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

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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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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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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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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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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Five Tips to Effectively and Compassionately Communicate Serious Diagnoses

Practice, Resources, Specialty Practice

As more ODs embrace the medical model, we are tasked with the tough role of bearer of bad news. Advances in instrumentation increase our diagnostic reach. But we need to handle this new responsibility well, judiciously, compassionately and wisely. In addition to an ethical, and caring service issue, this is also a business issue, which can greatly affect your practice.

Any optometric physician with a medical eyecare practice knows how hard it can be–sometimes on both patient and doctor–to communicate the sad news that the patient has a sight-threatening condition. Patients are unnerved, and an OD can sometimes struggle to strike a balance between remaining compassionate and communicating the seriousness of the condition and the need for ongoing care.

I find glaucoma and macular degeneration to be the hardest diseases to tell patients they have. They are difficult diagnoses to give because they are potentially blinding, and, in the case of glaucoma, asymptomatic. Both, in the initial phases, may not be creating a noticeable threat to vision, so it is difficult for patients to accept the diagnosis and begin a treatment plan, and accept the need for more frequent eyecare.

BALANCE HONESTY & COMPASSION

I focus on the patient, turning toward them, looking into their eyes, holding their hand (if it seems necessary) and not looking at my EHR. I want to really be certain they understand the diagnosis, and I want to provide them with resources to further understand and cope with their “new normal.”

PATIENTLY EXPLAIN DIAGNOSIS AND TREATMENT PLAN

I verbally explain the treatment plan and reinforce the verbal patient education with written patient education. I ask if there are questions after I give the diagnosis, and after I discuss the treatment plan. I also invite them to contact me with any questions that arise after they go home.

For example: “Mrs. Smith, let’s take a look at your retinal photographs from this year versus last year. As you can see, there are some small dot and blot hemorrhages in the mid-periphery of the retina. This is an indication that your blood sugar control needs improvement, and, if left unchecked, diabetes and your consistently elevated blood sugar places you at risk for permanent vision loss.”

MAKE SURE THE PATIENT UNDERSTANDS

I ask the patient to repeat to me what I just told them regarding their ocular condition. I ask them if they understand the circumstances that brought about the change in their ocular health. We discuss a treatment plan (medical intervention and nutrition). I explain that we want to “use our food as medicine.”

We discuss nutrition at length, both in the form of ideal daily diets and nutraceuticals. I prescribe Macuhealth nutraceuticals to all patients with drusen and/or a positive family history with a first-degree relative with wet or dry AMD. And I prescribe Macuhealth for patients with a history of smoking.

ANTICIPATE TOUGH QUESTIONS

The most difficult question to answer is: “why did I develop this condition?” In the case of glaucoma and AMD, there is a genetic risk, and not every patient is knowledgeable about their ocular and systemic family history. I find that many patients confuse cataracts and glaucoma. When the diagnosis is dry AMD, I like to empower patients with the fact that AMD has modifiable risk factors, and if they stop smoking, exercise, and be sure to eat more foods rich in carotenoids, they can minimize their risk of significant vision loss.

Another hard question is whether the patient will be able to continue driving. Driving is a task so critical for a person’s independence, and any loss of their central acuity can rob patients of their independence for driving and for many activities of daily living. In response to that question I might say: “We are going to closely monitor your eyes and vision, and follow the treatment plan I have prescribed, and hopefully, together, we can keep you driving safely for years to come. I can’t make any promises, but we’ll try our best.”

COMMUNICATE DIAGNOSES CAREFULLY TO ELDERLY & CAREGIVERS

Generally, the caregiver prefers not to be in the exam room, and if they are, they do not offer any information regarding the patient’s medications or medical history. I prefer to communicate with adult children of the patient and the primary care physician. Recently, a 91-year-old couple called my office because their adult children live in Arizona and California. They have no family here, and they could not start their car. We need to have a person to contact in the event of an emergency. This is so important today, when many families are not living near one another.

How do you communicate serious diagnoses in your practice? What lessons have you learned over the years about doing this in a way that ensures compassionate care, while protecting your practice?

MARY E. BONAME, OD, MS, FAAO

Mary E. Boname, OD, MS, FAAO, is the owner of Montgomery Eye Care, P.A., in Skillman, NJ. To contact her: mboname@mecnj.com.

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Insight with Dr. Melanie Sherk

Insights

Melanie was honored in 2005 by being named one of the 50 most influential women in eye care.

Aside from starting one of the largest multi doctor clinics in BC, Melanie is also

one of the founding members of Eye Recommend.

Dr. Melanie Sherk

Doctor of Optometry

White Rock Optometry Clinic

University of Waterloo 1979

White Rock, BC

What metrics do you track in order to gauge your success?

I’m a big believer in benchmarking and have managed my practice since the 1980’s with metrics. Tracking full exams, new patients, contact lens exams, prescriptions filled, capture rate, frames sold and revenues of each area give me baselines from which to set goals for growth. Revenue per patient as well as net revenues for each area of the office, clinic, optical, contact lens, allows me to identify which area of the office may need more attention at any given time. Other items like redo rates and revenue per staff hour are also monitored and used to make staffing or training decisions. I have always felt that management decisions should have facts to back them up and that’s what tracking metrics gives is facts.

What business books would you recommend other ECPs read?

Reading books from other industries and applying them to your own business can be very beneficial because it gets you thinking beyond optometry and expands your thinking to more general concepts. Books on customer service, management styles, habits of successful people etc can all be of benefit in setting your path to a successful business.

What advice would you give a new grad today?

One of the things that is exciting about our profession is that we can have both the clinical as well as the retail business together. Learn to devote time to both and find the opportunities that will allow you to engage in both aspects. Develop a balance in your professional life by taking an interest in clinical learning as well as practice management learning and devoting time to both by scheduling patient care time and practice care time. Don’t devote so much to clinical time that your practice suffers from lack of attention. Maintain balance between your work life and your personal life by devoting adequate time to your family, friends and interests. You will be happier and consequently more successful.

What is your favorite food?

Salad… who am I kidding… The trifecta of chocolate, caramel and nuts.

Something few people know about me.

I loved the show Corner Gas, so for one of my birthdays my husband surprised me by taking me to Rouleau Saskatchewan to see ‘Dog River’ I thought it was awesome but no one else seems to get it.

My perfect day.

Waking up without an alarm. Spending my morning hiking in the mountains or cycling, afternoon playing cards with family and friends, evening watching reality TV like Survivor or the Voice or watching the best movie ever – Deadpool.

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Roadmap to Success: Starting Your Independent Practice

Finance|Wealth, Practice, Resources

Editor’s Note:

This article is the first in a series to explore the process of buying an optometric practice. Along the way, we will introduce you to various subject matter experts, but we also want to hear from you, based on your own experiences. Whether you are in acquisition mode, exit mode or somewhere in between and have valuable advice to share with Jane and Steven, we’d like to hear form you.

Scroll down to the end of the article to view and add your comments.

Life is all about the milestones. Whether it involves physical or emotional growth, professional or personal endeavors, each of us are defined by the achievements, decisions and experiences that have led us to the present moment. Individual milestones will always vary, but for those of us in the eye care industry, there are a few standard benchmarks we can use to help us track our career progression and personal development throughout our lifetime as specialized health professionals.

Here’s a case study to help us visualize the career path a little better: Jane and Steven Buchan are a married couple and are both licensed optometrists. They graduated together with doctor of optometry (OD) degrees back in 2012, and have spent the last 4 years working as associates for a number of different practices, making a joint gross income of $190,000 per year. They also have a total outstanding debt of $120,000 from student loans which they hope to have paid off completely within the next 5 years.

Both of them have decided that they are ready to take the next step forward in their careers by purchasing an independent eye care practice which they can co-manage as partners. They have no children or other dependents, so it’s the perfect time to take a little professional risk – especially one like this with large potential pay-offs for career advancement and profitability. After several months of scouring through neighbourhoods, ads and websites across the province, Jane and Steven find what they believe is the door to their next chapter. What do they do next? Here are five important pre-purchase activities that they need to devote themselves to before taking the plunge:

Pick Your Experts

Jane and Steven have little to no experience evaluating, purchasing and establishing an eyecare practice from the ground up. It is important for them to find experienced and well-informed professionals who can help them through the process and make sure that all the nitty gritty details are accounted for and incorporated into their business plan and decisions along the way. They will need a lawyer and an accountant, preferably with direct experience in optometric practices. The accountant should be able to help them value the target practice, help forecast current and future expenses, and build a solid yet flexible financing plan that will also help pay for a little peace of mind. The lawyer can similarly help appraise the practice, and offer an additional take on the administrative and legal obligations that come into play when purchasing such an asset. Of course, the final Purchase Agreement, is a legal document that requires a full review. They may also come across a licensed business broker representing prospective sellers. As the Buchans progress further along their pre-purchase checklist, they will look to these allies to help answer some of their toughest questions and decisions moving forward.

Plan for the Business

Jane and Steven’s goal – like every other specialist who decides to establish an independent clinic – is to develop a stable, rewarding and profitable practice. That goal, however, needs to be translated into quantifiable metrics that they will be able to monitor and adjust over the course of the next few years as they improve their business acumen, adapt to suit their clients’ needs, and satisfy their own work-life balance and earning requirements. The business plan will also touch upon many aspects of the remaining four preparatory steps, and it is best used as a detailed game plan that re-calibrates and synchronizes itself with the future successes and failures of your new business.

Do the Math

The biggest chunk of the Buchan business plan should be dedicated to crunching the numbers and figuring out how much they can invest in their business, while still meeting other financial goals and maintaining a suitable quality of life. This is the step that gives them the a clearer yes/no picture on the purchase and it also lets them know how much wiggle room they have to make it better before it has even begun. Comprehensive and accurate financial forecasting will give them much of the direction they need for all the big decisions that are yet to come: What other fees need to be paid for before this transaction can be finalized? What should be paid off first? How much staff can they afford to hire? Should they upgrade the space or the equipment? It’s at this stage that they must ask themselves what price they are willing to pay to get what they want.

Raise the Funds

Once the Buchans have a solid idea of how much capital is needed to set the business up and how much extra they will need at regular intervals to keep it running, the next task will be to go out and find creative ways to raise that money. Many big banks offer special funding and financing options for professionals in the eye care industry, and other funding options can certainly be found through third-party lending agencies and even through the property seller. Additional funding options for equipment will also be explored, and we will tune in as they weigh the pros and cons of leasing versus buying equipment, keeping in mind that many pieces of technology can become significantly outdated and even obsolete in as little as three years.

Acquire the Talent

With many of the fixed business expenses accounted for in the previous stages, Jane and Steven would also need to find good people to assist them in the daily operation of the clinic and work with them as they continue to build this new practice. The biggest consideration for hiring, whether they are accepting applications for new staff, or taking on the existing manpower from the clinic’s previous owner, is the budget that they have set aside during the accounting phase for their human resources needs. This includes the obvious salary, benefits and possible employee discounts, but it should also make considerations for employment laws and tax obligations. In order to get the best possible picture of the legal and financial implications of their staffing needs, they should consult their legal counsel. Stay tuned for future articles as we accompany the Buchans on their insightful journey towards envisioning and building the practice of their dreams.

Here is information about the practice that have Jane and Steven excited. They made a few inquiries and attained a summary Income statement from a broker representing the seller (after signing a non-disclosure agreement). Click to view: Doctor EyeCare Optometry Income Statement
We’d like to hear from you:

What advice do you have for the Buchans?

What more information should they ask about?

Is this a good practice for them to consider?

What do you recommend they do next ?

Post your advice in the “Leave a Reply” box below.

LYANNE AUGUILAR

Lyanne Aguilar is a Toronto-based writer who specializes in finance and healthcare-related content, both in English and French

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When Patients Search for Eyewear Online, What Are They Looking At?

Digital Marketing, Marketing, Practice, The Patient Journey

When using the internet to search for eyewear, most people are usually window shopping online, according to The Vision Council VisionWatch Internet Influence Report. In other words, they are conducting research and activities that are utilized to help them purchase eyewear in-person at a future date. People most often compare prices of eyewear. They also look to the internet to examine possible brands, and to examine possible retail locations where they might eventually make a purchase in-person. People are somewhat less likely to use the internet to select the exact brand of eyewear they will buy, or to select the exact retail location where they will make a purchase. Finally, a small number of consumers are using the internet to review customer ratings/satisfaction relating to eyewear or eyewear retailers.

The doctor-patient relationship has changed. The internet has driven that change. Information now is just fingertips away. Now patients come to doctors after going on the internet to do a little research. This can be both good and bad.

The good news is the more educated a patient is about the problems they are facing, the easier it is to get them to follow your treatment plan.

The bad side occurs because the internet is filled with both accurate information and inaccurate information, but there are no flags telling patients they are reading inaccurate information.

In our youth, one of the first of the medical television shows (Marcus Welby, M.D.) was popular. It was the story of two physicians treating patients. Each week had a new disease that was the center of the show. The problem was, the day after the show doctors’ offices across the country would be inundated with people calling to schedule appointments believing they had the disease that they had seen the night before on the show. That problem has not gone away. We’ve all seen patients who’ve spent time on the internet coming into the practice convinced they have a problem they’ve read about after using the Symptom Checker on WebMD.

Patients also research glasses and contact lenses online. The problem is they do not know that there are significant differences between glasses or contact lenses design, material, or manufacturing process. Patients have a fundamental misunderstanding that just because my new glasses or contact lenses have my doctor’s prescription in them, it doesn’t matter where I buy them. The reality is that it does matter. Design, material, and manufacturing process matters.

For both spectacle lenses and contact lenses, the design of the lenses matters. Just consider for a moment how many different designs of progressive addition lenses exist. Selecting the best design for the patient matters. Every contact lens company has a different design for astigmatism lenses. Design matters. If the patient does not have the best prescription design in the lenses for the patient, the patient may not have the best vision.

Material matters. Material directly impacts abberations, weight and thickness of the lenses. If the patient does not have the best material in the lenses made for the patient, the patient may not have the best vision. The same thing is true for contact lenses. Some lenses are better for patients with dry eyes, and some lenses are worse. Some material gives patients comfort all day, while with other materials, patient comfort degrades as the day progresses. Material does matter.

Manufacturing process matters. We now have the ability–by using advanced manufacturing processes–to have patients see clearly edge-to-edge with their spectacle lenses. With older manufacturing process, there was only one place on the spectacle lens with the patient’s exact prescription. Manufacturing process matters with contact lenses as well. Edges, thickness, lens smoothness all matter.

Our job is to recognize that patients do go on the internet for information. One way to address this fact is to help patients with accurate information. Here are two important ways you can positively impact patient care.

1) Make sure you are telling patient about more than just the change in their prescription. “Mrs. Jones, there has been a small change in your prescription and I’m going to prescribe this for you so that you can see clearer. But I’m also prescribing the material, the design of the prescription in your lenses, and the manufacturing process so that you will see the best. It’s more than just your prescription, you need to have all of these other things exactly as I’m prescribing them to see your best.”

2) Take this week to examine your web site. Do you have information on your web site you can easily “push” to patients? We used to give patients brochures and paper handouts. In today’s digital world, you and your staff should be directing patients to your web site for information. “Mr. Smith, you have primary open angle glaucoma. I’m sending you a link to information on my web site about primary open angle glaucoma that I want you to read. I’m also updating the information on your digital medical record. My staff is going to show you how to access that information through our secure portal.”

Embrace the fact that patients are going to use the internet. Find ways to use this information positively by guiding patients in their online experience.

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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