“Money……it’s a gas….” Pink Floyd

Last month, I reviewed my own approach to building value in optometric practice. The goal is to get patients to return year after year, with their hopes of attaining the best current quality care and perhaps to learn something new in the process. I described a mostly interpersonal approach, where we might emphasize relating to the patient’s needs over all else. This is a bedrock that is hard to shake.

Does this have to be the only approach?

It strikes me that this “value” proposition has as many meanings as there are doctors who take it on. Apart from what I do, what options are out there?

Uber-Technology.  Some of our practices take a very technological angle in patient care. 

We have so many instruments now, with formidable challenges in getting best utility. 

Applying the impressive array of computer-analyzed scans via laser, ultrasound, and simple light can dazzle the patient. Perceived value can be very high on the patient’s part. I know of practices that accomplish this beautifully, yet we frequently see new patients who have been frustrated with the approach. 

My question here is the clinical value of high-technology testing as screening tools in the absence of suspected disease.   

Spurious results are inevitable. 

You’ve got some explaining to do when the test’s false positive rate is greater than the chance that the patient actually has the disease in question. Similarly, normative databases can raise concerns with a patient’s findings, when no pathology is present.

Then there is the economic aspect.

Does the “screening fee” subconsciously chew into the patient’s unspoken budget for that year, thus affecting eyewear purchases? 

Do we sense that the equipment company is calling the tune, based on high cost, servicing, and incompatibility with the next great model? Frustrations expressed on ODs on Facebook would indicate that these are significant issues.

Aside from the issues mentioned above, the technologically oriented practice does set a high bar for itself in human terms. Patients want to know what’s been done, and why, and what to do about the results. Does the doctor relate findings well, in terms of the implications for the patient? Our office regularly sees patients who complain that this was not the case at the previous practice. The common refrain is, “I had all these electronic tests, and nobody spent time with me to explain.” Patients are often intimidated by gadgetry and are reluctant to say so. However, if you can meet this high bar with a caring approach, it is a legitimate method.

Best economy.  One of the larger corporate practices touts that it provides the cheapest eye exams and eyewear available. Is this a viable model? It certainly is, based on the company’s place among the top eyewear retailers in the U.S. 

The grim reality is that many Americans don’t have solid insurance, and perhaps none, so the routine eye exam becomes an economic burden. 

The discounting approach, whether corporate or private, provides vision care that might not otherwise be afforded. Quality arguments are understandable, but in real terms, it often comes down to budget exams and eyewear, versus none at all.

I grew up in a blue-collar family, and had we not had great insurance, we would have taken this approach. Economists talk about the “income gap,” and despite a strong economy, there are many Americans who lack disposable income for things like prescription eyewear. This is far more than a niche, with needs filled by many optometric practices.

The Salon.  I have several friends who take this approach to practice. The rules are low volume, relatively high fees and materials charges, and tight leashes on accepted insurance plans.

The Salon practice a winner of an approach for the right doctor, though the stresses of an “off” day can be agonizing. 

Those holes in the schedule can be devastating, as per patient revenue is higher than that of the average practice. On the other hand, the lower volume may make doctor and staff feel challenged by the emergency call or insistent glass check.

These doctors tend to love what they do, and they relate it to patients and community.  The challenge is indeed the recruitment of new patients, which obviously has to be word-of-mouth in nature. I’ve come to enjoy the faster pace of the OD/MD practice, and would find the salon practice timeline to be challenging by itself!

These practice modalities don’t exclude one another, as hybrids do exist. Where do you and your practice fit in?