How small-footprint optometric practices can maximize profitability?

In small optometric practices, our success hinges on efficiency — the ability to optimize what we have, including our time. We do not have an abundance of space, doctors and staff to rely on volume alone.

I am the only full-time doctor in my practice. With two part-time associates, we keep two exam lanes going to see 15 to 18 patients apiece per day (30 to 36 total). That’s a pretty high volume for a practice our size. Our staff is small as well, with just four full-time employees and some part-time clerical help. The practice’s physical size is 1,400 square feet, including the exam lanes, waiting/optical area, pretest room, staff office and contact lens storage.

With declining reimbursements for exams and contact lens fittings and limited space for expansion or large equipment, we have had to maximize our profitability — not just per doctor or per patient but also per square foot. Here is how we have managed to maintain a thriving practice.

Private pay dry eye services

Dry eye disease affects about half the patients in optometric practices, so the demand for treatment is strong. In my opinion, the best help I can give them goes beyond what is covered by insurance, so it is a natural place to offer cash services.

We begin with a complete dry eye consultation, which has a cash fee. We review medications, health conditions, environmental challenges and makeup use, as well as what patients have already tried and how it has or has not worked. That information allows us to set up tailored treatment plans.

When the in-office, Lumenis light-based treatment was FDA approved for managing dry eye disease, we purchased OptiLight and began offering this private-pay procedure to patients with meibomian gland dysfunction and ocular rosacea. OptiLight has a small footprint, and we can use it in either exam room. Each patient has four initial 15-minute treatment sessions, which we set up in blocks for efficiency (one morning and one afternoon per week).

A tech helps me speed up prep and cleanup, but I can also easily do it alone if needed. In addition to helping our existing patients, our OptiLight has differentiated our optometric practices and produced a revenue-building number of referrals from both optometrists and ophthalmologists. Patients come from hours away, because we are the only optometric practices in the region that offers this treatment.

Along with these private pay aspects of dry eye care, we look for reimbursable tests and treatments that easily fit into existing visits. For example, we perform manual expression after OptiLight and do a lot of anterior segment photography for dry eye patients. We are currently evaluating the possibility of using InflammaDry (Quidel) or the TearLab Osmolarity System (TearLab), which not only would help us make dry eye treatment more customizable and easier to track, but also would provide a small reimbursement.

Lean optical strategies

Aside from dry eye, my optometric practices derives the biggest cash revenue from a few key optical strategies. Overall, because our waiting/optical area is not the biggest in town, we need to be strategic in our choices. Our optical manager is brilliant when it comes to not just following which styles are trending but also which ones are popular in our area. We sell a lot of the popular frames she selects. And she knows our patients so well that she can look ahead in the schedule and make sure we have the kinds of frames specific patients prefer in stock and ready for their visit.

We make it our goal to sell multiple pairs of glasses to each patient — one all-purpose pair and one pair of computer lenses or sunglasses. Twice a year, we do a trunk show eyeglass sale, partnering with a local med spa for a pop-up Botox (onabotulinumtoxinA, Allergan) clinic. We usually get new patients from this promotion as well as additional revenues. For contact lens wearers, we offer a free pair of polarized sunglasses for every 1-year supply of daily disposables. We keep the sunglasses in a variety of men’s and women’s styles that we purchase through a preferred vendor at minimal cost.

Experienced staff

Smart, experienced staff are a small practice’s best friend. We could not be profitable without them. In our patient flow, patients get an email directing them to our patient portal to fill out preliminary medical and insurance information, reducing tasks for the receptionist and shortening patients’ wait time. Staff also prepare in advance by checking the next day’s schedule, noting what each patient will need and who is eligible for new glasses. (Those who are not eligible are offered a cash discount.) When patients arrive, if they do need to wait, the optician gets them started with frame selection before their exam. Next, our technician does all the pretesting and inputs the data into our system.

By the time I see a patient, I have all the information I need. We discuss their goals and how they use their eyes all day, which allows me to customize their prescription. I want to make sure they feel they are receiving a good quality exam and not getting rushed. We can even slip in urgent visits more efficiently, because scheduled exams go so smoothly. All these strategies allow us to truly optimize our time and space for each patient, so we can be profitable while offering the finest care.

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