Progressive Focus©

Progressive Focus© Newsletter


Volume 4, Number 2 Summer, 2003
Helping You Manage the Expectations of Managed Vision Care

In This Issue:

More On Understanding And Increasing Patient Satisfaction

The way to higher levels of patient satisfaction in the optical dispensary is not always obvious

In the previous issue of Progressive Focus© I discussed the mechanics of designing and implementing effective patient satisfaction surveys. Obviously if you don't know how your patients feel about the services they receive or the way they're treated you can't plan and execute appropriate corrective or supportive action. And if you don't know how to ask the right questions you're unlikely to discover the true nature of any patient issues, good or bad.

Also in the previous issue we presented a guest commentary. Dr. Edlow's perspective on increasing patient satisfaction in the optical dispensary centered on a simple, straightforward premise: Premium products = patient satisfaction = financial growth.

Many optometric practices don't seem to appreciate this, particularly practices with a large percentage of managed care patients. Far too often when these patients present with defined eyewear benefits (e.g., a frame and a set of lenses every 24 months) doctors and staff seem almost resigned to accepting the deeply discounted third party reimbursements as all they're going to get for their hard work. And in doing that the practice sacrifices or dramatically reduces its chances to profit from the sale of premium product to a large slice of its patient population. Those opportunities should not be missed.

In this issue we'll explore this dilemma and offer suggestions on ways you can simultaneously increase patient satisfaction and grow your bottom line.

Misperceptions Can Be Costly


Be not swept off your feet by the vividness of the impression, but say, "Impression, wait for me a little. Let me see what you are and what your represent. Let me try you."

Discourses, Book 1

It's a bit bewildering that optometrists and staff would perceive that most managed care patients typically want only what's covered -- the "free" glasses provided by their vision plans – and, further, perceive that most of those patients don't want to hear about paying out of pocket for anything.

Sadly, as a consequence of such misperceptions, many practices do not present and discuss the benefits of premium lenses and/or lens treatments. And that means lost opportunity to increase patient satisfaction and generate profits.

My Experience is Quite the Opposite

I have found that most managed care patients are savvy consumers. Sure, there are some exceptions – patients who inexplicably ask for their Rxs so they can use a coupon at one of the chain opticals even though doing so will cost them more out of pocket than using their benefits in your dispensary. But, thankfully, most do know or will quickly appreciate when shown how they can maximize the value of those vision benefits by upgrading to something better.

Savvy patients and "tuned-in" eye care professionals will use those basic vision plan benefits as a starting point, not as the end point. Top practices will understand how to ask the right questions, elicit meaningful answers, and cause patients to lead themselves to the best possible solutions for their individual visual needs.

The Strange Dichotomy In Vision Care

Dr. Edlow hit it on the head when he described a fascinating dichotomy (some might even say a professional failure) in the vision care business. He wrote that on the one hand: "…because eye care providers fear charging more, they often may fail to recommend the highest quality vision products for their patients." On the other hand he opined: "My observations lead me to believe that patients who spend their money on the finest of frames, thinnest and lightest lenses, newest generation anti-reflective treatments, and best progressives are highly satisfied and motivated patients. They routinely spend more and, significantly, they refer more often."

Now, isn't that interesting? Because they fear charging a higher price and, possibly, upsetting a patient who's somehow been judged to be super price-sensitive, some vision care professionals don't discuss premium lenses.

In trying to be the "nice guy" they actually may fail to do the best possible job addressing each patient's visual needs. Yet those who do not pre-judge their patients' pocketbooks and do not misperceive the factors that are important to each patient when assessing his/her visual quality find that the results of presenting premium product and "selling-up" are happier patients and healthier bottom lines.

The Managed Care Patient's Mind-Set

What do typical managed care patients want or expect when coming to your office for vision care services? Do most have realistic or unrealistic expectations of what their vision benefits include, and at what cost to them? Does he really expect to walk out with "free glasses"? Does she really think that "free glasses" means any frames and lenses?

I believe that while some small number may present with ludicrous expectations, most patients do realize that the door to the candy shop is not wide open – there are plan-defined limits on eyewear benefits. However, it's clear that many employers and health plans have done a poor job educating their employees and Members who, not surprisingly, may have an inaccurate understanding of what is and is not a covered benefit. And if not properly "plugged," that educational hole can lead to patient disappointment and dissatisfaction when financial perception and financial reality meet at the dispensing table or check out counter.


Educational relations make the strongest tie.

Cecil Rhodes
His will, establishing the Rhodes Scholarship

It's not unusual that, on occasion, a patient will be surprised when told anti-reflection coating is not covered and will cost an additional "$X." And a patient might be upset or even angry when told that the plan covers basic progressive lens "Q" for a nominal co-pay, but premium progressive "Y," recommended by the optician, will cost something more.

And so the educational process comes into play. And that process must be handled carefully, professionally, but unashamedly. Selling-up is not wrong if there's benefit to the patient.

Where the practice can create problems is in those situations where clear, patient-centric recommendations are replaced by high pressure, hard-sell tactics, and a patient may feel as if the doctor or optician is simply trying to get into his/her wallet.

Every Practice Has Its "Joe"

Now certainly a few third party patients do not want to pay one cent out of pocket. They're simply not interested in the benefits of premium lenses or lens treatments.

When I was managing dispensaries that patient was "Joe." Every year Joe's vision plan paid for a frame and a set of lenses, and every year Joe got the same thing -- a brown plastic frame, 52 eye, with glass FT 28 lenses. For the first two years we tried to discuss progressives, but Joe wasn't interested. Nor was he interested in CR-39 or anti-reflection coating, or even a different frame.

Eventually, we knew that Joe was happy with those same glasses year after year. Pressing him however gently to consider upgrading would only have proven counter-productive and surely would have caused him to think less well of our practice.

But the overwhelming majority of managed care patients presenting in my three optical dispensaries were not like Joe. They came with a quite different attitude. Most of my patients considered their vision benefits -- whether defined limits on frames and lenses or a specified dollar allowance -- as "first dollar coverage" that they could use to facilitate the purchase of something better.

Except for the few "Joes" it was generally a no-brainer once the impressive benefits of premium lenses and/or lens treatments were properly explained.

Where Does the Educational Process Begin?

In your practice it's essential that the educational process begin with the doctor. Nothing, but nothing is a more powerful motivator and confidence builder than the doctor's helpful, professional suggestion.

This is not high pressure, hard-sell while the patient is in the chair. That's a sure-fire way to decrease patient satisfaction. But it does mean offering suggestions based upon exam results and lifestyle questions that should be asked before, during, and after the exam. That's concerned; that's professional.

It also does not mean that the OD must know every bit of minutiae about lenses and lens treatments. He or she need not know every detail that differentiates all progressive lenses, or every possible parameter for high index lenses, or A/R coating.

However, it's essential that the OD does understand that all progressives are not created equal. Armed with this knowledge and based on a patient's individual needs, the doctor then could appropriately suggest one or two specific premium lenses

The Fine Art of "Selling-Up"

The essence of "selling-up" is straight-forward. Provide relevant, personalized information to each patient so that he or she can make an informed, considered decision. In doing that the doctor and dispensary staff facilitate a process by which each patient concludes that the recommended upgrade has significant, demonstrable value and, thereby, affirms in his or her own mind "That's great. I want it!"

Properly done, patients do not feel as if they've had their pockets picked. Rather, they come away from the experience feeling as if they've had the finest, personalized, professional attention paid to their needs. And when a few days later they try on those new glasses with the premium progressives or the latest in A/R technology and compare this to their old glasses… Well, that's patient satisfaction.

Higher Levels of Patient Satisfaction

Patients, including those in third party plans, will vote with their feet if they are not satisfied with the care they get in your practice. Patients want to feel that they're important – that the doctor and dispensary staff are interested in them as more than just a "ka-ching" in the cash register.

Exceptional optometric practices treat each patient like gold, and cause each patient to rave about "my eye doctor" and "my new glasses." Those are the patients who are the most satisfied and who will help to grow your practice both directly (through their own purchases) and indirectly (through referrals).

Guest Commentary: Joan Wahlman

Are You Meeting Patient Expectations?

When a patient schedules an appointment with your practice he makes three simple, yet important assumptions:

  • That as the doctor, you have all the answers,
  • That as the doctor, you will fix the problem,
  • That as the doctor, you will offer state-of-the-art technology & solutions.

During an appointment your patient also has specific expectations:

  • That as the doctor, you will listen and identify her problem,
  • That as the doctor, you will discuss with her treatment options,
  • That as the doctor, you will recommend a solution to achieve optimal vision.

While these expectations may sound reasonable, it is my experience that many practices fall short on delivering. And when patient expectations are not met the result is an overall dissatisfaction with the practice.

Today's consumer has more opportunities than ever before to become educated on the many exciting advancements in eye care. Your patient is exposed to new products and surgical treatment options through avenues that are beyond your control -- Internet research, advertising, consumer reports, conversations with friends and family, etc.

Yet, the good news is that, in the end, they remain dependent on you for advice, and trust you to direct their care. You are their partner in exploring and selecting the right solutions.

What Does This Mean for Your Practice?

Meeting patient expectations now demands a "sales" approach to patient care -- offering personalized attention to a variety of visual needs that results in a willingness to pay a fair price for value. The right approach can create a win-win situation for both your patients and your practice.

In medicine the word "sales" is often perceived negatively, and many optometrists remain uncomfortable with the sales component of the exam process. Yet your patients scheduled appointments with the set expectation that you and your staff will educate them on ways to optimize their daily visual performance.

How you identify visual needs and recommend solutions can have a strong impact on your practice. A well-managed exam process can result in high levels of patient satisfaction leading to increased revenue and patient referrals.

Looking at Sales in a Different Way

Understanding a patient's lifestyle needs and educating him on eye care options that address these needs is known as the "consultative sale." You and your staff use this selling technique every day as part of the patient education process.

Simply put, consultative selling is rendering professional service through problem identification and education on the personal benefits of the recommended solution. The decision to buy remains with patients and is based on how each perceives the value of your recommendation to help improve or protect their eyesight.

The differentiating element in consultative sales, and the most important for a practice to embrace, is incorporating an expanded approach to understanding your patients' personal lifestyle needs. Once you have this knowledge you can then educate them on solutions for vision improvement as they progress through a broad range of daily activities.

For example, it is not atypical for a patient over 40 years of age to spend half the work day on a computer, actively participate in an outdoor exercise regime or sport, and be frustrated by decreased night vision acuity. As this patient goes through the exam process he makes the assumption that, in the end, the recommendation you make will address all three of these problems.

But one size does not fit all. How many times have patients called your practice to complain that they are not seeing well after picking up new eyewear? Gathering daily activity facts about each patient will not solve all problems, but this approach can certainly help reduce complaints and save the practice time and money.

How to Implement Consultative Selling into the Exam Process: The Lifestyle Assessment

The key to implementing a successful patient lifestyle assessment system is to develop and utilize an informational gathering protocol. This can be done in two ways:

1)   Adding a number of questions to the intake assessment process,

2)   Adding a Lifestyle Assessment Questionnaire to the intake process.

Every technician routinely asks, "Are you having any problems with your vision?" Why not also ask, for example (and document responses in the chart), "How much time do you spend reading or working on a computer each day? Do your eyes feel tired at the end of the workday? How much time do you spend outdoors? Do you participate in any contact sports? Are you having any vision problems at night? Do you wear sunglasses when you are outdoors"?

A better way to engage your patients in the consultative sales approach is to ask each to complete a Lifestyle Assessment Questionnaire either at check-in or during the initial evaluation. (See below) Answering the short questionnaire during the intake process directs your patient to focus on the specific needs and concerns to be addressed during the visit. You're then able to use those responses to make and reinforce recommendations for the transition from the exam room to optical dispensary.

Utilize the consultative sales process and you will find that you not only meet patient expectations but you also exceed their expectations, thereby bonding your patients, their families, and friends to your practice for life.

Joan Wahlman is President of JD Healthcare Consultants, a national firm of industry specialists who offer development programs to optimize practice growth in the key areas of Practice Management & Marketing.

Lifestyle Assessment Questionnaire

At the beginning of the exam, take a few moments to review your patient's responses. This allows you to identify and incorporate each patient's personal lifestyle needs -- and solutions to those needs -- into the clinical examination and follow-up discussion.

Lifestyle Assessment Questionnaire (front side)


As your discussion with each patient proceeds, document your recommended solutions to lifestyle needs in writing, just as you would document the patient's prescription for your optician. This can be accomplished in one of two ways:

  1. List options on side two of the Lifestyle Assessment Questionnaire (shown below),
  2. List options on side two of the prescription form.

Simply select the recommendation option(s) and place a check mark next to it/them. Let each patient know that your staff will take care of finalizing your recommendations. Give the recommendation form to the optician/technician who will review it with each patient. Never underestimate the value of the words: "The doctor recommends."

Use this example to get started. We recommend creating and saving your lifestyle questionnaire in a word processing program so that it can easily be updated with new products and services as they are added to your practice.

Lifestyle Assessment Questionnaire (back side, or back of prescription form)


Copyright © 2003-2007, Gil Weber, MBA. No part of this newsletter may be reproduced or distributed in any form whatsoever without the author’s prior written authorization.

These materials are intended to provide useful information about the subject matter covered. The author believes that the information is as authoritative and accurate as is reasonably possible and that the sources of information used in preparation of the materials are reliable, but no assurance or warranty of completeness or accuracy is intended or given, and all warranties of any type are disclaimed.

The materials are not intended as legal advice, nor is the author engaged in rendering legal services. The materials are not intended as a replacement for individual legal or professional advice. Information contained herein is presented only for illustrative purposes, and it should not be used to establish any fees or fee schedules, nor is it intended and it should not be construed as encouraging any user of the materials to take any actions that would violate any state or federal antitrust laws, tax laws, or Medicare or Medicaid laws.

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