Page 57 – Eye Care Business Canada

Create a Dry Eye Centre and Make it a Practice Builder

Differentiation | Business Strategy, Practice, Resources, Specialty Practice

Our aging population, along with the heavy use of digital devices and dry environments of work and living, mean more cases of dry eye. Creating a practice specialty–a dry eye center–as our practice has done, enables you to capture the opportunity to treat these patients, and keep them in your practice with services that address their needs.

I practice in a shared OD-MD practice with two ODs, including myself, and three MDs, and we seethousands of patients a year who experience dry eye.

The MDs and ODs typically share the same patients. Some cases are easily managed with lid hygiene and palliative care. More difficult dry eye cases are managed by the ODs through our dry eye center, which we call the Advanced Tear Analysis (ATA) clinic.

Our clinic is about 10,000 square feet. The exam room for ATA is about 100 square feet, so it does not require much space. The only thing that separates it from the other rooms is the addition of a LipiFlow machine.

The ATA exam can be used for any dry eye patients. However, the process is very thorough. Some cases of dry eye may not require the extensive testing. Patients who do not improve with treatment after one office visit will be referred to the ATA clinic, which is the minority of the patient population.
Each half-day may average from 9-13 post-operative and acute care patients. The ATA clinic will schedule only up to two additional patients for a half-day. Due to scheduling and post-operative care demands for time slots, the ATA schedules patients on two half-days a week. The exams can range from 45 minutes to an hour. We may see four ATA exams a week per OD. These exams take longer, but are 50 percent more profitable than a traditional office visit.

EXPANDED SET OF OPTIONS: NEW TOOLS

As the volume of dry eye patients grows, the OD can serve an unmet need. The OD can treat most cases of dry eye. For severe cases, the MD can do surgical procedures such as tarsorrhaphy, gold or platinum weighted eyelid implants, intraductal probing and punctal cautery.

CREATE A “DRY EYE CENTER”

The ATA exam represents the new exam that is dedicated to the diagnosis, management and treatment for the more difficult cases of dry eye. The patient must have had an initial comprehensive examination beforehand either at the practice, or at another practice. ATA exams share clinic space with post-operative exams and walk-in patients.

Comprehensive exams have their own set of rooms as these exams typically take the longest amount of time. The initial dry eye, or ATA, exams are held on two half-days a week for the initial testing and evaluation. Re-checks typically take less time, and can be scheduled throughout the week if necessary. LipiView II (TearScience) imaging is done on all patients, and the machine is centrally located near other pre-testing equipment. The exam room with the LipiFlow is reserved for the ATA clinic during scheduled treatments or possible treatments.

The Advanced Tear Analysis center at Durrie Vision. Having a specialized place, protocol and instrumentation for dry eye analysis and treatment.enables the practice tocare for a growing population of dry-eye patients.

There are many opportunities for managing dry eye in a refractive surgery practice, even if it is only during post-operative healing. Some post-operative patients need extra help with dryness. The majority of my exams are geared toward treating the ocular surface. Treating the ocular surface in general creates better surgical candidates, leads to improved visual outcomes and increases patient satisfaction.

DRY EYE: A GROWING PATIENT CHALLENGE

The prevalence of dry eye is estimated to be as high as 30 percent in some larger population studies for adults over age 50, with women suffering in greater numbers than men. Medications contribute to dryness. Environment and climate can also exacerbate dryness.

An unfortunate, newer trend of dry eye is that we now see younger patients in our practices. A less nutritious diet as compared to previous generations, increased electronic device screen time and contact lens overwear contribute to a poor tear film.

Dry eye is complex and multi-factorial. It is only getting worse, and the patients are increasing. Effectively managing dry eye is one of the greatest challenges in eyecare. Many patients who suffer from dryness struggle with vision, comfort, as well as quality of life. To ease the suffering of one of these patients is a rewarding experience. —Suzanne LaKamp, OD, FAAO

SET DIAGNOSIS & TREATMENT PROTOCOL

All dry eye patients need comprehensive exams. The following dry eye exam services incorporate additional testing for the ocular surface, that could not have otherwise been performed at the comprehensive exam.

The ATA patients get entrance testing with repeat retractions. The technician will then take the patient through HD analyzer imaging. The imaging is helpful in looking at image scatter from either problems with tear film or changes to the natural lens. It is a non-invasive test. Patients may get LipiView imaging if not already done at a previous exam. The patients all take the SPEED questionnaire.

At initial or subsequent visits, there may be various types of staining, tear break-up time, inspection for lid abnormalities, and Schirmer’s testing with anesthetic. A slit-lamp exam with meibomian gland functional testing is performed using either the Korb evaluator or with a cotton-tip applicator. There is no additional cost to providing questionnaires or a slit-lamp exam, other than chair time. LipiView and other equipment can be costly to a practice, and need to fit the practice budget. Dry eye exams services can help recover this cost, as well as performing LipiFlow.

Palliative treatments include a wide array of artificial tears (not sold in office) and punctal plugs. Specific artificial tears are recommended (Systane Balance and Retiane MGD are common), and samples are given. Our practice does temporary and permanent plugs. Plugs are a billable service for patients with insurance. Reimbursement for permanent plugs is typically good.

There are pharmaceutical options for treating dry eye. Patients are sometimes prescribed Restasis for tear film insufficiency. We have a new product, Xiidra, which is a promising treatment. More treatment options can lead to increased success. Corticosteroids and Doxycycline are prescribed for dry eye patients who experience a lot of inflammation, but carry a degree of risk with side effects. Many patients are now being treated with Omega 3 supplements or fish oil. We typically recommend higher quality brands such as PRN Omega Dry Eye formula or Nordic Naturals. Supplements can be sold in office, but we do not currently carry them.

Any patients with severe dry eye, such an non-healing epithelium or exposure, would be referred out of our practice. These cases could include surgical intervention, scleral lens fits, serum tears or amniotic membranes.

SELL DRY EYE TREATMENT ACCESSORIES

For managing meibomian gland dysfunction-related dry eye, therapeutic treatments include LipiFlow and BlephEx. We recommend all patients with meibomian gland dysfunction perform lid hygiene and warm, moist compresses for at-home maintenance. We sell the Bruder eye mask. While there are many warming moist eye masks on the market, patients like the convenience of having the mask available in office. Depending on quantity purchased, the Bruder mask can cost the practice $8-$12.50 each. Recommended mark-up would be at least 50 percent or greater.

We also sell Avenova lid cleanser. Most pharmacies charge the patient an average of 3x more for Avenova than for what we sell. It is much more affordable to get the product at our practice. The products are available at the check-out, where the patient will also schedule any following appointments. The warming eye masks and Avenova have been instrumental in helping our dry eye patients, as the majority have meibomian gland disease.

WHO MANAGES THE CASE: OD/MD

While all of the doctors at my current practice manage dry eye disease, the OD plays a larger role. The MDs spend more clinic time performing comprehensive examinations on surgical candidates, which is the largest revenue generator in the clinic. The OD sees a variety of patients including pre- and post-operative surgical care, acute care and patients for dry eye management.

Some of the dry eye patients include acute, resolving post-surgical dryness. There are also patients with chronic dryness for years without a history of surgery. The ATA clinic exams are performed exclusively by the ODs.

INVEST IN NEEDED INSTRUMENTATION

Most dry eye is evaporative, and some of the newer technologies work to improve meibomian gland dysfunction. The most valuable imaging equipment in diagnosing meibomian gland disease is the LipiView II. It is also one of best resources for educating our patients. For patients who suffer from meibomian gland disease, the LipiFlow is a great tool to have in clinic. LipiView and LipiFlow are essential to any dry eye clinic. While cost was previously a big hurdle for patient and practice alike, a recent decrease in activator pricing for the LipiFlow improves accessibility. More clinics will likely purchase the equipment, and hopefully the number of patients who get treatment will increase.

For patients with plaques along the lid margins, lid debridement is an effective procedure in restoring meibomian gland function. A golf club spud can be used in office, as well as the BlephEx.

Practices typically purchase the LipiView/LipiFlow and the BlephEx equipment. Length of time to profit varies per practice, and depends on what each practice charges for treatment. A typical yearly budget may require four LipiFlow treatments a month and 24 BlephEx treatments a month to be profitable.

As a cash-pay practice, we are fortunate to perform whatever testing we feel is best for the patient without concern for the varying insurer reimbursement policies. The testing aids in diagnosis and patient education. The patients are very receptive to testing. We charge for treatments such as BlephEx, LipiFlow, and punctal plugs. We also charge for products sold in-office such as the Bruder compress and Avenova. Each exam, including follow-ups, has a fee. We are reimbursed 100 percent for what we charge. For managed care patients, there is no current insurance coverage for meibomian gland dysfunction.

EDUCATE PATIENTS ABOUT DRY EYE SERVICES

Dry eye services are marketed within the practice by word of mouth. The doctors will refer current and new patients to the ATA clinic if the dry eye patients need further testing and follow-up. Current plans involve integrating the ATA online link into the main web site. We have one that we can give out to patients, but is not yet accessible to the general public.

We developed a dry eye handout that is available in all exam rooms. The handout includes various treatments for dry eye. LipiFlow and BlephEx are some of the listed treatments. It is helpful to have a handout that advertises provided services, which the patient may elect to later choose if palliative therapy is not enough.

The dry eye clinic is not currently advertised on the web site, but will be in the near future. The services are relatively new, and were mainly developed as a way to better serve our current patients. The practice model is direct business-to-consumer. Within a few months of beginning the dry eye clinic, patients new to the practice are scheduling. This was surprising considering we have not actively advertised outside of the practice. There have also been a few referrals from outside practitioners. The addition of LipiFlow has been driving some of this outside business for the dry eye clinic. Word-of-mouth is also contributing to the increase in new patients.

SUZANNE LAKAMP, OD, FAAO

Suzanne LaKamp, OD, FAAO, is an associate at Durrie Vision in Overland Park, Kan. To contact: dr.suzanne.lakamp@gmail.com

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Commit to Continuous Staff Training: It Pays Off

Human Resources, Training & Onboarding

Recruiting the right employees only takes you halfway to delivering high-quality care to patients. The other half of the challenge is training those employees. My practice takes a systematic, consistent approach to ensuring staff is prepared to deliver service to patients, and to help grow the practice.

In addition to spending about $6,000 per year on hard staff training costs (materials, testing fees, travel, seminars/meetings, meals associated with training, etc.), in our practice of 22 team members, we spend an immeasurable amount of time to training. Although we have not calculated the soft costs (down time for the trainers and ramp-up time for new employees) associated with training new team members, as well as ongoing training for all team members, I’m sure the amount would be very high.

But, I would argue that our return on investment is also very high. We can measure its effectiveness in the quality of our team that performs to the best of its ability every day. Our patients constantly remark on the outstanding customer service our team delivers. They trust our team, the entire team – not just our doctors – to provide them with excellent care and education. Those patients reward that trust by referring their friends and family to us!

GIVE EMPLOYEES & TRAINER A LEARNING CHECKLIST

We assign each new employee a trainer from within their department who excels at teaching and training. The team lead for the department is sometimes the trainer, but in our practice the owners/doctors and practice manager are never directly involved in the day-to-day training of new employees. The first piece of training material the new employee is given is a shared reference between the new hire and the trainer. It is a spreadsheet of items/areas to be trained, listed in chronological order, to organize the learning track.

When each new topic is introduced, both the trainer and the trainee initial the particular section of training that has begun. They each have to re-initial when they both feel it has been sufficiently trained/learned and they are ready to move on to the next subject. This helps to reduce instances of “I was never told that,” and it gives the trainee a chance to express that they may need the pace to be adjusted, or that they are having a difficult time with a particular training module.

A few of the 22 team members at Clarke EyeCare Center in Wichita Falls, Texas. Dr. Clarke says committing to staff training pays off in a staff that can deliver care patients appreciate enough to refer others to the practice to experience.

We have all of our office processes, including staff training, typed up in a shared document on our server that everyone in the practice can access. It is searchable so that anyone can type in keywords to pull up a process within seconds if they’re unsure what to do. Training processes are reviewed and revised by our department managers regularly.

START WITH HIPAA TRAINING

The first step of the training process is HIPAA training with our compliance officer. After that’s complete, the applicant shadows an appointed person in the department for which they were hired to experience first hand the culture/patient experience they are expected to provide. How and when we say things are equally as important as what we say. The tasks of the job can and will be learned in time, but the exemplary attitude is our first priority of training.

WHOLE TEAM WORKS TOGETHER TO READY NEW EMPLOYEE

Although we have a designated person to perform the initial training, the entire team works together to integrate the trainee into the culture of our practice by making sure that person knows our goal is for their experience to be a positive one. Not only do we believe they can succeed, but that we will all do everything we can to help them transition through the learning process successfully. They need to feel it’s a safe place to ask questions and learn from everyone.

We have used vendors to assist in training, in-person training (at regional meetings), and online training resources, such as training modules on the AOA’s web site, but we mainly rely on our people, our best resource, to train our other team members.

USE A TRIAL PERIOD BEFORE MAKING HIRE PERMANENT

We hire most of our employees through a temp-to-hire agency. In using their services, the trainee is the employee of the staffing agency for a period of 90 days. This gives us time to objectively decide if the trainee is learning and retaining the knowledge at a good pace, is reflecting our core values and team culture effectively, and if we’re going to end the probationary term by hiring them permanently. This 90-day term is a time for constant communication of our very clear expectations and frequent reviews of how they are or are not progressing.

DAN CLARKE, OD

Danny Clarke, OD, owns Clarke EyeCare Center in Wichita Falls, Texas, which received an All-Star award by The Great Game of Business. The practicerecently was named the Family-Owned Business of the Year for the SBA Dallas/Ft. Worth district ofTexas. Dr. Clarke is also the President of MODUS Practice in Motion, which offers open-book management training to optometric practices. To contact him: dbc@clarkeeye.com

JOELY ANDERSON

Joely Anderson is the office manager for Clarke EyeCare Center and is also the Vice-President of MODUS Practice in Motion. To contact her: joely@clarkeeye.com

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Increase Profits by Adding Staff: Tips on Timing & Recruitment

Human Resources, Talent Acquisition

This article makes reference to labour laws. Readers should ensure that they are familiar with the applicable Canadian Provincial Labour Legislation.

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.

It is important to carefully screen applicants, by e-mail first, then by phone, and then up to two times in person. Our office manager, and sometimes the out-going employee, are involved in the hiring process, in addition to me.

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. 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.

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.

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.

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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Capture a Prime Growth Opportunity with a Low Vision Centre of Excellence

Differentiation | Business Strategy, Practice, Resources, Specialty Practice

Low vision, caused by diabetic retinopathy, macular degeneration, glaucoma and other conditions, is affecting more and more of your patients. By the year 2030, the National Eye Institute projects that nearly 5 million in the U.S. will be classified as having low vision.

Dr. Richman works with a low vision patient, showing the patient how to use a magnifying tool that projects small type onto a large screen

We have focused on low vision care, and have built up this niche, so that approximately 30 percent of our three-OD practice is now considered low vision, and 100 percent of my part of the practice is visually impaired or legally blind. I personally see only visually impaired and legally blind patients, but my husband and partner in the practice, Harvey Richman, OD, sees visually impaired children in addition to his other patients.

WHAT MAKES A LOW VISION PATIENT?

Everything from premature birth to age-related macular degeneration can create a low vision patient. Providing this type of care has allowed me to see patients with conditions so rare that there are less than 10 documented cases in the medical literature, and others who have traveled from Europe and Africa to see me.

INVEST IN NEEDED INSTRUMENTATION

The retinoscope, as refraction is so important, is an essential tool to help you serve low vision patients. All good low vision exams require the appropriate starting point, and finding the appropriate prescription is invaluable. We have treated patients who were classified legally blind, and by simply giving them the right corrective lenses, they were able to enjoy the activities of daily living, or even drive!

Visual acuity assessment needs to be modified to be able to be done at different working distances. Charts that vary in size and format should be available, depending on the patient’s needs. Additionally, having appropriate magnifiers, lighting options and wavelength-specific filters is paramount.

A basic retinoscope can cost as little as around $70, while the more advanced ones can be over $1,000. A few magnifiers are available for less than $50, but the electronic devices are thousands of dollars.

INCREASE YOUR KNOWLEDGE OF LOW VISION PATIENTS

The American Optometric Association used to have a Low Vision Rehabilitation Section that had materials and courses available. That is now merged into the online database for members. There is a large program called Envision that occurs annually in Kansas, and offers continuing education annually. The most effective option for educating yourself about caring for low vision patients, though, is to communicate with other doctors who are doing low vision currently and pick their brain. Most of us are happy to share our experiences, good and bad.

Wavelength-specific filters that Dr. Richman’s practice sells. Offering the products in-house gives patients “one-stop-shopping” ease, enabling them to get the products you prescribe without having to travel to another location.

INVEST IN INVENTORY

The primary low vision-oriented eyewear that we stock are wavelength-specific filters (450-550nm) in frames. We have a few prism readers with high plus, but primarily prescribe the appropriate prescription to be filled, as we don’t have an optical.

PROJECT PROFITABILITY

In our office, much of the profit is in the service end. Devices are opportunities to make additional income, but we still focus on the professional component. Often, doctors double their cost for retail. This is a personal decision, as is prescribing glasses. That being said, profit occurs from day one as the first patient who is successful tells their friends, and the referring physician, and more patients roll in the door.

More significant than the revenues that come directly from low vision patients is the loyalty of these patients, who stick with the practice for years, and often refer friends and family, and speak highly of your practice in your community, and even online sometimes.

MARKET YOUR SERVICES

Our community learns of our low vision services through word-of-mouth (satisfied patients who refer others), our practice web site, the telephone book (yes, we still
use it because many older patients still look to it), and by meeting with low vision support groups and senior citizen community groups.

We receive referrals for consults from dozens of ODs and MDs. The OD referrals are more diverse, but the MDs referrals come primarily from retina specialists.

HELP IMPROVE PATIENTS’ DAILY LIVES

The primary areas reported problematic are reading and driving. Near activities are usually the easiest to manage with either a high-add reading glass or hand or stand magnifier. Some patients need a CCTV (electronic magnifier) to read longer or smaller print. Driving and television are more difficult due to state regulations and optical options. As mentioned earlier, sometimes an update in their glasses is enough, but when a telescope is needed, it is much more time consuming for the doctor and the patient.

OFFER EMPATHY

Much of what differentiates a good low vision doctor from a great one is their ability to empathize and counsel the patient through their loss-of-vision grieving process. Although the doctor’s primary job is to get the patient functioning again, at times we act as social workers or lay psychologists. There are times, however, that we need to get outside support also, which is when you would refer the patient to a licensed social worker or psychologist for assessment and management.

Initially, we live at my practice by the idea that if the patient is willing to work to help themselves, we can offer them the tools to meet their goals.

CATER TO THE LOW VISION PATIENT’S NEEDS

The first thing to remember about low vision patients is that they are visually impaired, not blind or deaf. Most low vision patients come with a family member or friend to help with filling out forms and to do other detailed tasks. Otherwise, the paraoptomtretric will help with the documents. Next, you have to modify the way you do pre-testing as the patients may not see the chair as well, and definitely have difficulty maintaining fixation on automated equipment. The other issue is discussing the financial variables of the examination. This can get pretty complex as the patient may think that everything is covered by their insurance, and often that is not the case.

Patients are seen for an initial visit, then usually a few weeks later for the dispensing of devices, training of devices or follow-up if dispensed the first day. Then, they are seen again about three months later to ensure that the devices are successful. We work with the referring doctor to make sure that all medical follow-up is done with them.

Third-party payers often cover the evaluation and management components of the low vision exam. Medicare specifically excludes the refraction, which is a primary component of the visit, so that is private pay. Depending on the severity of the impairment, training with the devices is billable to the insurance carriers also. Devices are rarely covered, but there are some plans that do.

MARIA RICHMAN, OD, FAAO

Maria Richman, OD, FAAO, is co-owner, along with her husband, Harvey Richman, OD, of Shore Family Eyecare in Manasquan, N.J. To contact: drrichman@lowvision-nj.com

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5 Things to Fix in Your Current Online Marketing Plan

Digital Marketing, Marketing, Resources

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You may think that simply having a website is enough to help your eye care practice attract new patients and increase practice revenue. However, a successful, well-rounded online marketing plan involves more than just a website. The following are five components of your online marketing strategy that you should fix now, if you have not already.

Your Website Features. Turbo-charge your website by including high-definition video content. The average Internet user spends nearly 90-percent more time on a website with media.¹ Blogs, social media, new-patient online forms, an e-store, educational resources, click-to-call functionality on your phone numbers and a map feature with directions to your practice, all help to keep patients on your website longer, convert them into patients and help increase practice revenue. Finally, make sure your website is mobile friendly, or Google will penalize it and your search rankings will drop. If potential patients cannot access your website from a mobile device or cannot find it online because it is buried on the fifth page of the search results page, they will turn to your competition instead.

Your Social Media Presence. You may already have a business page on Facebook, but also consider Google+, LinkedIn, Twitter, YouTube and Pinterest. Even if you are on all these social media sites, are you taking full advantage of them? Many social media sites are introducing “buy” buttons that allow online visitors to purchase a new set of eyeglass frames with the click of a button. You can also run advertisements on social media that target your patient. At the very least, make sure you are sharing your seasonal promotions on your social media business pages.

Your Online Reputation. Did you know that 88 percent of consumers trust online reviews as much as personal recommendations?² That same percentage read reviews to determine the quality of a local business.³ This highlights the need for practice owners to closely monitor and quickly respond to both positive and negative reviews on sites such as Google+, Facebook, Yelp and specific health care sites like rateMds.com. In fact, Harvard Business School study showed that a one-star rating increase on Yelp has been shown to increase practice revenue 5 to 9 percent.

Your Paid Advertising Campaigns. Nearly 65 percent of people click sponsored ads when searching for a service or product online.⁴ A pay-per-click (PPC) advertising campaign is not something you can ignore. Once you have done your keyword research and have designed compelling website landing pages that convert visitors into patients, make sure you are taking full advantage of the advanced PPC features available. These include broad match modifiers, negative keyword lists (so you do not pay for ads that will not convert visitors into patients), ad extensions (that allow you take up more real estate on the search results pages without an extra cost) and mobile device bid modifiers. You should take 20 minutes every week to review your PPC strategy and update it as necessary.

Your Search Engine Optimization (SEO) Strategy. Less than 10-percent of people advance to the second search results pages.⁵ This highlights the need to rank highly. However, it’s more difficult than it seems, especially in competitive markets. Google does not make it any easier by constantly updating the ranking factors in their search algorithm. Nonetheless, there are best practices you can follow that increase your chances of ranking well. Provide a user-friendly experience and increase your SEO efforts through unique informative content, including media that keeps visitors on your site longer. Include relevant keywords on each webpage add meta data, including page title tags, headings and meta descriptions, onto each webpage. Make sure your practice name, address and phone number are consistent across all platforms and encourage quality websites to link to yours.

If you are not marketing to your online audience you are likely losing potential patients and revenue. However, by fixing these five things now, you can make your website and online presence work for you, helping to recruit new patients, retain current ones and foster word-of-mouth referrals. Remember: Your website is your best sales person, and it never goes on holiday.

Want to Learn More?

Learn more about effectively marketing your practice online by contacting iMatrix, a leader in websites and online marketing solutions designed specifically for eye care professionals like you. Call 1-800-462-8749 for more information.

CASSANDRA RANSOM

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Develop a Strong Web Presence for Your Specialty Practice

Digital Marketing, Marketing, Practice, Resources, Specialty Practice

In order to stand out from competitors and build a strong patient base, it is essential that eye care practices build a solid online presence. However, practices that serve a specialty population, such as sports vision, vision therapy, low vision, or pediatrics, should take a slightly different online marketing approach than a general eye care provider. Here are three tips your specialty practice can use to build a better online presence and stand out in your niche:

Think Like Your Target Audience

When developing an effective online marketing strategy, it is crucial that you understand your audience and how it differs from those seeking general eye care information. The first thing to consider is why your patients are seeking an eye care specialist. Often, the motivation to find specialist care is a recommendation made by a teacher, coach, or another general eye care professional. The second consideration is whether your marketing is targeting the patient themselves, their care givers, or other professionals that could serve as a referral source. Typically, you will find there is one audience segment that is most prevalent and your marketing content plan should be tailored to speak to the needs and wants of that group. For instance, a vision therapist’s website would probably address the concerns of parents while offering education on symptoms and therapies, while a low vision office’s website might be geared toward patients and include more information on corrective devices.

Create High-Quality, Specific Content

In many ways, content is the foundation for online success. Search engines and online users alike love original content. High-quality content tailored to your audience helps educate your prospective patients, positions you as an expert in your specialty field, and organically boosts your online rankings. When developing a content strategy, make sure your content is easy to understand, and most importantly, that you are offering enough topic-specific information to highlight your practice expertise. For example, in addition to the standard office information pages, the website of a sports vision specialist might have custom pages detailing the difference between a general eye care provider and a sports vision provider; the skills sports vision can improve; the variety of testing modalities typically used, and therapies and technologies one might encounter at the office. The sports vision emphasis could also be carried through to the website’s images, special offers, and blog content.

A social media best practices guideline suggests 80 percent of what you post should be sharable, interesting, and not self-serving; the other 20 percent can be about you – or your business (think special offers, announcements, photos). The purpose of this ratio is to diversify your social media content in order to better engage with followers. It also encourages you to look to outside sources for shareable content. Using the 80/20 rule, the majority of your social media content should be shared from other online authority sources that align with your specialty. While you probably do not want to share content from a competitor, you can look to organizations, journals, university studies, product demo videos, inspirational or funny memes, and statistics to source content that keeps your social media pages active, interesting, and in-tune with your niche offerings.

Optimize Your Pay-Per-Click (PPC) Strategy

PPC advertising is a fast-acting marketing tool that brings in impressive results. It specifically targets only local and interested patients who are looking for a specialty practice such as yours online. However, since there is a cost-per-click (CPC) that comes out of your budget each time an online user clicks on your ad, it’s important that each lead is promising.

In order to drive down CPC, consider including specific, long-tail keywords as opposed to solely bidding on generic, short keywords that already have heavy competition among general and specialty practices alike. For instance, the phrase, “where can I find a pediatric eye doctor” or “kids eye doctor open now near me” captures searches with specific, conversational queries. While you can still bid on general keyword terms such as “pediatric eye doctor” and “Greenfield Park kid’s eye doctor,” by including long-tail keywords, you are able to capture the market on those specific keywords at a lower CPC.

When it comes to developing a strong online presence for your specialty practice, one must consider who the website is trying to attract and design the content and ads to appeal to that group. Taking the time to research your audience, craft compelling and original content, and optimize your advertising efforts will help boost your website’s visibility and attract more, new patients.

AMANDA NAVARRETE

Content Specialist with iMatrix

Amanda Navarrete is a content specialist with iMatrix, the leader in vision care website and marketing solutions. For a free, one-on-one website consultation with an iMatrix Internet marketing expert and to get a special Optik reader promotion, call 877.596.7585 or visit imatrix.com/OPTIK216.html.

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