Hurry Up and Fit Them While They’re Young

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With an aging population, the opportunity to fit both current contact lens wearers and emmetropic patients with multifocal contact lenses is enormous. The benefits of doing so range from delighting patients through to increasing your revenue from higher value contact lenses and add-on sales of reading glasses. So take a moment to consider your practice: do you talk about multifocal contact lenses with every emerging presbyope or do they take a back seat until you have tried and exhausted other options such as monovision?

There are, of course, a number of positives for fitting monovision: it is quick, easy and costs no more than ‘normal’ contact lenses. However, monovision does not do so well in the long run for many patients. As the required near addition increases over time, it becomes more difficult to use the same prescription for both reading and intermediate distances. In my experience, more than half of monovision wearers have difficulty once the near add is over 2.00D. It is then that an alternative solution, such as multifocal contact lenses needs to be explored. The difficulty of this approach is that the patient already requires mid to high adds, and these are harder to adapt to.

My preference is to be proactive and fit multifocals early. In much the same way we might recommend low add varifocal spectacles to ease adaptation, fitting low add multifocal contact lenses makes initial adaptation easier for patients. It also maintains their binocular vision and provides a contact lens solution that can adapt with them over time.

Starting the Conversation Early
While no multifocal contact lens can promise to deliver perfectly clear vision 100 per cent of the time, steps can be taken to promote successful outcomes. In my experience, the most crucial step is to get communication right. Conversations about presbyopia should happen early, before its onset. I routinely talk to pre-presbyopes about what will happen to their vision in the future. It means they are not surprised when reading becomes more difficult and that they are aware of their options.

Communication is also key when it comes to setting expectations. Defining success with multifocal contact lenses helps patients frame their experience more realistically. Explain that multifocal contact lenses will work for a majority of the time and that supplementary reading glasses may occasionally be necessary for fine detail. Setting realistic expectations enables more patients to feel their contact lenses are working as well as could be expected. Scoring the relative convenience of both their spectacles and contact lenses works well too. An 8 out of 10 may not be perfect, but it’s certainly ‘good enough’ for many patients, particularly if they also score their reading glasses or varifocals at the same level. Also bear in mind that multifocal contact lenses are not the best option in every case: patients with unrealistically high expectations or specific detailed visual demands may do better with other forms of vision correction.

I follow three tips when fitting multifocal contact lenses. (1) I always use the manufacturer’s fitting guide, which will have been produced after extensive research. If the guide quotes a particular rate of fit success, it will have been achieved by following specific steps, so no matter how tempting it is to stray, I cannot recommend strongly enough that sticking to the guide should lead to the greatest fitting success. (2) I assess vision with ‘real world’ targets. I try to understand my patient’s visual environment and use that to assess how well they can see. Use real life reading material, ask patients to view their smart phone, tablet or laptop and check their vision across the street. Optimise their vision for everyday tasks. (3) Know when to stop making adjustments. As a young practitioner trying to achieve perfect vision, I would tweak multifocal prescriptions a lot, a practice that is not realistic and leads to disappointment. Use the fitting guide to make one or maybe two adjustments. Have the confidence to face your patient and say ‘this is as good as we can get it’. It is amazing how often they will accept that statement and happily choose to continue with those contact lenses. It avoids the endless pursuit of perfection and puts a sensible limit on chair time.

Increasing Choice for the Practitioner and Patient
Good choice exists for frequently replaced soft multifocals with options available in daily disposable and monthly modalities. Adding to this selection, it is worth being aware of some more recently released designs too. Available in three adds, Johnson & Johnson’s 1-DAY ACUVUE® MOIST® Multifocal is a new hydrogel daily disposable. It combines the performance of etafilcon A with an optimised aspheric centre-near design that accounts for pupil size variance due to both refractive error and age across the power range. Bausch + Lomb’s Biotrue® ONEday for Presbyopia is another new hydrogel. It delivers a centre-near, three-zone progressive design with two add powers. Less recent, but an important alternative in this category is the Clariti® 1-Day Multifocal from CooperVision, currently the only multifocal daily disposable available in a silicone hydrogel material. With many patients choosing part-time contact lens wear, increased choice in the daily disposable portfolio is welcome. Perhaps the most recent addition in the frequent replacement sector is the PureVision®2 for Presbyopia from Bausch + Lomb. Offering an updated design with a wider intermediate area and predictable, efficient fitting, it is a welcome addition to the silicone hydrogel category, alongside other options such as Alcon’s AIR OPTIX® AQUA Multifocal which offers three add powers.

In summary, fitting presbyopes with multifocal contact lenses is best done early and with good clear communication to ensure your patient’s expectations are realistic. Have confidence to be proactive with this group of patients and you will experience the professional and business rewards that follow.

This article was published originally in OPTIK Magazine, February 2016.

KAREN WALSH, MCOPTOM

Karen Walsh, BSc(Hons) PGDip MCOptom FIACLE Medical Research Fellow Phone: (519) 888-4567 ext.37548 Email: karen.walsh@uwaterloo.ca Karen graduated in Optometry from Cardiff University, Wales in 1997. She subsequently worked in the UK across all forms of clinical practice, along with supervising undergraduate contact lens clinics at Aston University, Birmingham. Following seven years of working with Brian Tompkins in his independent practice that specialized in contact lenses she joined Johnson & Johnson Vision Care as a Professional Affairs Manager for the UK & Ireland in 2007. Karen has authored clinical articles and educational training programmes on both contact lenses and UV radiation; she has lectured internationally, and has taught at the VISION CARE INSTITUTE™ of Johnson & Johnson Vision Care in both Prague and the UK. She holds a post graduate diploma in Clinical Optometry from City University, London and is a Fellow of the International Association of Contact Lens Educators. She joined the CCLR in 2015 and currently holds the post of Medical Research Fellow.

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The Challenge of Selling Multiple Pairs

Advertising & Promotion, Marketing, Pricing, Products | Services | Industry News, Resources

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Despite the fact that most of your clients own numerous pairs of gloves and shoes, several hats or caps and many other accessories that serve to improve their comfort and enhance their appearance, getting them to buy a second pair of glasses is often a real challenge. And yet, glasses serve a dual function as a medical/well-being necessity and a fashion accessory. Both functions provide excellent starting points for selling multiple pairs of glasses.

Why do some wearers own more than one pair of prescription glasses? A survey of about 10,000 Americans conducted by Vision Council[1] has some answers. For 39.3% of respondents, it is important to have an extra pair of glasses as a back-up. 36.9% of people gave convenience as the reason: a different pair of glasses in different locations (home and office). The third reason given was functionality; 34.2% of multiple pair eyewear owners have different pairs for different activities. This reason was popular among men over the age of 45.  Finally, a handful of people stated fashion as their reason (to complement their wardrobe). A more recent survey conducted by VuePoint IDS also found that the “fashion accessory” aspect was one of the least popular arguments used by Canadian eye care professionals to encourage the sale of multiple pairs.

VuePoint research indicates, that Function trumps Fashion, when it comes to advocating a second pair sale.

Over the last few years, pollsters have not seen any major swings in the intentions of wearers. It is therefore up to eye care professionals and the industry as a whole to educate the client to associate visual comfort with wearing a different pair of glasses for different activities.

The Power of Advice

Of course, clients have access to information everywhere, namely on the Web. Are they well informed? Not necessarily, but they are willing to listen to advice. One of the main influences on consumers when choosing their glasses is the recommendation of their eye care professional. It is well known that advice provided in the examination room is golden. That’s the first key to success, according to a recent poll by VisionWatch,[2] followed by appearance and affordability.

Considering that only 20% of patients[3] own a second pair of glasses, the potential is enormous. Manufacturers are doubling their efforts to help you give the best advice, to increase sales and to encourage people to purchase multiple pairs of glasses.

In our December survey, 60% of our readers stated that they need more training to perfect the technique of selling multiple pairs. On top of reducing the cost of lenses, that’s what ZEISS proposes with its marketing material and training to encourage the sale of multiple pairs. At the same time, ZEISS has launched a DriveSafe ad campaign targeting consumers. The lenses are designed to provide the best vision while driving in all conditions. Compelling safety arguments are likely to positively influence clients and convince them to purchase a second pair of glasses.

Oakley has also launched its prescription sun lenses with Prizm technology to enhance vision for people who enjoy outdoor recreation activities. These lenses facilitate outdoor activities such as golf, baseball, hiking and cycling. Essilor recently introduced a line of lenses for connected people. The Eyezen lens won the Silmo d’or 2015 award and is designed for most patients who are worried about the effects of blue light from digital devices.

Room for Education

“Did you know that 25% of consumers are willing to invest in a second pair of glasses when they are told it’s the best visual solution? Informing the client about available products is educating them, advising them, and guiding them to make an immediate or future purchase. Various concrete actions can be implemented to create opportunities to recommend a second pair,” says Arnaud Reichenbach of Essilor’s client service department.

Reichenbach believes that you can spend a great deal of time and money developing new strategies to attract clients, but often the potential is already in your office. With the right tools, you can take advantage of that potential. Initiating the discussion in the examination room, keeping the message consistent, knowing your offer well, and identifying the advantages and benefits for consumers are all marketing elements that will help you sway them. Ask questions that give you an idea of your clients’ individual needs. The questionnaire will provide valuable information to help you make the sale. Using open-ended questions to identify needs and closed-ended questions to confirm them creates an opportunity to reinforce the validity of purchasing multiple pairs.

“Everyone can benefit from owning multiple pairs, each tailored to a specific visual need: Crizal® No-Glare lenses, Xperio® sun lenses, Essilor® Junior lenses, Transitions® lenses, Essilor® EyezenTM lenses, Varilux® DigitimeTM specialized lenses, protective eyewear for sports, lenses that filter blue light such as Crizal® PrevenciaTM, not to mention current promotional programs such as Perfect Pair or Multi-Pair PlusTM. Of course, you need to automatically tell consumers about these products,” concludes Arnaud Reichenbach.

Encourage Trying Different Lenses

Consumers may think that, due to the fact that they darken when exposed to sunlight, photochromic lenses are a substitute for sunglasses, reducing the possibility of selling multiple pairs of glasses. “This is not the case,” says Isabelle Tremblay-Dawson, marketing director at Transitions Optical. “According to our research, 33% of Canadians, independent of whether or not they wear Transitions lenses, buy a second pair of glasses. This shows that proposing Transitions lenses does not hinder the sale of a second pair of glasses and reinforces the main advantage of photochromic lenses as a first pair, which is to generate higher profits on the first pair of glasses, while leaving the door open to the sale of a second pair.”

But the Transitions study also shows that 38% of Canadians do not wear or stopped wearing (32%) Transitions lenses because they prefer sunglasses. This means that they were not informed of the differences between Transitions lenses and sunglasses.

There are numerous opportunities to promote the sale of a second pair of glasses during a patient’s visit. While discussing the patient’s visual needs, the optometrist can mention the advantages of Transitions lenses and talk about the additional benefits of polarized sunglasses for when the patient spends time in bright sun or in conditions where the sunlight is bouncing off surfaces such as water or snow.

“At the end of the consultation in the examination room, the optician should join the conversation. The optometrist can summarize the discussion with the patient about multiple pairs, thus opening the door for the optician to continue providing the patient with information about available products,” says Isabelle Tremblay-Dawson.

Incentives and Promotions

Stephanie Gingras, marketing and promotions specialist, points out that “when an eye care professional orders two Rx for the same patient with the same prescription, the ECP receives a 60% discount on the standard price listed for the second pair of lesser value. For independent offices, we offer a program that allows the ECP to easily offer a second pair.”

In addition, since April 2015, Hoya has developed an iPad app––HVC Viewer––which allows patients to experience the lenses before they wear them. In a few seconds, the patient can see the benefits of lenses and comes away with a highly motivating and personalized experience. This is a wonderful way to stay ahead of the game!

Lens design is another advantage when it comes to promoting multiple pairs. In particular, lenses designed with iD FreeForm Design Technology are progressive lenses supported by the Integrated Double Surface Design that provide a wider field of vision. Another example is the Array free-form progressive lens, which features variable length corridors for better adaptability and acuity, even when the wearer is in motion.

The Reading Corner

Most of the time, people in their forties start having a hard time reading restaurant menus or their smart phones.

Presbyopia affects 1.7 billion people worldwide today, and that number is expected to soar to 2.1 billion by 2020. A U.S. study showed that nearly half of young presbyopic patients avoid wearing reading glasses for fear of appearing old.[4]

These clients are therefore likely to be open to purchasing multiple pairs of glasses for reasons associated with appearance. Reading glasses aren’t what they used to be and manufacturers know how to design styles that are original and attractive. This is the case with Read Loop, a unique French company with a collection of about 60 extremely stylish and very colourful frames… Attractive to young (and not so young) presbyopic patients! ThinOptics recently introduced a line of ultra-lightweight, thin frames that can easily fit in your suit or jacket pocket, and its universal case can even be attached to the back of a smartphone.

Finally, a new study has confirmed that of the 77% of Canadians that require a prescription to see, 10% of them use reading glasses that they change every year or so. Over 3.4 million pairs were sold in the last year![5] This market, along with single vision sunglasses and protective eyewear, are key markets for starting a conversation about multiple pairs.

Some Keys for Multiple Pair Success: 

  • Understand the needs of each patient
  • Start the conversation about multiple pairs of glasses in the examination room
  • Sell the second pair before the first
  • Discuss eyewear designed for outdoor activities before indoor glasses
  • Talk about safety and visual advantages
  • Transfer information to the optician to ensure consistency in your message
  • Improve training in selling multiple frames for your sales team
  • Use available marketing tools to prominently display promotions
  • Identify frames that are part of a promotion to reduce the time it takes to select a second frame
  • Offer payment options, if any
  • Update the client’s file for the next visit. This will help you remember the last discussion you had, validate any changes in the client’s visual needs and adjust your recommendations accordingly.

Source: Inspired by our VuePointIDS survey, by Arnaud Reichenbach of Essilor and by the Review of Optometric Business (several articles by Mark Wright, O.D., FCOVD, and Carole Burns, O.D., FCOVD).

 

[1] http://www.theopticalvisionsite.com/marketing-trends/the-vision-council-report-fashion-v-s-function-in-eyewear/

[2] http://www.visionmonday.com/business/dba/article/doctorretailer-recommendations-among-top-reasons-consumers-cite-for-lens-choice/

[3] https://www.2020mag.com/CMSDocuments/2010/1/2ndPair_Guide_LR.pdf

[4] http://www.reviewob.com/new-study-nearly-half-of-americans-want-to-avoid-reading-glasses.aspx

[5] Study published by VuePoint IDS together with VisionWatch and VisionWatch Canada. https://infoclip.ca/en/insights-into-canadian-and-us-vision-consumers/

ISABELLE BOIN-SERVEAU

Isabelle is a longtime observer and chronicler of the optical industry and the Editor-in-Chief of OPTIK Magazine and Tmag Optical Trends, VuePoint Publications.

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Metrics to Manage By: How to Compute Optical Sales Capture Rate

Finance|Wealth, Practice Metrics & Benchmarks, Resources

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There are two important metrics that ODs should be monitoring in thedispensary: Optical Capture Rate and Inventory Turnover Rate. We’ve pulled these metrics from a recently published discussion, by VisionWeb, of eight metrics that optometric consultants Gary Gerber, OD, and Steve Sunder, of the VisionWeb team, consider the most useful diagnostic tools for independent ODs. Their e-book, 8 Benchmarks ODs Need to Monitor in Their Practice, comes with a downloadable Excel sheet that does all of the math for you! The e-book can be downloaded HERE.
In order to present the data for these metrics, we have drawn numbers from the Management & Business Academy (MBA) – a research program sponsored by Essilor. Over seven years, MBA gathered performance data from more than 1,800 US optometric practices. It has published the most comprehensive compilation of benchmarks currently available. You can visit mba-ce.com to access the MBA metrics research.
While the first article in this series discussed two key revenue metrics every practice should be keeping track of, this article will present two key metrics ODs should be monitoring in their dispensary.

DOWNLOAD COMPLIMENTARY E-BOOK:

8 Benchmarks ODs Need to Monitor in Their Practice

OPTICAL CAPTURE RATE

Showrooming has become a big problem for many eyecare practices. Patients are coming in and trying on frames in your dispensary, only to go home and make their frame purchase online. Evaluating this metric can help you determine if your practice is falling victim to showrooming.
You can look at this formula two different ways. Adding the results of these two formulas should give you 100 percent of your patients given a prescription. Let’s take a look:
Formula 1: Number of Patients who Filled their Prescription in your office / Number of Patients given a Prescription = Optical Capture Rate.
MBA Example: 44 Filled Prescriptions / 68 Prescriptions Given = 65% Capture Rate

OR
Formula 2: Number of People who didn’t Fill their Prescription / Number of Patients given a Prescription = Walkout Rate
MBA Example: 24 Unfilled Prescriptions / 68 Prescriptions Given = 35% Walkout Rate

Industry data, based on consumer surveys, indicates that independent ECPs perform 68 percent of all exams given, but sell only 44 percent of frame units. That’s how we got to the numbers used in the MBA example above. Close to one in three patients of typical independent ODs take their eyeglass prescription to be filled somewhere else, and this walkout rate represents a large loss of revenue for ECPs.
The MBA surveys also indicated that many ODs grossly underestimate the true walkout ratio of frame purchases by their patients. And relatively few ODs are taking the time to track their capture rate. While it’s uncertain for sure that all patients who don’t purchase frames from you are purchasing from another vendor, you can gain a reasonable estimate by tracking the number of frames dispensed and the number of Rxes given.
Survey data shows that patients take their eyewear Rx elsewhere, usually to a chain provider, for perceived reasons including:
• Lower price
• Better selection
• Better assistance from greater expertise of chain opticians
• More attractive merchandising of frames
• Greater focus of chain retailer on selling eyewear
If you’re unhappy with your practice’s capture rate, these are the areas you should be focusing on in your dispensary.

METRIC #2: INVENTORY TURNOVER RATE

Measuring inventory turnover rate in your dispensary is a simple metric to monitor, as most practices have easy access to the variables: number of frame sales in units and number of frames in inventory over the same period.
The Formula: Annual Frame Unit Sales / Number of Frames in Inventory Annually = Inventory Turnover Rate
*MBA Example: 1,603 / 890 = 1.8 Inventory Turnover Rate

Inventory turnover is highly correlated with practice size, so a single benchmark for all practices can be hard to determine. The median practice, measured by MBA, has an annual inventory turnover rate of 1.8, while practices grossing over $3 million had an annual turnover of three or more.

Larger practices have a higher turnover because a majority operate single locations and are able to offer patients more choices without increasing the number in inventory proportional to their volume differential, over smaller practices.
Keep in mind, a high frame turnover is not always a desirable goal. Frame turnover can be kept high if you have limited options available, which might be the case for higher-end dispensaries. But, having lower inventory can lower your eyewear capture rate. Typical ECPs carry 5-10 percent fewer frame options than they should to optimize patient selection.

Action Points to Fine-Tune Frames Inventory

Assuming your practice offers sufficient selection, a higher turnover can be achieved by:
• Regularly monitoring turnover of each frame and frame brand, and eliminating the number of frames with no unit sales in 12 months and slow-moving brands.

• Eliminating duplicative product lines.

• Limiting the amount of frames in storage and not on display to less than 5 percent of total inventory.

 

Related Review of OptometryArticles

Key Benchmarks to Track for Practice Profitability

Key Revenue Metrics for Independent ODs: Revenue Per Patient & Revenue Per Staff Hour

Top Metric to Track: Eyewear Rxes per 100 Complete Exams

THOMAS F. STEINER

Thomas F. Steiner, Director of Market Research for ROB, has spent more than 25 years helping eyecare practices succeed, including pioneering the introduction of color contact lenses into optometry. To contact him: tnlsteiner@comcast.net

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Metrics to Manage By: Revenue per Patient & Revenue per Staff Hour

Finance|Wealth, Practice Metrics & Benchmarks, Resources

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One of the most important management tasks in any eyecare practice is routinely tracking practice performance. Keeping a close eye on key metrics can reveal the successes, failures and opportunities. As CEO of your practice, you need to be on top of the financial health of your practice, and take corrective action to improve the areas of your business that may be falling behind compared to others. This is where key metric monitoring comes in.
VisionWeb produced an e-book, authored by Gary Gerber, OD, of the Power Practice;and Steve Sunder of VisionWeb, that includes eight key metrics deemed the most helpful in measuring the performance of independent optical practices. Their eBook, 8 Benchmarks ODs Need to Monitor in Their Practice, comes with a downloadable excel sheet that does all of the math for you! The eBook can be downloaded HERE.

DOWNLOAD COMPLIMENTARY E-BOOK:

8 Benchmarks ODs Need to Monitor in Their Practice

METRIC 1: REVENUE PER PATIENT

Revenue per patient is calculated in a few different ways, depending on if you want to determine revenue per comprehensive exam patient, or revenue per all patients (including medical eyecare treatment patients). Let’s take a look at both formulas below:
The Formula: Gross Annual Revenue / # of Annual Exams Performed = Revenue/Patient
*MBA Example: $659,736 / 2,156** = $306
OR
The Formula: Gross Annual Revenue / # Total Patient Visits = Revenue/Patient
MBA Example: $659,736 / 2,598*** = $254

The national performance of ODs on this metric is very slowly increasing, through inflation and the gradual increase in dispensing of new technology products. On top of that, there is considerable variation in gross revenue per exam across practices. The most productive 10 percentof practices see revenue per exam nearly two thirds higher than the median (see table below).

*MBA example numbers are based off MBA norms. MBA has not directly measured gross revenue per medical eyecare visit, but available data suggests that the average revenue per medical eyecare visit is roughly comparable to that from an eye exam visit.
**Assumes 1.1 complete exams per hour for ODs working 1,960 hours annually (49 weeks at 40 hours per week).
***Assumes 2,156 complete exams and 442 medical eye care visits (17 percent of total visits).

Shown above in the chart are MBA (US data) norms: The median is $306, but the goal to aim for is the higher amount achieved by the75th percentile of all OD practices in the database. The highest percentile achieves an even higher revenue figure.

Improving Your Gross Revenue per Exam

If your practice is falling below the median, there are opportunities to increase revenue per exam with little or no cash outlay through office practice changes. Many variables can impact gross revenue per exam, but ODs should focus on the following to help increase revenue per exam:
• Average eyewear sale/dispensing ratios for premium lenses and frames
• Eyewear capture rate
• Professional fees
• Eyewear retail pricing
• Multiple eyewear purchase ratio

METRIC 2: REVENUE PER STAFF HOUR

Monitoring revenue per staff hour will help you evaluate the efficiency of patient management by your staff, and can signal if your office is over- or under-staffed. The median staff hours and revenue in this calculation can vary depending on the time period you want to measure. Here we look at annual hours and revenue, but you could also measure this on a monthly basis.
The Formula: Gross Revenue / Annual Median Staff Hours = Median Revenue/Staff Hour
MBA Example: $659,736 / 7,949**** = $83

****Equivalent to four full-time staff members.

Revenue per staff hour is weakly correlated with practice size, and the norm for this benchmark hasn’t changed in over seven years of measurement! Sixty percent of practices have a revenue per staff hour ratio between $70 – $100. If you’re getting a revenue per staff hour over $100 you should review your workflow and determine if staff additions would improve patient service. On the other hand, if your practice is suffering from a low performance on this benchmark, it could be from:

• Over-staffing
• Low revenue per complete exam
• Active patient base too small to support staff
• Staff hours to OD hours ratio of five or more – indicative of an inefficient patient service process

Related ROB Articles

Top Metric to Track: Eyewear Rxes per 100 Complete Exams

Top Metric to Track: Complete Exams per OD Hour

Top Metric to Track: Gross Revenue per Complete Exam

THOMAS F. STEINER

Thomas F. Steiner, Director of Market Research for ROB, has spent more than 25 years helping eyecare practices succeed, including pioneering the introduction of color contact lenses into optometry. To contact him: tnlsteiner@comcast.net

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Metrics to Manage By: How to Calculate Chair Cost per Exam

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This final article of our three-part series on important benchmarks ODs need to monitor, looks at chair cost and expense ratios. All six benchmarks discussed in this series were pulled from a VisionWeb discussion of eight metrics optometric consultants Gary Gerber, OD, and Steve Sunder, of VisionWeb, deemed as important metrics to be tracked on a regular basis.

When we break down these benchmarks, we look at data drawn from the Management & Business Academy (MBA),a research program sponsored by Essilor. Over seven years, MBA gathered performance data from more than 1,800 optometric practices across the US. It has published the most comprehensive compilation of benchmarks currently available. You can visit mba-ce.com to access the MBA metrics research.

DOWNLOAD COMPLIMENTARY E-BOOK:
8 Benchmarks ODs Need to Monitor in Their Practice

In total, the benchmarks covered in this series have included:
• Gross Revenue per Patient
• Gross Revenue per Staff Hour
• Optical Capture Rate
• Inventory Turnover Ratio
• Chair Cost
• Expense Ratios
If you want to monitor these benchmarks, plus two bonus benchmarks, in your own practice, you can download VisionWeb’s e-book HERE.

Chair cost is an important metric for independent ODs, providing one basis to establish professional fees and make judgments about which managed care plans to accept. There are a couple different ways to look at chair cost. You can determine chair cost from the total number of annual visits, or total number of annual exams.
Formula 1: Fixed Costs / Complete Annual Exams = Chair Cost per Exam
MBA Example: $260,876* / 2,156 = $121 per Exam
Formula 2: Fixed Costs / Complete Annual Patient Visits = Chair Cost per Visit
MBA Example: $260,876 / 2,598 = $100 per Patient Visit

The first thing you need to do in order to determine your chair cost is to calculate your fixed costs. You can calculate your fixed costs by subtracting your operating expenses, your doctor payroll, and your net, from your gross income. From there, you will divide your fixed costs by the number of complete annual exams, or annual patient visits, to get your chair cost.
MBA norms calculate a chair cost of $100 per patient visit. The most important thing here is making sure that your chair cost is lower than your insurance reimbursement.
*Fixed costs were determined by this formula: Gross revenue minus OD compensation minus Net minus COG.
MBA norms calculate a chair cost of $100 per patient visit. The most important thing here is making sure that your chair cost is lower than your insurance reimbursement.

METRIC #2: EXPENSE RATIOS

Monitoring expense ratios helps ECPs develop annual budgets and evaluate opportunities to raise net income by reducing expenses. The MBA has published expense ratios for the major expense categories that all independent ODs face.
The Formula: (Expense / Revenue) x 100 percent = Expense Rate to Revenue
MBA Example: (Cost-of-Goods): ($191,323 / $659,736) x $100 = 29% of Revenue

Typical expense ratios vary by practice size. In general, larger practices have somewhat lower ratios for cost-of-goods, occupancy, and general overhead expenses, but somewhat higher staffing ratios. The result is that larger practices, on average, enjoy net income ratios 10-15 percent above the median for all practices.

THOMAS F. STEINER

Thomas F. Steiner, Director of Market Research for ROB, has spent more than 25 years helping eyecare practices succeed, including pioneering the introduction of color contact lenses into optometry. To contact him: tnlsteiner@comcast.net

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Key Financial Metrics to Track–and Improve–for Profitability

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One of my favorite expressions is “measure twice and cut once!” These words of wisdom have been a mainstay of the construction industry for years. If you double-check your measurements, it is less likely that errors will occur and the business will be more profitable.
This business philosophy can also apply to an optometry practice. It is important to measure the financial key metrics of a practice in order to maximize the NET income and ensure an efficiently run business.
Here are the Hayes Center for Practice Excellence’s 7 Key Financial Metrics and how my practice has benefited from measuring and monitoring these financial benchmarks.
How do you measure the 7 Key Metrics?
The use of a computer financial software program has made the reporting of financial metrics much easier. We use QuickBooks by Intuit for all of our bill paying and deposits. At the end of each reporting period, my business manager generates a profit and loss statement with “percentages of gross income” selected in the reporting criteria section. Some initial work is required to set up the categories in QuickBooks based on deposits and payments to vendors and suppliers during the reporting period.

IDENTIFY KEY METRICS

 

ET SPENDING GOALS

Cost of Goods Sold COGS (26 percent-32 percent) – The Cost of Goods sold category is always the highest single expense in a traditional optometry practice. The following items should always be included in your Cost of Goods:
• Lab bills, blanks, uncut lens blanks
• Frames and cases
• Fair allocation for lab floor space
• Lab equipment, edger, surfacing equipment, dye unit
• Pro rata share of optician’s salary (excluding labor as a COGS is a common mistake)
Staff Expenses (18 percent-24 percent) – The second largest expense for traditional practices is what it costs to employ and support your staff. Staff expenses does not include the salaries paid to employed ODs; that goes under Doctors’ Net Income. Staff expenses also does not include wages for lab employees who cut, edge or surface lenses. Those wages go under the Cost of Goods category. Staff Expenses includes the following:
• Salaries
• Payroll taxes
• Uniforms
• Insurance
• Continuing education and other training
Occupancy Costs (5 percent-8 percent) – If you own your building, treat yourself as the landlord and your practice as the tenant who rents from you. Be sure the practice pays you fair market rent even if the building is paid off. Otherwise, you will be personally subsidizing the overhead of your practice in our profitability model.
While rent and interest are tax deductible, principal payments are not. The total you are spending to occupy your office is what counts, not how much you write off. The following are all considered occupancy costs:
• Rent
• Property taxes
• Utilities
• Maintenance
• Janitorial
• Insurance (property)
Examination Equipment (3 percent-5 percent) – Your examination equipment includes not only the equipment, but also the expenses associated with the equipment such as:
• Leases
• Interest on Loans
• Depreciation
• Service Contracts
• Maintenance
Marketing and Promotion (1 percent-2 percent) – Marketing expenses are highly discretionary. Interestingly, low-netting practices tend to spend more on marketing than high-netting practices. However, this does not mean that low-budget advertising is the way to go. The effectiveness of low-budget advertising is questionable. Things you should include in marketing and promotion are:
• TV, radio, and newspaper advertising
• Direct mail advertising
• Yellow Pages listings (However, this cost is often lumped in with the phone bill.)
• Web site
• Recall Services
• Web Review Site fees (Yelp, etc.)
General Office Overhead (6 percent-9 percent) – This category will include all other expenses you have for running your practice. It should include things such as the following:
• Front office equipment
• Phone
• Postage
• Legal fees
• Accounting fees
• Dues
• Subscriptions
• Insurance
• Office Supplies
Doctor’s Compensation (30 percent+) – The last item on the Hayes Seven Key Expenses is doctor’s compensation. Hopefully, this will be your largest percent of gross. This compensation would include:
• Salaries for the owner and any employed ODs
• Heath Insurance and Other Benefits
• Corporate Profits
• Pension and Profit Sharing
• Personal automobiles
• Cell Phone

SET PERFORMANCE GOALS

What made you change the way you look at your practice finances?
One of my job responsibilities at Southern College of Optometry is Director of the Hayes Center for Practice Excellence. I teach current and future optometrists the business side of practice. This provided me with the opportunity to enter into a Master of Business Administration program at a local university. My practice was struggling with its profitability and I was also looking for answers. The completion of the MBA degree taught me how to better manage the business side of my own practice. I can now share this knowledge and my experiences with students and fellow practitioners.
What are some of the variables that can affect the key metric percentages?
The first variable to look at is your fee structure. If fees currently charged for professional services, as well as materials, are too low, then the resultant key metric percentages will be significantly affected. This may signal the need to raise fees to compensate for increasing costs and expenses. Our practice had gotten complacent over a 3-4 year period and did not raise fees. This resulted in a steady decline in our NET income. We initiated a review of our current fee schedule and raised our professional service fees over a two-year period. Ophthalmic material fees were also adjusted where needed.
The other variable to examine is expenses. As mentioned in the breakdown of the Hayes 7 Key expenses, Costs of Goods sold and staff expenses are the two biggest expense categories. I personally feel that a staff that is efficient and productive should be well compensated, so I don’t have a problem with staff expenses being on the high side of the 18-24 percent range. Our staff expenses are 24 percent and they are very dedicated and hard working! Assuming the practitioner is doing a good job managing their operating expenses such as occupancy costs and equipment expenses, COGS is the category that deserves the most attention and can have the greatest impact on your bottom line.
What about Managed Care?
There is no doubt the increase in the number of managed care vision plans has affected the profitability of many optometry practices. Lower reimbursements can translate into lower collected gross receipts and lower NET income for the doctor. There are ways to battle this giant! Increased use of staff delegation and improvement in patient flow through the office can result in improved efficiency, and thus, more patients can be seen during the work day. But other changes may be needed to maximize the practice NET income. Better optical material purchasing decisions along with policies controlling other office expenses need to be in place. We scrutinize all purchases in the office and compare prices before a decision is made. We also use a manageable amount of good debt when purchasing major equipment and make lease hold improvements. By measuring the key financial expenses regularly and running your practice like a business, managed care can be beneficial to many optometry practices.

How did measuring your practice improve the bottom line?
After setting up our QuickBooks accounts and measuring the expense categories, we found our COGs percentages were significantly out of line with the Hayes Key Metric suggested goals. We made a change in our office manager and frame buyer and empowered a new trusted employee to correct the COGS problem. By doing this, our office reduced the COGS percentage in a short period of time. Our new office manager/buyer was given a budget and began the task of reorganizing the frame inventory and examining the ophthalmic lens and contact lens expenses. She eliminated some of the frame companies that had poor customer policies and this allowed us to increase our bargaining buying power. Our new office manager also attended education courses on frame board management and merchandising. Negotiations with ophthalmic lens suppliers also helped with margins. Contact lens purchases were more closely monitored and product returns expedited in a timely manner. In other words, the entire practice mentality changed and resulted in a significant increase in the net income.
How was your new office manger compensated?
Part of the new office managers/buyers salary compensation package was a merit-based bonus based on the improvement in the NET income. As a result she received a sizeable bonus, but more importantly, the doctor’s NET income was significantly improved.
Improve YOUR Practice’ s Profitability
I would make a couple of suggestions to my colleagues. Enroll in a business course at a local college or university. This additional course may provide a fresh new way to look at the financial health of your practice.
Another helpful change I made in my practice was joining an optometry peer group. It allows for the sharing of practice ideas and additional practice management education. I would strongly recommend a practitioner join one of these groups.
But the most important suggestion I can make is measure and measure again! Take the time to set up a financial software program and begin to measure the Hayes 7 Key Financial Metrics. You may discover an expense category that needs addressing or maybe that fees need to be increased. You won’t know this unless you take the time to measure the metrics and evaluate them!
If you measure these key metrics, you may be surprised to find out how successful or problematic your practice may be. Even if your efforts increase the practice NET income by 1 percent, the profitability of an average $600,000 practice will increase by $6,000….and no one would be upset about that!

Related Review of Optometry Articles

Advice for New and Experienced ODs: Understand Essential Business Concepts
Getting There: Planning a Successful Optometric Career
Practice By the Numbers: Track Your Key Expenses

GERALD A. EISENSTATT, OD, MBA,

GERALD A. EISENSTATT, is director, Hayes Center for Practice Excellence, at the Southern College of Optometry. Dr. Eisenstattalso is the owner of his own independent practice, Memphis Family Vision in Memphis, Tenn. To contact him: geisenst@sco.edu

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Cornucopia of Practice Prosperity Tips

Practice, The Patient Journey

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KEEP THE SMALL PROMISES

If your patient is seated and hears your staff say, “The doctor will be right in to see you,” yet it takes 15 minutes before you enter the exam room, your patient may wonder if this failure to meet expectations pervades into other areas of service. With this in mind, if the little promises aren’t met, don’t be surprised if your patient feels uncertain about buying those $500 premium progressive lenses. So, as a team, set realistic expectations for your patients and aspire to meet or exceed them with consistency.

FERTILIZE THE FLOWERS SO THEY CROWD OUT THE WEEDS

Your practice is like a garden. You want flowers, not weeds. Some patients are like weeds in their behavior, yet it’d be inappropriate to kill them by spraying Roundup. In these cases, the better approach may be to water and fertilize the flowers (the good patients) so they grow and crowd out the weeds (the bad patients). I’m not saying to be rude or to offer poor service to the weeds, but refrain from going above and beyond in service because you don’t want to encourage them to refer their friends, family and co-workers, who will likely have a similar demeanor to them. Sure, you can also dismiss a patient, akin to pulling out a weed. Yet indiscriminant dismissal of patients can unnecessarily inflame feelings, especially if these patients were already not planning to return.

DIRECT ATTENTION WHERE IT’S NEEDED

Have you noticed how young children often do not know how to react to the air puff tonometer until looking at their mother? If the mother is fearful and communicates this to her child, even if non-verbally, it can make it difficult for your assistant to obtain a measurement. Yet if the mother’s expression is nonchalant, as if it’s no big deal, the measurement is often readily obtained. Similarly, adult patients look to their doctor to know how to respond in several instances. If you ask your new contact lens wearer, “Are you having any problems?”, rather than, “How are you enjoying freedom from glasses?”, you may accidentally train your patient into looking for problems and being overly critical and turning into an unpleasant whiner. In the same way, if you spend a significant amount of time discussing the change in the numeric value of the patient’s glasses prescription, you may misdirect attention from the patient’s need for UV protection due to pingueculae and an incipient cortical cataract.

BUILD VALUE BY EDUCATING INCREMENTALLY

Throughout the patient care cycle, there are opportunities to incrementally educate the patient on the value of your practice’s service. Instead of your reception staff just telling Mrs. Jones to, “Please fill out this welcome form,” make sure the patient also hears, “… because it helps us better serve your needs.” During the preliminary exam sequence, don’t just have your technician say, “Put your chin here,” but also have the patient hear, “This instrument measures the fluid pressure in the eyes, which can help the doctor diagnose eye health problems.” It doesn’t take much additional time to build value with short explanations, and doing so can make patients feel much better about their exam and for selecting your practice.

UNDERSTAND YOUR PLACE

You are an optometrist–not a rock star, celebrity or sports icon. I’m sorry to break it to you this way, but this means that few of your clientele truly want to follow you on Facebook and Twitter. The reality is that optometrists are closer in this realm to gynecologists and psychiatrists, as there isn’t much organic consumer desire to follow these professionals through social media. Therefore, while you need an online presence, realize that your time and attention is still best directed toward patient care and the patient experience, rather than digital expressions of narcissism and self-promotion. Providing a high level of consistent service is arguably still the most powerful form of marketing since your delighted patients will promote your business and serve as practice ambassadors.

PURSUE A SMALL NUMBER OF GOALS AT ONE TIME

In your strategic planning for 2015, make sure that you set a realistic number of goals. In the field of psychology, “goal dilution” describes how the more goals you have, the less likely each of them will actually get done. So, at any given time, prioritize the top three initiatives, but probably not more than that, and concentrate and expend enormous effort to implement them and see them through.

BRIAN CHOU, OD, FAAO

Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.

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Install a Referral System–and Track Your Growth

Marketing, Practice, Resources

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When new patients come in, we ask how they came to us, and an average of 50 percent are friends of patients, and 65 percent are family of patients. Surprisingly, about 25 percent come from search engines, and the remaining from insurance lists, and passersby. Before the advent of search engines and social media, our second-largest source of referrals were insurance provider lists.

Tracking referrals from patients to friends and family, and delivering service that impresses patients enough for them to spread the word about us, continues to bring new patients into the practice.

We started our practice cold 28 years ago. We started with the referral of our very first patient by a friend of a friend. Since then, we have always placed a high value on referrals. I believe it is the best way to bring in patients who are most likely to be loyal over time. We make a concerted effort to treat each patient like our only patient and try to make everyone feel like family.

The patient intake form Dr. Smith makes available for patients on her practice web site.

Dr. Smith says it’s important to ask new patients how they found your practice, and to encourage those who had a positive experience to let their friends and family know about your services.

USE EVERY OPPORTUNITY TO ASK FOR REFERRALS

Many patients make comments like, “I should bring my husband/wife in” or “I should bring my kids in.” This reassures us that we did a good job of marketing our practice during their visit because they want their family and friends to have the same experience.

When a new or existing patient calls for an appointment, our front office staff asks if there is anyone else in the family we could help make an appointment for. If a patient expresses appreciation for a job well done, then our staff says, “Thank you! It has been our pleasure, and if you or any of your family or friends need our services, we would be happy to help them as well.”

To increase the likelihood of people wanting to tell their friends and family about a business, that business should excel and stand apart from the norm. People vary in what things and experiences may impress them most. However, If you look at the most successful businesses, especially service-oriented businesses such as restaurants, hotels, and healthcare practices, it is undoubtedly the service that drives the most referrals.

Our practice mission statement is “Focused on your needs. Committed to excellence.” Our goal is to have our patients tell others that they had excellent, thorough care and that we provided great service.

We e-mail thank you notes and surveys to every patient after their exam. We currently have a 95 percent satisfaction rate with a “yes” when asked if they would refer others.

TRACK CONSISTENTLY

For the past 23 years, we have tracked where our patients come from. We have a Welcome Sheet, which we ask every new patient to fill out. If the answer to the question of how the patient found us is left blank, the front office staff is responsible for asking the patient directly. On the rare occasion that the response to that question is still blank by the time the patient reaches the exam room, I ask the patient directly myself. It is really a pleasure to hear that most of them are referred by friends, work colleagues and family members.

OFFER EXCEPTIONAL SERVICE & SAY THANK YOU

In California, where our practice is based, it is illegal for any healthcare professional to offer incentives for referrals. However, we make sure our patients are thanked and appreciated verbally for their referrals.

By focusing our efforts on providing exceptional care and service to our patients, we hope to earn their loyalty and the referrals of their friends and family. You can’t put a price on service and building relationships with patients. It is like putting a price on friendships. I believe that as old fashioned as this may seem, building a practice based on loyalty and referrals is far less expensive and time consuming than the cost of any type of ad marketing or media advertising. Our practice has not had much response from paid advertisements. It may be that the public does not respond to objective ads anymore with the advent of more subjective, personal internet ratings.

We used to have a large ad in the yellow pages, which was astronomically expensive. It was a big book of large ads for businesses, which made it difficult for consumers to decide where to go for services. Now, with internet reviews that are free for consumers to use, we virtually have free advertising by the reviews placed by our patients.

Approximately 25 percent of our new patients find us directly through internet search engines and reviews.That is a lot more than the number of patients who came in after seeing our yellow page ad, which was only about 5 percent.

RELATED ROB ARTICLES

Reach Out & Serve Hispanic Patients

Cultivating Patient Loyalty: Five Steps to Success

Five Ways to Ensure that Patients Return

TRAIN STAFF TO OFFER A MEMORABLE EXPERIENCE

The majority of patient referrals are from happy, satisfied patients who report having had the most thorough exam, or best service, ever. We also receive many referrals from long-time patients. Other popular referral sources are patients who have not received successful contact lens fits elsewhere. Many refer their friends, colleagues and family members simply because our staff has shown them great customer service, and were able to develop a strong rapport with them.

I cannot over emphasize the value of a well trained staff in order for patients to want to refer others. The staff actually spends more total time with our patients than the doctors, so it is imperative that our staff is on board with our goals and objectives for growing the practice. Patients will stay with a practice or leave a practice very easily because of their interactions with the staff.

TAKE OPPORTUNITY TO PASS ALONG PRACTICE BUSINESS CARD

When a patient compliments our office, a front office staff member might give them a business card and say, “Thank you so much! We appreciate your compliment! Please take a business card in case you know someone who may need our services.” Most of the time patients take business cards, or ask us for our business cards, without any prompting, and this is really the best compliment they can give us!

BEVERLY JUE-SMITH, OD, MBA

Beverly Jue-Smith, OD, MBA, is the owner of San Ramon Family Optometry, Inc., in San Ramon, Calif. Dr. Jue-Smith also is owner of Optometric Consultants, a private practice consulting firm. To contact her: srfoptometry_drb@yahoo.com

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Incorporating Vision Therapy Into Your Practice

Practice, Resources, Specialty Practice

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Vision therapy is a richly rewarding aspect of optometric practice. It provides opportunities to make a positive difference in the lives of old and young alike as you to equip them with the tools to learn, socialize, and achieve their dreams.
It also happens that vision therapy is a powerful practice-builder for an optometric practice. The strong family bonds you form in working with children and their families can provide numerous referrals that can grow your patient base exponentially.
In order to succeed in incorporating this optometric specialty into your practice, you need to acquire training and skills in the clinical aspects of vision therapy—and you also need to develop a professional network that provides you with a growing patient base. In this series of videos and links to resources, Review of Optometric Business provides a primer on “Vision Therapy: How It’s Done!”

Acquiring the Tools to Practice Vision Therapy”
To learn more about vision therapy, begin by building your knowledge base and skill level through a host of resources. >>Click HERE to View>>

“Vision Therapy: A Great Practice Builder”

If new in practice, or even if you are established, vision therapy offers growth opportunities. It is a revenue-builder as a fee-for-service specialty. It also is a strong generator of referrals for a patient population (children and young families) that often has yet to choose an eye doctor. Remarkably, one successful case in vision therapy can provide up to 50 referrals. >>Click HERE to View>>

“Key to Referrals: Work with Occupational Therapists”

To generate referrals, work closely with the occupational therapist that a child may already be working with. Inquire about this at intake, then ask the parent for consent to contact the therapist. The key is to work as a team with other professionals for the good of the child. Once you establish working relationships with occupational therapists, their influential referrals to your practice will prove to be a powerful patient-base builder. >>Click HERE to View>>

“Plan to Expand…and Offer More Services”

When you succeed with vision therapy, the need to expand comes quickly. Think ahead toward bringing in associates to provide more services and meet growing needs. Your alma mater or nearby optometry school may prove a fertile source of associates who share your values and work ethic. Further, in this mobile society, patients frequently move, and new potential patients move to your area. AOA resources can help you to locate and recommend capable optometrists who provide vision therapy in other areas of the country—and can help other optometrists to find you and refer families to your practice. In addition, embrace the AOA InfantSEE program to serve a vital need and build your practice in the process. >>Click HERE to View>>

“Caring for Children: Helping Kids to Be the Best They Can Be”

In our society, children are greatly underserved when it comes to eyecare. By offering a comprehensive eye exam to the young, you can spot vision conditions that, if left untreated, can result in a child being labeled learning disabled—and this can hold them back in life. In many cases, vision therapy can turn that around. Equip yourself to give a child the visual tools that enable them to be a great student. >>Click HERE to View>>

ANDREA P. THAU, OD, FAAO, FCOVD

Andrea P. Thau, OD, FAAO, FCOVD, is founder of Dr. Andrea P. Thau and Associates in New York City. She is an AOA Trustee and past president of the New York State Optometric Association. To contact her: APThau@AOA.org

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Marketing by the Numbers: Measure Often for Success

Advertising & Promotion, Finance|Wealth, Marketing, Resources

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Many practices have marketing plans, but too few regularly measure the performance of those plans to see how effective they are. Establishing benchmarks and taking regular performance measurements can maximize your ROI (return on investment). Without such measurements–and without adjustments to fine tune the plan–you’re just conducting a guessing game. The key is to measure what works and what doesn’t, then you can home in on the right marketing formula to increase revenues and profits.

IDENTIFY MARKETING OPTIONS
Calculate and Track Marketing Campaigns
to Prioritize Marketing Spend1. Calculate cost of campaign.2. Calculate expected return on investment.3. Track activity related to marketing activity to determine how much money is coming in. Here is a formula to use to help determine ROI:Cost of marketing event or campaign X .33 = how much money you need to generate from the event or campaign just to break even.Example: Trunk show that costs $2,000 to market and organizeAssuming an average profit margin of 30 percent and a campaign, then you’ll need to generate at least $6,000 to pay for the campaign–just to break even: $2000/.33 = $6,000. Therefore, the trunk show used here as an example would need to generate at least $6,000 in revenues to yield $2,000 in profits–the amount you invested in the event. Otherwise, it is not worth to investing in. Of course, you want to make a profit and pay for the campaign so in this case you might want to generate $8,000 from this trunk show–yielding $2,400 in profit or $400 more than you invested in the event.4. Prioritize which marketing campaigns are worth investing in long-term based on which generated a return on investment.

Patient communications.Use e-mail, Facebook and other social media to deliver your messages.

Events. Host regular open houses/ frame trunk shows. Advertise in advance.

News event. Leverage a news event to contact your patients. Announce the addition of new equipment, products, services or staff.

Newsletter. Do monthly e-mail newsletters. Newsletters should be educational. Include an action that encourages patients to come in or call your office.

Business cards. Give your staff their own business cards with their name on it to hand out. This encourages them to meet people in the area.

Unique feature. Set yourself apart by offering a unique customer value added feature that also serves as a marketing piece. For example, some doctors offer chocolate bars with their name and logo.

MEASURE RESULTS BY MONTH
Actual
Minimum (promise)
Stretch Goal
Marketing costs
Number of leads generated
Sales (gross collections)

Take into Account Total Costs
The marketing costs measure only the direct costs related to the campaign: printing, food and entertainment. They do not include labor, rent or other general overhead costs. We also exclude cost of goods, and this is a function of the total gross sales. However, the sale price offer or promotion should be higher than your cost of goods. Also, any discounts on sales items could affect the profit and change your profit margins (break-even amount). Tip: Package materials in your promotion so the combined profit is still maintained. For example, discount frames only if combined with high-index lenses or a pair of sunglasses.

Evaluate the campaign every three months if a recurring event.
If the campaign spans a longer time period, measure results on a weekly basis.

Constantly evaluating the success of marketing via thorough measurement makes it more likely these efforts will result in more patients in your exam chair.

Related ROB Articles

Practice Opportunity Costs: Build, Buy or Start-Up?

2011 a Boom Year in Practice Sales?

How to Compute Net Cash Flow

ALISSA WALD, OD

Alissa Wald, OD, and her husband, Scott Daniels, own Practice Concepts, a firm that provides practice sales and coaching services. To contact them: 877-778-2020 or scott@practiceconcepts.com.

SCOTT DANIELS

Alissa Wald, OD, and her husband, Scott Daniels, own Practice Concepts, a firm that provides practice sales and coaching services. scott@practiceconcepts.com.

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