palm Beach, Fla., where Dr. Jasper moved her practice, Advanced Eyecare Specialists.

To retain patients, we limited our scope of searching to less than five miles. We didn’t want to inconvenience existing patients, so we ended up choosing a space less than .5 miles away from our old space, and yet we already have seen a large increase in new patients.

Location, Location, Location

Location is key. I really think you need patients and prospective patients to have an easy-to-see street-front view of your practice. People need to see you as they drive by. If they pass your sign daily, they will think of you when the time comes for eyecare and new eyewear. You need a good sign and good logo that is easy to see from the road to maximize the potential of your location. I have many friends that are successful in business centers with no prominent street-front view, and I am happy for them, but I suspect they would be even more successful if patients could see them more easily.

We chose our location because it is on a street corner that has 26,000 cars drive by daily, according to a feasibility study of the location that we conducted prior to signing the lease. We also chose it because it had the availability to have a very large sign on the corner with our name on it.

Patient Convenience

We currently have eight staff members, so we needed space for those eight cars, plus space for patient cars, and will need more space as the practice grows. We knew we had to have parking or patients would be discouraged from shopping in our dispensary. Our city of West Palm Beach, Fla., does not have much public transportation, so parking matters. We also wanted to find a location close to neighborhoods. We find that our patients like to see a doctor close to home and we wanted to find a location close to their homes. We have people who come to see us from many miles away, but the majority of our patients are moms bringing the family who are from the neighborhood immediately surrounding the office.

Announce Relocation with Bold Statement on Practice Web Site

I knew many patients would visit our web site before making their appointment, so I made sure our site featured the following announcement of our move:

“We’ve MOVED!
Since 1941 we have been serving our patients in West Palm Beach. As of January 3, 2012, we’re proud to announce that we have moved to a newer, larger facility just three blocks away so we can better serve YOU! Please give us a call for directions before your next visit.“

Think Long-Term Growth

The large, enhanced optical shop featured at the new location of Advanced Eyecare Specialists.

We thought in terms of the long run when choosing our space. We knew that in our old space we would be limited in the number of patients we could see and would not be able to bring in a second doctor without a second and third exam room. It isn’t cheap to expand, but we also knew that with upcoming changes in medical care resulting from health care reform, we needed to be prepared to adapt to change.

Renting Is OK, Too

Purchasing an office space that can become a long-term investment is the ideal, but sometimes it is not possible. In our case, we rented this space we just moved into after searching for a location we could buy for two years unsuccessfully. Our lease is for five years. It typically takes 10 years to recoup the costs associated with moving, so prepare to stay put for a while following your relocation.

Compare What You Have to What You Would Be Getting

The optical in our new space is five times as big and has twice the number of frames and higher-end frames as our old space. We still have the same number of chairs In the optical, but our goal was more shopping space, not seating space. We now have a pre-testing area as well as a separate room for special testing so we can maximize our ability to move patients through the office quickly. We also were able to purchase more instrumentation for better patient care. We now have three exam lanes fully automated with Marco TRS systems, and the entire office uses electronic health records for maximum efficiency.

Delegate Search but Devote Time to Looking

A doctor with a full patient load probably will have difficulty setting aside the needed time to conscientiously shop for office space. In my case, I turned over much of the detailed searching to my husband, who also happens to be my practice’s business manager. We looked at more than 20 locations over a period of two years before making our final selection.

Don’t Forget: Office Space Must Enhance Patient Experience

You can have all the best instrumentation and best looking office and great selection of frames, but when the patients start coming into the office, the experience also has to be amazing. The beauty of the new space is that we have been able to create systems and efficiencies that make the patient experience one that they will want to return for. At the end of his exam, one of my patients recently said to me: “Dr Jasper, the office is beautiful, and the staff is amazing. The experience you have given me today well justifies the fee you charge.” That is what we strive for every day, and the new office has made that even more of a reality. To give our patients time to adjust to the new location, we kept our fees the same for the first six months following the move and then raised fees by $40. Happily, the majority of our patients have made the move with us.

 

APRIL L. JASPER, OD, FAAO

April L. Jasper, OD, FAAO, is the owner of Advanced Eyecare Specialists in West Palm Beach, Fla. She is featured in a cover story in the Spring 2012 issue of MBA Insights. To contact her: drjasper@aeswpb.com.

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Hubble-Proof Your Contact Lens Practice

Marketing, Practice, Pricing, Resources

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Editor’s Note: Hubble Contacts started supplying Canadian residents late in 2017 and provides its services to Canadian addresses. The Canadian price point is $40 for a monthly subscription (versus $30 US for US residents).  TV and Internet ads do spill over from US media to Canadian viewers. InfoClip.ca previously reported on the funding Hubble received for a Canadian launch. Click here to read more.

By now, you’ve probably heard–or seen on TV or online–that Hubble has launched. Not the space telescope, but an online subscription service marketed as a low-cost source for daily disposable contact lenses.

Hubble clearly presents their value statement–and independent ODs who specialize in contact lens services are challenged to be clear in presenting ours, as well.

First off, with Hubble the contacts won’t be the ones we have prescribed for the patient; rather, they are a generic daily disposable created especially for Hubble. The lenses are made of a version of methafilcon with a Dk/t of 18.8, rather than today’s standard of Dk/t of 80 or even 100 for premium lenses. In other words, Hubble lenses allow four-five times less oxygen to reach the cornea that do branded lenses than we regularly prescribe.

Whatever the quality of the lenses, the lure of inexpensive daily disposables may be hard for patients to resist. The site touts: “With your first shipment you’ll get 15 pairs of Hubble lenses for free. Just cover the monthly $3 for shipping & handling.” After that first complimentary shipment, you can get 60 lenses per month for $30.

The site has a doctor locator to facilitate prescriptions especially for Hubble lenses by connecting the patient to doctors who have Hubble fitting sets, and are open to writing prescriptions specifically for Hubble’s product.

Instead of being alarmed about this new price-driven option for consumers, at our practice we have a practical and workable solution: Before we talk about price, we talk about value.

Increase Marketing of Daily Disposables
One thing I like about Hubble is they are promoting daily disposable contact lenses. Currently in the U.S., daily disposables are just under 30 percent of the contact lens market. One of Hubble’s goals is to grow that market. That growth would be good for Hubble, but also good for us as practitioners.

I have a large three-doctor practice that places a heavy emphasis on contact lenses. Last year my practice generated just over $3 million in total revenue. Approximately 17 percent of our total revenue is generated from the sale of contact lens materials, and another 8 percent from contact lens professional fees.

Our practice is close to 60 percent daily disposable lenses of all soft lens sold, and 76 percent daily disposables in the spherical category. We have gotten to those figures by educating patients on the advantages of the daily disposable modality. In my view, there are two advantages to daily disposables over other modalities: health and convenience.

My staff and I explain to patients that having a fresh lens every day is the healthiest way to wear a contact lens. That statement by itself is usually easy for a majority of patients to understand. Most patients who are in a frequent-replacement lens can relate to the feeling of putting a new fresh lens on. Now they can have that feeling every day.

For convenience, I merely ask patients if they like cleaning their contact lenses. Most, if not all, patients do not like having to clean their lenses every day. I explain to them that with daily disposables, cleaning is a thing of the past. Also, they will save the average of $100 per year that most people spend on contact lens solutions.

To sell any product you need to show the consumer why that product is better than other products. Contact lenses are no different.

Price Isn’t the Primary Motivator for CL Buyers
Price is not the number-one reason people purchase a product. Research reveals that price often is the fourth mostly important reason for purchasing, following functionality, utility and brand. Ten percent of consumers purchase based on price alone. For that reason I’m not overly concerned about Hubble. As independent practitioners, we should concentrate our efforts on the people who buy based on the other reasons listed above. Besides, how many patients come to us to purchase on price? My guess is most come to us for other reasons.

Even Hubble realizes that price isn’t the only reason to purchase from them. Like other companies, they are trying to build their brand. Greycroft Partners’ Ellie Wheeler, a Hubble investor says, “In a lot of categories, you didn’t care about a brand until you did. We’re making a bet that Hubble can create a brand that resonates with consumers. Delivery and convenience are only part of what they’re offering.”

Click here to read more about how Hubble and Warby Parker are impacting the industry.

Talk In Terms of Benefits
Rather than getting mired in a price conversation, point out the benefits of the contacts you prescribe. If the patient broaches the possibility of purchasing from Hubble instead, emphasize how the contacts you prescribe provide greater benefits to the patient’s eye health and vision than those available through Hubble.

In my practice, we don’t talk price as much as we talk value. For us, that value proposition is twofold: health and new technology.

For health, I mention to patients that the newer lenses to the market generally allow about four times more oxygen to reach the cornea than older-generation lenses. The cornea needs oxygen to function properly. Inadequate oxygen supply can lead to a higher incidence of corneal ulcers, an increase in redness and corneal swelling, which can result in poor or changing vision. I use that wording rather than neovascularization or edema to make it easier for patients to understand.

New technology is also mentioned to the patient and explained, as newer materials that are healthier, more comfortable and more wettable, which aids in reducing a dry eye feeling.

Hubble contact lenses are made from methafilcon A, which is a material that has been around for over 15 years, and has a Dk of 18. In comparison, newer daily disposables, such as Oasys 1-day (Dk 103) and Dailies Total One (Dk 140), are both over that 100 Dk threshold. They are also manufactured to help maintain moisture in the lens better than previous-generation contact lenses. Without getting into medical jargon, I explain that the contacts I have prescribed allow more oxygen to permeate the lens, and keeps the lens moister, resulting in greater comfort, and less chance of having to take the contacts out and switch into glasses for relief on a long day.

Most patients assume all lenses are alike, and Hubble is trying to capitalize on this perception. It is our job as optometrists to educate our patients as to the difference in lenses. Again, in our office we do this by highlighting the differences in lenses, such as oxygen transmission, wet ability, comfort, technology, etc.

Offer Resistant Patients Options
In our daily disposable lenses we have several tiers of products. On the high end we offer lenses like Dailies Total One and 1 Day Oasys. We explain to the patient why these cost more–higher oxygen, newer material, more comfortable, etc. I recommend those lenses first as I believe they are better products. From there we move down the lens category list to lesser-priced products if cost is an issue. My experience has shown that most patients will opt for the better product, and even if they do not, they will still purchase the lower-priced daily disposable lens, and stay in the daily disposable category.

If patients are skeptical, then I at least let them experience the better lenses by letting them “test drive” the contacts I have prescribed outside the office for a week. Nothing sells a daily lens better than letting patients experience the comfort and convenience of the newer lenses that are on the market.

Closely Track Your CL Sales & Adjust as Needed
Internet sales account for 15-20 percent of all contact lens sales, and Hubble itself has not yet had a significant effect on our practice.  Our sales of contact lenses remain strong, and it is integral part of our practice, accounting for close to 20 percent of our revenue. If we see sales drop, then we will have to rethink our pricing.

I do not think we would lower the price of our premium lenses, but we may offer a lower tier if too many sales are leaving the practice. We have to be careful in that area, as trying to be too many things to too many people can be a disaster for a business. Just look at companies like Sears and JCPenney that tried to be too many things, but they weren’t really great at any one thing. As an independent practice, I believe we need to have a game plan for what type of practice we are going to be. If you are high end, stick to high end; if you are low cost stick to low cost. That is what Hubble is doing, and they know their niche.

Even the founders of Hubble realize their limitations. When asked about the potential for Hubble, co-founder Jesse Horwitz replied: “Dollar Shave Club and Harry’s together have taken 20 percent of the cartridge market. If we were to take 10-15 percent of the U.S. market, that would be $600 million, but we are also expanding the market. If you can claim a few points of market share, you can have a very good-sized business.”

As independent optometrists, we should focus on the 80 percent of patients who want to buy from us, and not the 20 percent who want to shop elsewhere.

 

KEN KRIVACIC, OD

Ken Krivacic, OD, is the owner of Las Colinas Vision Center in Irving, Texas. To contact him: kkrivacic@aol.com.

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Why an Ontario Judge Ruled in Favour of the Optometrists and Opticians Against Clearly

Finance|Wealth, Practice, Products | Services | Industry News, Tax & Legal Matters

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The Ontario Colleges of Opticians and the Ontario College of Optometrists jointly filed an application in December 2016, as is their right under Ontario legislation, to request the Court to issue an order to Clearly to comply with Ontario’s Regulated Health Protection Act and the related Optician Act and Optometry Act. The case was heard in October 2017 and the court rendered its decision on January 11, 2018.

The Ontario Supreme court ruled in favour of the Colleges of Opticianry and Optometry, ordering Clearly to comply with Ontario regulations. For those not inclined to read the 31-page decision by Justice J. Lederer, here is a synopsis of the key points in rendering his decision in favour of the Colleges.

The Investigation

The Colleges used the investigative services of a legal firm to purchase eyeglasses online from Clearly.ca. While the site has clear notices regarding the requirement for an up-to-date prescription, the investigators were able to find links on the site that allowed them to proceed to order glasses without meeting the requirement of a valid prescription. The investigation details the use of the site and interactions with non-professional and professionally trained staff (Optician) based in the British Columbia head of office of Clearly. In each case, glasses from Clearly were delivered to their respective customers in Ontario.

Eyewear:  Consumer Retail Product or Health Care Delivery?

The Court distilled the case down to the definition of “dispensing” as a “controlled act” that is imbedded in the related health legislation and regulations of the province of Ontario.

Submissions by Clearly argued that the rise of e-commerce is satisfying consumers’ demand for more choice and competition, and implied, according the decision, that the Colleges are complicit in a wider effort of professional associations and colleges to protect competitive advantage in the market.

The Court however dismisses this argument as unhelpful and irrelevant. “It could be right. It could be wrong. It does not respond to the issues at hand,” wrote Justice Lederer in the decision.

The judge noted that basis for the decision lay in the underlying purpose of Ontario’s regulated health professionals legislative framework. Unlike British Columbia, where legislation was changed in 2010 to reflect a purpose of consumer choice and enhanced competition, such is not the case in Ontario, where the framework of professional monopolies exists to deliver health care while protecting the interests of Ontario residents. The decision reads, “There is no justification for imposing the purpose of health professional legislation from British Columbia on those who reside in Ontario.”

Why Were Optometrists in Quebec Unsuccessful in Blocking Internet Sales?

A similar action taken by the Ordre des optometrists du Quebec v. Coastal Contacts Inc.  ruled in favour of the company against the Ordre (College) in December 2014. What was different then and there?

Turns out, words do matter!  The Quebec case is distinguishable in the detailed definition of the practice of Optometry in Quebec’s code, which includes the words “sale and replacement of ophthalmic lenses.” The decision in the Quebec case is driven by the word “sale”. The law of British Columbia ruled the day since it was determined that the sales contract between the company and the resident was substantially entered into in BC, and that the product was only “delivered” to a resident in Quebec.

“Dispensing is qualitatively different than selling”, wrote the Justice. As such, notwithstanding the position held by the Company and their attempt to draw parallels with various classes of pharmaceutical agents, the Judge returns to the basic tenets of the Ontario Legislation; “…what professional (optometrists and optician) is responsible for providing the health care associated with obtaining eyeglasses and contact lenses (“prescribing”, ”preparing”, ”fitting”, “adjusting”, “adapting” over the internet from Coastal and Clearly?  I repeat, apparently this is not one.”

No Harm, No Foul

Clearly’s counsel additionally submitted that controlled acts should be narrowly interpreted and that evidence of “risk of harm” is a requirement of the Colleges; “Despite the recommendations of two seasoned regulatory law firms, the colleges have not introduced any evidence of the risk of harm.”

The Court however held that the risk of harm assessment is intrinsic to the controlled act (“Dispensing”) definition in the related legislation and that the Court has no role in the risk assessment of harm. To suggest otherwise, is, according to the decision, “…to negate the value of the regulation.”

 So, Now What?

Clearly is appealing the decision. While the appeal process is underway, Clearly plans to continue to service customers in Ontario.

Clearly representatives advised the following; “Clearly is committed to making vision care accessible worldwide and believes that the Internet is complementary to other distribution channels”, says Clearly Managing Director Arnaud Bussieres. “Clearly is well-known for accessibility, affordability, consumer satisfaction and quality of service throughout its eighteen years in business,” added Bussieres.

According the company, Clearly has a history of engaging in dialogue with optometrists and opticians across Canada to find areas of collaboration and ways to provide better products to consumers. “We don’t see this decision impacting our progress and ambitions of working directly with eyecare professionals to address opportunities for additional vision care access in the market,” commented Bussieres.

The Ontario Association of Optometrists (OAO), upon request, indicated they were “not in a position” to comment, given that the application was brought on jointly by the College of Optometrists and College of Opticians.

A statement from the Ontario Association of Opticians was not available at the time of publishing.

 

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Tie Your Staff Incentive Program to Gross Revenue per Doctor Day

Finance|Wealth, Human Resources, Practice Metrics & Benchmarks, Resources

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Any well-oiled machine works smoothly because all the moving parts work in synchrony with one another. So too does a  successful Optometry practice.

We are often asked what the best way is to motivate staff. Although there is merit to rewarding staff individually based on very focused goals and targets, one of the best ways to motivate for team effort is a group incentive based on total gross revenue.  The basic premise is that if everyone performs well at their assigned tasks, the team will meet their goals.

For simplicity’s sake, a practice can set monthly targets based on a percentage increase over the same month last year. A more strategic approach is to set targets based on revenue per “Doctor Day”.

Calculating Doctor Day Revenue
You can calculate revenue per “Doctor Day” by dividing the number of patients you see in a month by the number of days there is a doctor available for an entire day (7 hours) in a month.

Two doctors seeing patients in one day equals “2 doctor days”. For example, Dr. Opto generated an average of $80,000 each month and was in-office for an average of 20 doctor days each month.  Dr. Opto’s revenue per “Doctor Day” is $4000.  We recommend building in a 10% increase and then using this as your target. So in this example, the target revenue per “Doctor Day” for Dr. Opto would be $4400 per “Doctor Day”.

To get started, set up an excel spreadsheet with gross revenues targets for each doctor day in the office. The next step is to ensure that every member on your team understands how their efforts contribute to the attainment of the “Doctor Day” Revenue Goal.

Setting goals based on Doctor Days makes the incentive program fair, since we know that we need a doctor in the office. If the doctor takes two weeks off in July, then the targets should reflect this: some months like February are shorter with less Doctor Days, and March is a longer month with usually more Doctor Days. The targets need to match.

Fairness in the incentive program will enhance staff buy-in.

Link Behaviours to the Targets

Setting goals will only be effective if staff can see a direct link between their behaviours and the results.

Here are some tangible actions that can be established for each department:

Front desk staff

  • Understand and follow scheduling rules
  • Practice scripts to ensure they are ready to answer the more difficult objections and questions
  • Ask to book in family members that haven’t been seen in a while

Pre-testers

  • Anticipate who will need what testing
  • Check insurance coverage

Gallery staff

  • Make note of if and when the patient last purchased
  • Ask to give current glasses, including sunglasses, a “tune up”
  • Check insurance coverage

Lab Staff

  • Make sure jobs are ordered and received promptly.
  • Ensure jobs are delivered to patients in pristine condition

Doctors

  • Make notes on each patient on what tests and products you are anticipating the patient will need
  • Practice a solid hand-off to staff
  • Make solid, multiple-solutions recommendations from the exam room

Getting staff to contribute to this list and make suggestions to the above will further enhance buy-in to the program.

In the beginning, the owner of the practice should keep track of the results and share them with the team each day. This is a chance to rally the team spirit and encourage enthusiasm for the day ahead.   This is a great opportunity to reflect quickly on things that went well and things that did not go so well in the previous day. Once this routine is well established, many offices are able to successfully pass this role to their office manager.

It is key for staff to make the association between proactively engaging with patients to offer solutions rather than passively serving patients and improving the revenue per Doctor Day.

Lastly, when it comes to motivation, it is important to keep the reward and the positive result as close together as possible. We recommend either rewarding at the end of the month or quarter, but we wouldn’t recommend waiting longer than a quarter.

Sharing a percentage of the gross revenue at the end of the month is a great way to celebrate success!

 

KELLY HRYCUSKO

is the co-founder and managing partner of Simple Innovative Management Ideas (SIMI) Inc. and expert Practice Management contributor for Optik magazine. She can be reached at info@simiinc.com.

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Insight with Dr. Peter Rozanec

Insights

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Dr. Peter Rozanec owns a two doctor clinic in Port Credit Ontario.

Peter has been active within the profession of Optometry both at the

association level and the college level. Peter is the co-founder and current moderator

of the Canadian Optometry Group or COG for short. COG is a private online forum

consisting of close to 1000 OD’s across Canada.

 

Dr. Peter Rozanec

Port Credit Optometry Clinic, Port Credit, ON

Doctor of Optometry, University of Waterloo, 1990

 

Why did you choose your field?

I choose optometry because I had bad eyesight and I really liked visiting my optometrist the most – he (Dr Harvey Mayers in Toronto) was professional and with my being ‘a gadget guy’, he had all the latest cool ‘gadgets’ so optometry felt like a natural fit.

What advice would you give a new grad today?

Listen to thought leaders in your profession. Participate in your association and college – be a volunteer. You’ll meet great people and learn from them. Find a good practice analyst/coach that will objectively assess your practice and help it grow. Market your practice one patient at a time – subtly make every patient your ‘sales rep’ when they walk out your door. Have your patient’s back, and they will have yours. Lastly, and not less important – join the Canadian Optometry Group – which is a free email resource for Canadian optometrists that allows you to get real-time information on cases, news etc from your peers in Canada. Email me at peter.rozanec@gmail.com

What changes to eye care do you see coming down the pipe?

Practice consolidation. Solo practice will die a slow but not so painful death. At the very least, you may see very rare examples of ’boutique’ practices catering in very specialized care but for the most part, you will see more multiple practitioner practices with more services under one roof.

Where do you see your practice/eye care in 10 years?

On a personal side, I plan to be in practice a lot less in 5 years. I would, however, like to work in some limited capacity seeing patients so as ‘to keep my mental saw sharp’, volunteer again at the college and/or association, and allow for more time to travel which I really enjoy doing with my wife. Optometry will be alive and well in 10 years, 25 years, a 100 years. Every decade has brought optometry challenges and its naysayers, but the profession and its knowledge base continues to grow – which is the mark of a healthy profession.

What is your favorite TV show / Netflix series?

Seinfeld and Breaking Bad. Having said that, my favourite show as a kid and teen was Hogan’s Heroes, in university it was Cheers, and in my working years it was Seinfeld. Because all were well-written they have withstood the test of time. Breaking Bad is a phenomenal series that has set the bar so high it will be difficult for other shows to surpass it – it’s ‘The Godfather’ of drama series.

How have you changed since high school?

I see the world far more in shades of grey rather than black and white. And perhaps that – and this is somewhat tangential – I also see that maybe the only thing that might bring the world together is an alien invasion – that we would fight off, and allow us to realize that we have a lot more in common as humans, than those petty things that often set us apart.

Dr. Peter Rozanec circa 1964

 

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Cross-Train Staff for Consistent, High-Level Patient Care

Human Resources, Training & Onboarding

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Failure to deliver the best care and services because one person is out sick is not acceptable. It is costly to your practice, and avoidable through cross-training. Our four-OD, 19-support staff practice, which delivers over 6,000 exams per year, has found cross-training to be an effective way of ensuring consistent care.

In addition to consistency of care, cross-training also has allowed us to provide staff with opportunities to grow in our practice. Sometimes we find a staff member has a great desire to learn something new, and occasionally, we may find a staff member has a strength that we didn’t realize until they performed another task in our office.

The staff of Miamisburg Vision Care delivers consistent care to patients, thanks to cross-training. Each is trained in a primary task and at least one secondary task. There is no disruption to patient service and flow when a staff member is out sick or on vacation

Along with the benefits to our patients, cross-training helps us keep our staff happy, as they feel more valuable, and experience joy when they find something new they can become an expert in.

IDENTIFY WHERE CROSS-TRAINING IS NEEDED

In deciding what tasks to cross train, we first reviewed the areas where we already had challenges throughout our day, but also looked at situations in which the variables can’t be controlled, such as when patients come in late causing a bottleneck in pre-testing.

In those situations, having an additional staff member who can step in and do pre-testing is beneficial. Or having another employee who can pinch hit in the optical when the opticians are backlogged can mean the difference between making and missing a sale.

As another example, it would be great to have everyone trained in all areas, but working with the billing, and reconciling an EOP, is not critical to patient care. So, be sure to prioritize in cross-training areas that most impact patient care, or those that patients perceive to be something that should not include significant waiting, like scheduling an exam or picking up contact lenses.

It is important to continually expose your staff to the secondary tasks you would like them to perform, so the skills stay fresh in their minds.

Our personnel manager is responsible for setting the schedule to ensure each staff member is placed in both their primary and secondary tasks throughout the upcoming week. We always have in place a back-up for key tasks in case an employee is absent. After the daily schedule for primary roles is determined for the upcoming week, we then decide who the back-up employee will be for each of the key roles in the office for each day. It’s like having an under-study at all times for each essential role in the office.

SET EMPLOYEE EXPECTATIONS

It can be challenging when an employee finds their primary task is not what they want to do, and they would rather perform their newly learned task. We prevent this from happening by having a clear conversation with the staff member to set expectations and the purpose for learning the new task.

For instance, we told an employee, who was a scribe and pre-tester, that we needed her to learn contact lenses since one of our contact lens technicians was going on maternity leave. We clearly indicated that she would be working as a scribe, and that was her primary role, but we also were having her learn contacts to ensure we could maintain consistency in patient care for contacts. The other thing we did was to provide scheduling to allow her to work in both roles once the contact lens technician came back from maternity. She was thrilled to be able to work in both roles, and this allowed our practice to maintain the excellent care without the patient suffering or waiting because we couldn’t handle their needs.

TRAIN IN PRIMARY & SECONDARY TASKS

The importance of cross-training is it ensures there is no change in the care you provide every patient, regardless of who is sick or on vacation.

Staff should always have, at a minimum, a primary task with a secondary task, and possibly other tasks they learn well enough to perform when necessary. What If only one person can take retinal photos, or run ancillary tests, such as a visual field? At the worst moment when a field is needed for patient care, you can be stuck making the patient wait while performing the task yourself. Or what if somebody decides they want to try contact lenses, and needs training, but your primary trainer is gone? It is much better to be able to help the patient right then versus having them come back. This works for all areas, like dispensing glasses or contacts, scheduling patients, or patient pre-testing.

CARVE OUT TIME FOR CROSS-TRAINING

The time needed for cross-training varies, but can be done in many ways. A big thing I do in my office is include training during our weekly meetings. This generally means we break up into groups and the person who has the best knowledge of a primary task will teach someone the task as their secondary responsibility.

We also make sure that whenever an employee is not needed for their primary task, they shadow the employee doing their secondary task. For example, an employee who normally performs contact lens training may follow the visual field tester if there are no fits being done at that time.

There also is continued training during the course of a typical day by the personnel manager in my office, on-the-job, as the need arises.

 

DR. DAVE ANDERSON, OD

Partner Miamisburg Vision Care, Miamisburg, Ohio

Dave Anderson, OD, is a partner withMiamisburg Vision Care in Miamisburg, Ohio. To contact: doca@burgvision.com

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