Seven Expert Tips to Getting the Best Lease

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

Negotiating a lease is not something that you’ll do very often. Prepare for the discussion and take heed of the following seven tips for success:

Initially offer about 20% less than asking net rents
Know that net rent is the negotiable portion of the deal. The additional rent or taxes, maintenance and insurance (TMI) are actual costs that are passed directly to the tenants and are not negotiable.
If you are a new practice go for a shorter initial term, such as three or five years, with a couple of five year renewal options. This provides an escape if things don’t work out.
If you are an established practice or very confident of success, a longer initial term (ten years) will enable you to fix the rents for a longer time and get a tenant improvement allowance (TI) from the landlord.
Go for as much free rent as possible….try to get three months totally rent free (no net rent or TMI) for your practice buildout, plus three more months net rent free to get established up and running.
Make sure your lease is assignable so you have the option of selling your practice in that location.
Insist on an exclusivity for all optometric, optical and ophthalmic activities.

THOMAS A. BOLLUM

Tom Bollum is a former retail optical executive and now a commercial real estate broker with Avison Young. He has sourced and negotiated locations for many optical stores across Canada.

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Six Steps to Achieve and Maintain a High Per-Patient Revenue

Finance|Wealth, Practice Metrics & Benchmarks, Resources

SYNOPSIS

High per-patient revenues are the core of practice profitability. Six steps get you there.

ACTION POINTS

CALCULATE PER-PATIENT REVENUE.Divide receipts by number of refractions.

PRESCRIBE FROM EXAM CHAIR. In your exam, recommend lens treatments and explain lifestyle benefits.

EDUCATE STAFF ON PRODUCTS. Have lens and contact lens vendors present to staff on how products provide solutions to patient visual challenges and eye comfort.

Our practice consistently achieves a high per-patient revenue (PPR) of $400 to $410 every year. Six steps keep our PPR high.

The optical dispensary in Dr. Click’s office makes eye wear very accessible to patients.

CALCULATE PPR

We use a very simple formula to track our PPR daily. Total receipts divided by number of refractions = PPR. I understand that this is a big picture number and that it does not separate out the medical visits or contact lens follow-ups from the routine eye exams.

DOCTOR PRESCRIBES FROM EXAM CHAIR

My staff of three and I practice chair-side doctor recommendations. I always recommend AR and Transitions to everyone. AR is standard on all lenses and is only not on lenses unless the patient specifically states they don’t want it and understand how they will be negatively impacted. When the lenses are presented to the patient we name all of the lens benefits without naming the brands.

We educate the patient how each benefit will directly impact their lifestyle issue or complaint. We also let them know the amount of savings they will have by using their vision benefits. If a patient decides they don’t want a specific item then we tell them what feature they are giving up. Most of the time patients decide not to downgrade their lenses once they understand what it means to their daily life. But sometimes they do and we try to make sure they truly understand everything, and aren’t making their decision based on misconceptions.

TALK PPR IN STAFF MEETINGS

We talk about the PPR at our weekly business meetings. I always believe the entire staff should know what all the goals are and how we are tracking because each staff member directly impacts the total patient visit. In our staff meetings, we teach the front desk to set the stage with a friendly, positive attitude. When the patient perceives that it is a warm, friendly and professional office, the patient is more likely to purchase glasses and/or contact lenses from us. I think the more knowledgeable each staff member is about their role, the more competent we are, and thus, the higher our perception of value.

PROVIDE NEEDED STAFF EDUCATION ON PRODUCTS

Everyone is encouraged and supported to obtain as much CE or courses as they can. The insurance specialist attends webinars and seminars about insurance updates. The optician and technician attend classes to keep their certification up to date. We also have vendors come in at least once a quarter to educate us. We recently had a Nike sunglasses seminar and we have a scheduled Transitions meeting in a few weeks. I have the entire team attend a portion of the meeting so that they know that we offer the product and know who to refer to within the team for more information if needed. My goal is to make sure that every team member knows what we are capable of doing for our patients even if they won’t be a part of the resolution.

HAVE VENDORS HELP STAFF PRESENT NEEDS-BASED SOLUTIONS

All the vendors are great in helping the practice improve PPR. Essilor is excellent at staff and doctor training for needs-based solutions. Needs-based solutions are where the entire team is recommending products that fit the patient’s needs. It involves everyone being more involved with the patient by asking detailed questions that lead to conversations about what people do for work, fun and hobbies. Every team member who works with a patient is encouraged to have three questions that they ask the patient to facilitate conversations.

Contact lens vendors are great in strategizing ways to increase annual supply sales, and our frame vendors help with frame board management so we can make sure we have fashionable and good quality frames. Our frames have a built-in two-year warranty, which increases the value of the frame because patients know they are covered if something unforeseen happens.

KNOW & ADDRESS COMMON CULPRITS BEHIND LOW PPR

I have found two main reasons for us having a lower PPR than expected some days. The first occurs when see a lot of patients who do not have a prescription need. We try very hard to educate all parents on the importance of children’s eye exams and we do see a lot of kids annually who don’t have a prescription need.

Fortunately, patients who have not had a prescription change still often purchase new eyewear because we reference our vision treatment plan from the previous year and base our recommendations on the part of the plan that wasn’t filled.

The second situation in which we see a lower PPR is when the practice is under-staffed. It is very important to have a well trained team as we have seen it negatively impact our bottom line.

RESOURCE ON INVENTORY MANAGEMENT

A detailed discussion of managing eyewear inventory is found in Key Metrics: Assessing Optometric Practice Performance, from the Management & Business Academy, sponsored by Essilor. For specifics on stocking inventory, see “Frames Inventory and Turnover” on page 28 and “Soft Lens Inventory by Practice Size” on page 37. –ROB editors

MAINTAIN ADEQUATE STOCK OF KEY INVENTORY

The effort to increase per-patient revenue starts in the exam room with the doctor and is then reinforced in the optical. But you have to have a good selection of merchandise inventory. It is disappointing when a patient is excited to buy and then decides not to when you don’t have the frame look they want.

Our goal is to have a 3x turnover per year per frame. So, a smaller practice like mine has about 400 frames in inventory as our goal of refractions is 1,200 this year. In contact lens inventory, we stock 100 one-day boxes: 50 from two individual vendors. In contact lens trials, due to space, we have trials of the lenses that we prescribe the most. If someone wants or needs a different brand, we order in the trials as needed. The trial sets are big and different sizes; we don’t have the room to have all the fit sets available, but we make sure that we can always give patients something at the date of their exam.

RACHAEL CLICK, OD

Rachael Click, OD, is the owner of Preferred EyeCare Center in Mount Pleasant, SC. To contact her: drclick@preferredeyecarecenter.com.

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Increase Profits by Adding Staff: Tips on Timing & Recruitment

Human Resources, Managing Others, Talent Acquisition

SYNOPSIS

Adding employees can boost overall profitability–when the timing is right and the selection process is efficient. Learn key steps to hire well.

ACTION POINTS

DETERMINE HIRING NEED. When your staff is overloaded, look at the financials to see if the numbers justify including another staff member. Employee expenses should be around 20 percent of gross revenue.

GET INPUT FROM EXITING STAFF. Ask the staff member to write a description of what they do and make notes for the new team member. Discuss good applicants with them to get their opinion.

NARROW DOWN APPLICANTS. If you have 100 or more applicants apply, call about 20 of those for a phone interview. Have about five in for in-person interviews with the office manager.

My practice prides itself on the high level of customer service that we deliver to patients. That service begins with recruiting the right employees to serve patients. Over the years we have developed a system to decide when new employees are needed, and then to find and hire the people we feel are best matched with our practice mission and patient needs.

Our practice has grown over the past 16 years to over $2 million in gross annual revenues, 11 full-time employees, one full-time OD and two part-time ODs. We have tried to stay ahead of, and encourage, growth by hiring customer service-oriented personnel when opportunity warranted it, and the financial metrics indicated it was the right move.

Our office manager is in charge of our hiring process. She approaches me when she feels there is a need for a new staff member and we discuss the situation. If the numbers confirm the need for a new hire, she begins the process, keeping me updated, and consulting with staff members who will be helpful in the decision.

Staff photos and certifications in the hallway near the practice’s pre-testing room. Dr. Cass says it is important to carefully screen applicants, by e-mail first, then by phone, and then up to two times in person. His office manager, and sometimes the out-going employee, are involved in the hiring process, in addition to himself.

DETERMINE THE NEED TO HIRE

Our practice focuses heavily on customer service, so when we find that our staff is overloaded we begin to look at the financials to see if the numbers justify including another staff member. One of the first numbers that we look at is employee expense.

Employee expenses should be around 20 percent of gross revenue. While not a hard number, it can serve as a guide–anything lower may indicate that our staff is stretched too thin, and anything higher may indicate inefficiency.

Staff are usually quick to tell the practice manager, or owner, when they think additional staff are warranted. When this occurs in our office, it would be discussed at our monthly staff meeting and we would look at the numbers with the staff to see if an additional employee was justified.

I always point out to staff that if we hire an additional staff member, we expect revenues to go up, and therefore, would increase monthly collection goals. Since we bonus our staff on monthly collections, they are less likely to make an unnecessary recommendation for additional staff.

We also look at gross revenue per staff hour. Management & Business Academy statistics list the median revenue per staff hour at $83. Anything above $100/staff hour could indicate the staff is stretch thin, and anything below $70 could indicate inefficiency. Additionally, a rule of thumb is four staff per full-time equivalent OD. These numbers are just guides, though, and practices like ours, that focus on customer service, are not afraid to be slightly over-staffed.

PROTECT YOUR PRACTICE: KNOW WHAT NOT TO ASK

Languages spoken. In general this question should be avoided unless the need to communicate in a given language is essential, but even in that case, be careful not to imply that it is a requirement.

Age. The Age Discrimination in Employment Act technically applies only to employers with greater than 20 employees. Despite this restriction, regardless of staff size, it is a very bad decision to ask an applicant’s age, or make any hiring decision based on the stated or perceived age of the applicant.

Medical history. There is no universal prohibition on obtaining such information, but the Genetic Information Non-Discrimination Act of 2008 specifically prohibits any employment decision based on any information obtained regarding applicants genetic data, medical or family medical history. Obtaining medical information only sets up an employer to explain hiring decisions they would likely wish to avoid having to explain.

Criminal arrest and conviction records. This is a growing area of discrimination retaliation, and should be approached with caution. The Equal Employment Opportunity Commission has challenged the use of background checks, and is encouraging a “Ban the Box” movement, eliminating any potential investigation into an applicant’s records. Unless a mandate of state law, arrest record checks are a bad idea, and criminal checks should be conducted only if allowed by state law, and then only if truly necessary.

Credit checks. This should be avoided unless the position the applicant is interviewing for would require such scrutiny. The Federal Fair Credit Reporting Act does not prohibit obtaining credit checks on job applicants, but it does establish that an employer has liability if conducting a credit check in any way could, or does, adversely affect the applicant’s credit status. Some states have specific laws related to credit checks.

Aptitude tests. While not illegal, or even a bad idea, you need to be careful you are not imposing a discriminatory situation based on the construction of the test. Basic math, spelling or general information tests are all fine as long as they do not pose an advantage to one applicant over another.

Drug testing. Legality and application of drug testing for job applicants is almost exclusively regulated by State law. In the absence of State-specific law, employers should be careful in the application of drug testing for applicants. In most cases, it would be advisable to mandate drug testing only after a job offer is made with that offer contingent on a negative drug test outcome.

CREATE & IMPLEMENT A SYSTEM TO HIRE PERSON YOU NEED

When a new staff member is needed, we follow a step-by-step approach for searching and hiring. Having a system in place is essential, as the average job listing brings 250 resumes, with each requiring five minutes to sort through, according to Local Eye Site’sreport, The Real Cost of Unqualified Applicants. That totals 20+ hours of work basically to sort out the unqualified.

POST OPPORTUNITY. We use a local site called www.southeasttexas.com. A single ad is free, premium ads, or multiple ads, are available for a small fee. We give a clear description of the job, and ask for applicants to e-mail a resume to our office. We also ask existing staff members to encourage people they think would be a good fit for the practice to apply.

SUBMIT BY E-MAIL. All the resumes submitted by e-mail are reviewed by my office manager, while any resumes submitted by fax or mail are shredded. The ability to follow instructions and use a computer are job requirements.

CALL FINALISTS. Applicants with resumes that show promise are called for a phone interview. We typically call about 20 percent of the applicants who properly submit a resume.

NARROW FIELD. Applicants who do well on the phone interview are invited to the office for an in-person interview with our office manager.

MEET IN PERSON. Applicants who do well in the in-person interview are invited back for an interview with myself and the office manager.

BREAK A TIE. In the case of a tough decision, we might ask two applicants to come and work with us for one day and be paid for that one day. We let them know that it is also an opportunity for them to see if they would really like working in our office.

INVOLVE EXISTING STAFF IN RECRUITMENT

If an existing position is vacated under good circumstances (moving, taking another position elsewhere, wanting to be at home with children), we try to include the out-going employee in the process. We ask the staff member to write a description of what they do and make notes for the new team member. We would also discuss good applicants with them to get their opinion.

Having the out-going staff member sit in on the interview can be a good idea, however, it is generally not advisable to have the applicant “interview” with other members without the office manager present. The applicant can be introduced to the staff member as part of the interview process, but an applicant should not be left alone with a staff member who is not trained in what may or may not be appropriate to discuss with the applicant.

NARROW DOWN APPLICANTS

We often have 100, or more, applicants apply. We would typically call about 20 of those for a phone interview. We would usually have about five in for an in-person interview with my office manager.

We usually ask about salary requirements in the initial phone call. We confirm the amount needed at the in-person interview. We try to be very competitive with pay. We want to pay more than our competition, so that we get the best candidates. We also let potential applicants know that we have many perks and offer a bonus system which can typically boost income by the equivalent of almost $2/hour, or more, in a good month.

I think it is very important for the office manager to like an employee and take ownership of the decision to hire the employee. If a doctor makes a bad hire, it creates tension between the office manager and doctor, and it can be more awkward for the manager to approach the doctor about the mistake. However, if a manager makes a bad hire (which happens with even great office managers), the doctor can easily forgive the manager and move on in the hiring process.

I usually share my opinion with the office manager and let her know what I like at each step of the process. I review the resumes she picks, I talk to her about her notes from phone calls, and her notes from interviews, and give her my honest opinion on the in-person interview I am involved in. I stop just short of telling her who to hire. That was even true even when a friend of a friend applied for a job. The applicant made it all the way through the process, and it was down to the final two, before my office manager asked my opinion. She was hired, and has been a great employee.

Research from the Management and Business Academy, showing staffing levels according to practice size. Dr. Cass says he would always rather be slightly over-staffed than under-staffed, as having slightly too much staff gears the practice toward growth and ensures topnotch patient service.

CHOOSE DISCUSSION TOPICS FOR INTERVIEWS

Recommended discussion topics during the interview include describing the business to the applicant and the general aspects of the job they are considering, asking them about their past job experiences, asking them to describe their strengths and weaknesses as an employee and asking them to describe how they would handle particular job situations or challenges.

The goal of the interview is to get the applicant to talk, not to talk to the applicant.

The applicant interview process is a time to get to know the employee as a person and potential member of your team. We look strongly at communication skills, how the applicant carries themselves, their attitude and professionalism.

NARROW DOWN TO FINALISTS

We usually do two in-person interviews, which are an important part of our process. We ask for references, but don’t always call them since most applicants will choose people who will say great things about them. We are more concerned with past work experience, and would prefer to call a previous employer.

Obtaining references is a standard practice in the hiring process, but no applicant in their right mind would ever provide a reference who would not provide a stellar recommendation for the applicant.

We want to know from past employers if the employee was dependable, friendly, and got along well with other staff. When talking to a prior employer, simply asking if the applicant would be eligible for re-hire at their business is often the most telling piece of information.

RECRUITMENT RESOURCE: QUESTIONS FOR APPLICANTS

CLICK HERE to download a complimentary PDF with questions to ask applicants for employment in your practice.

HIRE FOR PERSONALITY & TRAIN FOR SKILL

Skills and experience can be a plus, but personality, and how they would fit with our team, count for much more. We can train someone to do most of the tasks in our office, and in fact, we often prefer to train them rather than work to correct habits or processes that don’t work for us.

We require all of our staff to be certified through AOA, ABO or JCAHPO. Employees not certified are not eligible for bonuses, so we provide full support for certification. We have training materials in the office, we will work with and tutor employees, and will pay for the first attempt at the certification exam. We also constantly train, partnering with vendors to provide training in our monthly meetings and taking staff to education meetings (in fact, we just took three staff to Vision Expo West 2016).

MAKE THE OFFER

My office manager calls to make the job offer. These are very pleasant phone calls usually, as the applicants who have made it through our process are sure they want to be employed by us, and therefore, happy to hear they have been chosen. We let the employee know that employment is probationary for the first 90 days, and that permanent employment will be offered after successfully completing 90 days.

PETER J. CASS, OD

is the owner of Beaumont Family Eye Care in Beaumont, Texas, and president of the Texas Optometric Association. To contact: pcassod@gmail.com

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The Growing Ransomware Threat: What If Your Data is Held Hostage?

Practice, Technology

Editors’ Note:
Ransomware targeted to health professionals has been reported in the consumer media of late. Here are two first-hand accounts of optometric practices, one in Canada and the other in the USA, of their ransomware experience and advice.

Ted McElroy, OD, was shocked to find his practice cyber-attacked by ransomware that encrypted all of his business files and patient data, essentially freezing his practice. After exploring his options, he paid a $3,000 ransom to the hijackers to get back in business. On investigation, he corrected weaknesses in his backup system, and he devised a defensive plan should an attack happen again. Data hijacking is part of a growing trend, as cyber criminals target medical practices and health care systems as easy prey and willing payers. How prepared are you to defend against cyber criminals?

Defensive Plan: Continually monitor your backup to be sure it’s working and archived offline. If attacked, be prepared to wipe clean your entire computer system and re-install it. Negotiate with hijackers to send you the key to open your data, not for their price, but for what it costs you for your IT personnel to re-install. Estimate: three hours or $300.

Patient Privacy Concern: Are you sure your patient data has not been breached? You may be required to inform all patients of a potential breach of their patient data and payment method.

BACK UP FILES. Back up your files both on external hard drives (around $100 a piece at an office supply store) and also back it up in the cloud using a service like Carbonite, or one its competitors. The cost of backing up your data online depends on the amount of data you have to back up. In the case of Dr. McElroy’s practice, it costs just $89 a month to back up online, “in the cloud.”

GET WHOLLY IN-THE-CLOUD: Choose an electronic health records and practice management system that resides wholly in the cloud. EHR/practice management systems that reside entirely online, in the cloud, guarantee the security of your data as part of your contract with them, and if the information is encrypted by a hacker, they are the ones who are responsible for paying the fee to unlock it, and if the information is breached and exposed, they are responsible for paying damages to your practice to cover related expenses and the potential loss of patients.

DON’T LOAD NEW SOFTWARE FROM E-MAIL: When loading a new piece of software onto your server, first load it onto a zip drive. Then, do a virus scan to make sure no viruses are present, and only then load onto your server.

We Are Not Immune!

By Perry Amos, OD, OAKVILLE OPTOMETRY

In the summer of 2016 my office received an e-mail that wanted me to pay a ransom fee and if I didn’t pay a sum of money something bad would happen to my office computers or their data. Everyday, for the next several days the one computer that opened the original e-mail would get a pop-up message reminding me that I had to pay or else!

I would just close the pop-up and continue with my day. Shortly there after, I tried to review a patient’s visual fields and I could not open the file. In fact, I could not open any of the hundreds of visual fields that I have stored on the server. They were all encrypted. With a bit of research, I determined that any folder opened became encrypted and that folder could never to be opened again. I was able to work for the day as the EMR did not seem to be affected and the IT person we hire was able to rid the computer and the server of the ransomeware and thankfully for backups we were able to re-populate the visual fields data.

What I learned from this experience was that I should have taken the ransomware threat more seriously and called the IT fellow in the first place. It cost me more in time and worry than it did in dollars and it likely all could have all been avoided if I was more aware of ransomeware.

FURTHER READING: Learn more about ransomware–and how health care providers are being targeted:

Ransomware on the rise in Canada: How to protect your data

Has Health Care Hacking Become an Epidemic?

Why Hackers Are Going After Health-Care Providers

Healthcare is a Win-Win Target for Hackers

TED MCELROY, OD,

Ted is the owner of Vision Source Tifton in Tifton, Ga, and the president of SECO

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Insight with Dr. John Mastronardi

Insights

John is a partner in a 2 location, multi-doctor practice in Windsor, ON.

Currently he sits on the board of directors of FYIdoctors

and is the past president of the Ontario Association of Optometrists.

Learn his thoughts on the patient experience, hiring on personality and his favorite flavor of ice cream!

Dr. John Mastronardi

Doctor of Optometry

Windsor Eye Care Centre

University of Waterloo 1996

Windsor, ON

Why did you choose your field?

I always had an interest in science and math as a student. I had the opportunity in grade 12 to participate in a co-op position at a laboratory at H.J. Heinz. At the end of the year, my supervisor there said that I did a great job but she couldn’t see me working on the pH and colourimetrics of baby food the rest of my life. She said, “I could see you being an optometrist” and the rest is history. I am forever grateful to her and think it’s important to give back by mentoring whenever the opportunity presents itself.

What is something you have done in your practice to help set you apart?

We have tried to create an environment and experience that really gives our patients no reason to leave and every reason to refer their friends and family. That process started a decade ago by merging a few smaller clinics into a larger, fairly central location with easy access and parking. While you can never be everything to everyone, we forged a plan to address the most commonly sought after desires of our patients over the years: knowledgeable and empathetic doctors, a clean, state-of-the-art, welcoming environment that is a coalescence of healthcare and retail, a large selection (in style, brands and value) of ophthalmic and sunwear, and a support team dedicated to delivering unparalleled patient care and fashion advice. They were lofty goals but the ongoing positive feedback from our patients reaffirms that we didn’t do a bad job. Paying meticulous attention to every detail of the patient experience is something that set us apart years ago and something that we continue to dedicate ourselves towards under our new banner of FYidoctors.

How do you hire new staff? What is the process and who does the hiring

While staffing and HR will often be listed as the single biggest challenge to running a practice, finding the right candidates is absolutely the key to success of a building a great practice; I would say it is equally or more important than having very good optometrists.
Our office manager does the hiring for both of our locations. He will initially cast a net for new candidates by placing ads online (workable, kijiji, facebook), checking with industry contacts and reps, or actively soliciting “stars” based on comments from our patients that buy their eyewear elsewhere in town. He will sift through the resumes looking primarily for backgrounds in customer service excellence, hospitality and/or the fashion industry. Personality trumps previous ophthalmic experience every time!
Candidates will be invited in for an interview where we will have a minimum of two to three team members present to ensure we get different perspectives. Candidates will also be asked to answer a 20-30 minute multiple choice test on Talentsorter.com to determine if there is a fit with their personality, drive and other factors. From there, we decide quickly and don’t give a great candidate a chance to take another offer!

What’s your favourite past time/hobby?

Travelling the world with my family would be my favourite thing to do when outside of the office. Whether it’s a five day raft trip down Desolation Canyon off the grid, a river safari in Botswana, or a 4 generation family supper on a remote countryside in Molise, Italy, family time exploring off the beaten path is just utopia for me. Some will say our three children are spoiled because of this; I will argue that I’m the spoiled one with priceless memories that we share. Next up in 2017… gorilla trekking in Rwanda.

What is your favourite TV show?

I will agree with our colleague Wes McCann here – Schitt’s Creek. It’s the only show you need to watch for a great laugh.

What was your last indulgence?

This morning at work….. Ben and Jerry’s The Tonight Dough ice cream. It is stocked in our freezer at the office at all times and serves as the perfect filler when I have a no-show in the schedule.

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When to Fire a Patient – and How

Practice, Resources, The Patient Journey

What do you do when a patient causes your practice distress and disruption, and can’t be satisfied by reasonable solutions? Maybe you should fire them.

Exceeding a patient’s expectations with every visit is our practice goal. We nearly always succeed in meeting that goal. But once in a while a patient can’t be satisfied, and causes such a disruption that we take the most drastic step: We “fire” them.

There will always be patients who are not happy. They typically have been to numerous offices, and not one office has met their needs. We train staff and doctors to be prepared to be “doormats” in the service industry. We stand up to verbal or sexual assault, and defamation of character, but do give patients the benefit of the doubt and apologize many times when it is most likely not our fault.

Our staff does a good job knowing when to come find the doctors to determine if further action with the patient is necessary. We can’t stop patients from posting bad or negative reviews online, but we can be polite and courteous in difficult moments. Surprisingly, many people just want to be heard. We have never gotten a negative review that I know of after firing a patient. Always fire in love. A book that has been a helpful guide for us in handling challenging patients is “Love Works” by Joel Manby.

We should let go of more patients than we already do. We probably fire 1-2 patients a year, and there are times when we would be justified in firing the patient, but choose not to. We see ourselves as people who are not perfect, and believe that a bad interaction with a patient often results from a difficulty in that patient’s life, and we are just receiving the side effects of their bad marriage or financial problems. Grace is extended a lot in our office.

>>Click HERE to download three key situations when you might fire a patient>>

Set Protocol for Potential Patient Firings
The owners have the final call on firing a patient, as any legal ramifications from letting a patient go will fall on the shoulders of the owners. We ask our staff to communicate the story to myself, or my partner, and we will discern actions to take. Our managers and doctors know when they should alert us from examples we have given them of the types of situations in which a patient should potentially be fired.

Managers will initially interact with the patient, so that all avenues of pursuing harmony are taken, but if that doesn’t work, they present the story to my partner or I for next steps. We usually obtain a history on the patient from the doctor in our office caring for them, and will find out if the patient is in a tough place in life. Sometimes special circumstances result in us extending grace when otherwise we would not.

Knowing When to “Fire” a Patient
We once had a mother who kept returning her son’s glasses complaining of “manufacturer defect” when the damage was clearly the effect of the son not caring for the glasses. We completely understood and empathized the first time, and communicated to the mother that we can warranty the glasses, but future pairs might not be as easy to exchange since the damage did not appear to be the result of a manufacturer defect.

The first time the mother came in with the broken glasses we went out of our way to provide a replacement, but we educated the mother that we might not be able to replace it again. This mother returned multiple times with all kinds of stories, and when staff said they could not warranty the damaged glasses, she insisted on seeing the doctor. Once she visited with me, she said my staff was mean and not cooperative with her (I knew the whole time my staff went out of the way to help her because I was a part of the process of helping them make decisions on how to handle the situation).

During my conversation with her I decided she was not a good fit for our office, and told her this. I told her that if she would like a referral I would be happy to give it to her. We cordially parted ways. I followed up with a letter thanking her for her previous business with us, and apologizing that we could not meet her expected needs. I referenced a couple of other reputable ECPs she could visit nearby, and then offered to send her records wherever she would like them.

We do not communicate to another OD or OMD that the patient was difficult at our office because I don’t assume that the patient going to the next office will have the same problems. There are so many variables to not being a good fit between a patient and office. I usually let the patients pick which doctor they would like to transition to, and in my letter to them, I recommend other good ECP offices in town.

Protect Your Staff from Harassment
A staff member once came to me and told me patient John was showing her inappropriate pictures in the optical on his phone. I listened to the story and told the staff member that John’s behavior was unacceptable, and that I would visit with the patient.

The patient came in a month later and I took five minutes to tell John: “One of my staff members approached me saying that you received some pictures on your phone that you thought would be good to share with her, and the pictures made her uncomfortable.” I listened to his reasoning, then said, “I understand that we all have the freedom to do what we would like. At this office we value and respect women, and to show pictures like you are talking about is not acceptable here. This first time I thought it would be best to acknowledge how we feel, John, because I really enjoy taking care of your eyes and seeing you on a regular basis to manage your glaucoma. If this should happen again, I would have to ask you to see another doctor outside of our office, and I don’t want that to happen. Does that make sense?”

He received it well and we haven’t had issues following our conversation. Setting difficult situations up to potentially have consequences requires visionary thinking to map out in your mind what could happen. This directs you to communicate to patients what the outcome of certain behaviors will be. Make sure they understand that you don’t want to have to let them go as patients because you, the doctor, value your relationship with the patient.

The main legal concern we have is abandoning a patient who is under chronic medical eyecare. In these situations we will make the referral and schedule the patient to see the new doctor. We will continue to manage the patient until they have been seen by the new doctor. Otherwise, the letter will state when a patient’s next recommended exam is and how they can access all of their records.

Editor’s note: If you permit harassment of staff to continue to occur after you have been made aware of the situation, then you can be legally liable for creating an environment of harassment.

Prepare for the Patient Who Doesn’t Take it Well
In occasional situations you may have to escort individuals off the premises due to combative or abusive verbal behavior. In situations explained in this article, it is never a bad idea to seek the advice of a professional, whether that be an attorney, or consulting with the local police. Hopefully it never comes to that, but as the owner of your practice, always be prepared.

CHAD FLEMING, OD, FAAO,

Chad Fleming, OD, FAAO, is a partner with Wichita Optometry, P. A. in Wichita, Kan. To contact: optometryceo@gmail.com

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4 Ways To Create Community and Beat Online Sales

Differentiation | Business Strategy, Marketing, Practice, Resources

Jean Rickli, at the #AliveSummit Podium in Vancouver.

Jean Rickli from JC Williams, a retail consultant group with offices in Toronto and Montreal, spoke to attendees of the Essilor Canada Alive Summit in Vancouver in March 2017. Rickli’s seminar focused on the importance of creating community around your optical practice. Shoppers today – especially Millennials – are seeking an experience when they shop. While brick-and-mortar shops may not be able to beat online prices, Rickli says nothing replaces the experience of going out to shop.

Here are some of the Alive Summit and Rickli’s suggestions on how your clinic can compete with online shops:

1. Be Unique

Offer specialty services that aren’t available to customers online. For example, La Fabrique de Lunettes, in France, offers the exclusive service of frame rentals. How would it affect your sales if you could counter every, “I wouldn’t wear that frame everyday.” with, “you can rent this fabulous pair of sunglasses for that trip to Vegas!” Not into rentals? Stocking vintage frames creates a quick and easy way to set your practice apart.

Freshly backed Cookies from MayFair Optometry.

Find a way to offer more in store by creating a new shopping environment. Frank and Oak started off only selling clothing. Today, some Frank and Oak stores offer coffee and even hair styling services to their customers! Mayfair Optometric Clinic, in Victoria, BC, installed a cookie oven in their lab so they can bake cookies for their customers every Saturday. Office manager, Mary Lou Newbold says customers love coming into their clinic to the smell of freshly baked cookies. It also entices the customers to stay a little longer and enjoy a warm cookie!

Some optical offices dispense their glasses with artisan chocolates, or even sit down and share a beer or glass of wine with their customers. If you’d rather not involve food, gift wrap up those complimentary sprays, cleaning cloths, and cases so customers feel like they’re receiving a present from you. If you make your customer’s experience memorable they’ll be more likely to return and share their experience with others.

2. Show Your Expertise

Whole Foods built a greenhouse on top of one of their stores to demonstrate that they not only sell food — they grow it too! Take a cue from this idea and do adjustments in plain sight to highlight your expertise in optics. If you’re designing or redesigning your store, consider having the lab clearly in view behind a window. Customers love behind the scenes peeks. Your clients will be delighted to see lenses edged on site and how you make each pair of eyeglasses specially to order.

3. Share the Love

Does your office contribute to the community? Sponsor an event or team? How do you share your involvement? Many offices do good deeds around the community, but forget to share this to their customers. Frame pictures of your team helping out with a cause, or exhibit contribution awards your clinic has received. By displaying your office gives back, you’ll demonstrate that a purchase at your office also helps the community.

Environmental impact is important to consumers. Showcase brands that have low environmental impact and reuse production materials or recycled items. What about your office’s environmental impact? Are you a paperless office? Proudly proclaim your environmental commitment on your website or other materials.

4. If You Can’t Beat Them, Join Them

If you can’t compete with online shopping — join them, but with a different angle. If you have extra storage space, you can provide the convenience of online shopping for your customers by adding the Penguin Pick Up service to your store. With Penguin Pick Up, customers can direct their online purchases to be delivered to your store.

Penguin Pick Up is available in many Canadian Locations

They no longer have to wait at home for a delivery, or risk missing it while they’re out. The customer is notified by Penguin Pick Up that their package is ready at your store, which they can collect when it’s convenient for them. Aside from providing convenience to your customers, this service may help introduce new people to your location and encourages traffic to your store.

Rickli acknowledges that online options have made optical shopping more competitive, but, there is a silver lining. Take the online shopping industry shift as an opportunity to reach out to your customers. If your patients are buying online, ask them: Why? You may assume price is the only reason to shop online, but your customer might have a different reason.

Perhaps your clinic could work on speeding up delivery of services, or change up your frames stock. Don’t be afraid to ask the tough questions and have a hard look at your clinic. Online comparison may seem like a hardship, but it might be the motivation your clinic needs to hone your strengths and grow your store into an extraordinary place in your community.

SARAH LETT

Sarah worked as an ECP for 12 years before co-founding Mass Velocity Media. Now she helps ECPs and other professionals achieve success through web and graphic design and development, social media, SEO, and copywriting. Her clients range from global pop superstars to non-profits.

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5 Optical Dispensary Upgrades – and the ROI from Them

Office Design & Renovation, Practice, The Patient Journey

Revamping your optical can create an environment that makes patients want to shop and make a purchase, increasing your revenues.

Last year, my four-OD practice, Wichita Optometry, undertook a revamp of our optical dispensary.

The day I joined Wichita Optometry, September 1, 2010, I thought that the office needed a facelift. The details of how that was going to happen began to evolve six years later in September of 2016. The office felt dated and dingy with golden oak and faux, sponge-painted walls. I wanted patients to walk through the door and experience a bright, cheery and modern atmosphere.

Taking on an optical remodel can seem daunting in the beginning. You need to figure out a budget, establish the look you are going for, find contractors and put in the time to see that everything gets done as you had envisioned.

The remodeled optical in Dr. Blasi’s practice. Dr. Blasi says the revamp required careful planning and budgeting, but was well worth the time and money. The practice expects strengthened optical sales, and an enhanced patient experience, as a result.

Set Your Budget
The initial budget was $40,000, and we ended up at $45,214. I feel like we have a totally new office, and it was worth every penny!

Identify Key Needed Changes
The first needed office update was new paint for the walls and trim. We have always been attentive about keeping the office clean, but somehow we had overlooked something as simple, yet powerful, as a fresh coat of paint. I went to Sherwin Williams to pick out the color scheme.

We decided on a gray color scheme and white trim and doors. This made a huge difference. We painted the whole office for $15,000. That also included scraping and repainting the popcorn ceilings.

The second thing that needed to go was all the old, clunky, yellow oak optical displays. This made the office look dated and cluttered. A great deal of time went into deciding what the new displays would look like, and who we were going to purchase the displays from. We decided on a streamlined, modern look, and picked LED-lit acrylic displays with wood-backing from Frame Displays. The LED back-lighting, along with the LED track lighting, really helps show off the frames. The acrylic boards allowed for the dispensary to be more open. The total cost for all the new displays, and LED lighting for those displays, was $15,900.

We replaced our old tile in the entry way and patient’s bathroom with luxury vinyl flooring, which is a great material because it is easy to clean, has no grout, is low noise and does not become slick when wet. Since we replaced the carpet a couple years ago, we left it. Material and labor costs were a little over $2,000 to redo the entry way and bathroom flooring.

New reception desks are expensive. After looking into different options, we decided to replace our formica with a metal-looking formica to give it an updated look. We also had a company that remodels cabinets come out and paint/glaze all the yellow oak cabinets. This turned out looking fantastic! The total cost to do all of this was $7,000.

New lighting and decorations, such as art prints for the walls, or sconces, accounted for the rest of the budget.

Find a Contractor: Solicit More than One Bid
Most of the contractors that we used we either knew from previous work they did for our offices, or were recommended to us by people we knew. This was one of the most challenging aspects of the remodel. Just because one person recommends a contractor does not mean that they are up to another person’s standards. We always had at least two contractors bid the job before we decided who we would hire.

Try to Schedule Construction for Off Days
Almost all of the work was done on the weekends, when we are closed. The benefit of this was it did not disrupt patient flow and we could keep the office open the whole time. We made sure to post signs on the doors that said “Please excuse our mess.” However, it required a significant amount of time for the practice owners at the office during the weekends for 10 weeks.

Measure to Assess Effectiveness of Renovation
Before the remodel we were able to display close to 700 frames. Currently, we display around 900 frames. This has allowed us to add more frame lines and expand our sunwear selection.

Frame turnover is the main metric we will track this year to determine whether the optical revamp paid off. We typically turnover frames 3-4 times the total number of stocked frames per year. In addition, our EHR allows breakdown of frame sales, which we will compare year-to-year.

The perception which staff and patients have of the office also is part of the payoff. Perception is reality, and when patients see you investing in an updated look, they are more likely to feel they had a better, more fun experience.

Rightly or wrongly, competency is often equated with appearance. The American way is that if you do not upgrade, and have the newest technology, or newest look, then you are outdated and “not keeping up.” That feeling of not being able to keep up then trickles down to all aspects of the office. We hope our opticians will become more energized and excited about showing off the end result of the optical revamp and our new frame lines.

I can say at the end of the process, the revamp was a lot of hard work, but the end result has been great. We have positive feedback from staff and patients, and we feel like there has been a renewed sense of excitement throughout the office.

ASHLEY BLASI, OD

is an associate with Wichita Optometry, P. A. in Wichita, Kan. To contact her: ablasi3313@gmail.com

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Put Your Vendors to Work to Build Your Practice

Practice, Products | Services | Industry News

The vendors who sell our practices products like contact lenses and frames are more than just suppliers of goods; they also are experts in important areas of our practices. A knowledgeable rep can help you find ways to be more profitable, and patient-accommodating in your optical and contact lens prescribing and sales.

The key is to ask for their help, directly and upfront.

Optometry is a service industry, and we rely on vendors to supply the materials we use to treat patients. I use eyewear vendors, contact lens vendors, equipment vendors and marketing vendors to better my two-doctor, four-employee practice, We Are Eyes, in Boca Raton, Fla.

Good vendors become business partners and advisors. They can be valuable sources of information, helping the practice and the doctor evaluate the potential benefits of new products, identify opportunities, or cut costs. They know that if my business grows, their business grows also, so they have a vested interest in helping me succeed.

There have been a lot of mergers recently in our industry, including the recently announced Essilor/Luxottica merger. Vertical integration is changing the way optometrists do business. Moving forward, I will likely start to reduce the number of vendors I use, and will focus on building closer relationships with a handful of vendors. Fewer vendors definitely saves on time. By having fewer bills to pay, accounting is much easier. Plus, ordering higher volumes from fewer vendor increases your chances of getting discounts compared to ordering small volumes from multiple vendors.

I like to work with vendors who still care about the success of small businesses and optometry as a profession, and can provide reliable, personalized service. I rely on vendors to show me the newest in technology or latest in styles. If it sparks my interest, then I need to know the price point right away. I have to know that the price point is in line with my practice, and that I can get a good return on investment.

Let Vendors Know Practice Goals & Demographics

Vendors need to know a practice’s general philosophy and target market. Just as a doctor needs to get to know the needs and goals of a patient as an individual, vendors need to know what makes each practice unique.

For example, if a practice wants to add or grow a specialty niche service, like sports vision, then frame reps may want to show sportier styles or optical lenses designed for UV protection and enhanced peripheral vision. And the practice would want to ask the vendor for marketing material, posters of athletes wearing their frames for the office and digital images that can be posted on social media.

You also should let vendors know the average price point of complete eyewear for your target market. Vendors should know what your typical patient spends on eyewear in your practice. It’s a waste of time for both the rep, and the practice, to discuss frames that are outside the budget of the average patient in your practice.

Seek Their Help in Creating Compelling Optical Displays
Knowledgeable frame reps can help you display the inventory in your optical. Many practice owners may not be experts in merchandising. Frame reps can help rearrange displays to showcase and highlight the latest designs, and tell a story with their products. Good frame reps will also educate your opticians of the features and benefits of their products, which allows for better customer service, and facilitates higher sales and profits.

For example, a frame rep can help you, or your opticians, find the best frame groupings for your displays, and may have ideas on what times of year different frame styles will sell best. They have seen what has worked in other practices, and can even show you photos from other practices of how their products have been displayed on frame boards, to spur sales.

Attend CL Vendor Educational Dinners & Request In-Office Education
When a new contact lens product is released, vendors typically have an educational dinner meeting with local doctors, who can then request a visit to their office to educate staff.

For example, I attended the educational meeting, and immediately scheduled a time for the rep to come to the office. The last thing I want is to prescribe something for a patient if my staff doesn’t know what it is and why I prescribed it.

Meet One-on-One with Vendors
A great way to establish good communication lines with vendors is to meet with them outside of the office, usually in a one-on-one lunch meeting. While you are busy with patients, it is nearly impossible to absorb other information. It’s nice when a rep is in the area and stops in to say hello or check on the practice, but it’s challenging to make any real decisions when you only have a few minutes.

A lunch meeting away from the office allows the practice owner, optician or office manager, to listen and ask questions without distraction.

Network with Vendors at Optical Conferences
Most vendors will attend conferences to display their newest products and meet with their accounts. It is a great opportunity for practice owners to network, learn and build relationships. I love going to the exhibit halls to see reps and managers, whom I don’t get to work with in person regularly.

For instance, I recently attended the Global Specialty Lens Symposium in Las Vegas, and I met a consultant with whom I’ve worked with over the phone several times. I wanted to thank her for all the help she has given me, and to get her advice on a challenging specialty fit that I have been thinking about. I also got a chance to learn about her background and previous training. This face-to-face meeting solidified my confidence in her, and I look forward to working with her again in the future.

THUY-LAN NGUYEN, OD

Thuy-Lan Nguyen, OD, teaches at Nova Southeastern University College of Optometry and works part time as an associate at We Are Eyes in Boca Raton, Fla. To contact her: TLNGUYEN@nova.edu

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6 Key Points for Purchasing Instrumentation for Profitability

Practice, Products | Services | Industry News

Purchasing instrumentation, from fundus cameras to OCTs and digital retinal imaging, isa large investment, with a potentially huge return for your practice.The right instruments allow you to provide full-scope medical eyecare for your patients, and can enhance your practice brand. Patients are sent the message that you provide cutting-edge care, creating a practice differentiator. To ensure we purchase only the right instruments for our seven-doctor, three-location practice, we use a careful process that weighs value against cost.

An OCT, along with new retinal camera software, is the most significant instrumentation purchase our practice has made over the past few years.The OCT has been extremely valuableand has paid for itself.

We also have a Tear Lab in each of our three offices that has helped our ODs tremendously with dry eye work-ups.The OCT and tear lab have each had positive ROI’s.

The page on Dr. Richter’s practice web site detailing the instrumentation used to provide full-scope medical eyecare to patients. Dr. Richter says that in addition to enhancing patient care and the practice brand, any instrument purchased must be able to deliver a return on investment in dollars and cents.

DEFINE BRAND, BUILD PRACTICE WITH INSTRUMENTATION

By purchasing new equipment annually or bi-annually, you are sending a message to your patients that your office cares about providing comprehensive eyecare. New equipment also can assist in being a practice builder, as it creates a brand that your office is reinvesting in healthcare, and that the practice is the finest in the area, offering you a competitive advantage.

The most recent example of an instrument that has enhanced care, while providing us with an advantage over competitors, is our Tear Lab, of which we have one in each of our three offices.We consider our practice as a dry eye specialty clinic.So, all of our assistants in the three clinics use this instrument to perform the tear osmolarity test on any patient who may be a dry eye suspect relative to his/her answers in the pre-testing phase of the exam.

INCORPORATE ANTICIPATED INSTRUMENTATION INTO ANNUAL BUDGET

We set annual budgets for every phase of our practice at the beginning of the year.The partners of the practice discuss equipment at that time and determine if it is best to proceed with each instrument discussed, or to wait.Most of the time, we anticipate the need well in advance of a major purchase, and line up vendors offering a good value purchase.

DESIGNATE PARTNER TO FOCUS ON INSTRUMENTATION

Initially, we had two partners and I was the designated equipment person.I continue in that position with seven ODs and three practice locations.We have a partnership designation that any capital costs over $5,000 must be brought to the administrative group–our partners, plus two other employees–for further discussion.

BRADLEY D. RICHTER, OD

Bradley D. Richter, OD, is a partner of Eye Care Center in Fridley, Maplewood and Maple Grove, Minn. To contact him: Brad.Richter@eyecarecenters.net

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