How much is your time worth? This month, we spoke with Thomas Pinkston, OD of Haywood Family Eye Care in Waynesville, North Carolina about the process for setting and re-evaluating contact lens exam fees.
Q: Determining what to charge for a contact lens fit can be tricky, particularly for those who are new to practice. What factors do you recommend considering when deciding what to charge for a contact lens fit in your practice
A: The biggest factor that I recommend practitioners look at when setting contact lens fees is “Value.” Every time we spend money, no matter the product or service, we are looking for value. So are our patients. Determining what each patient values individually and what patients value as a group makes this more complicated. Contacts have become commoditized and patients have dozens of options, including online vendors and neighboring competitors. Our contact lens evaluation must then bringvalue to each patient. Without value, patients will not return to our offices. By using the term “Value,” do not conflate this to “cheap” or “low cost” but more so, “worth.” When you set your fees, think about how you bring value to each individual patient: Did they understand their options? Did your office help them interpret their insurance benefits and how that will impact their annual supply? Did you review any benefits you have available to ship to their home? Did you review any advantages you offer when the patient orders a year supply from your office? The contact lens evaluation is more than just ensuring a contact lens fits and best corrects a patient's vision. The evaluation is the entire process, including the presentation and discussion of the lens itself and the patient’s purchasing options. I liken this process to shopping for a new car. All vehicles will transport me from one point to another but what do I value in my own vehicle and how are those options presented me based on my needs and wants? Patients are thinking about these fees and what they are receiving from your office as a result. Don’t set your fees too low and don’t let patients think they were undervalued. It is our responsibility to ensure the following year that there is no question about “What did he really do last year for that fee?” If a patient is asking me that question on a return visit we have already failed miserably with them at our first interaction. The topic of contact lens fees was recently featured on the Clark Howard Website. Patients will expect you to show them how valuable you are to them, regardless of if they verbalize it to you. Consider a number of factors, but most importantly how are your fees are going to bring value to each patient
Q: Should CPT code baselines be taken into consideration? (for example, if you consider the amount of time invested in a sphere fit to be similar to the time invested for a 99213 medical visit, should you consider setting a similar fee?)
A: Time is important to consider when setting fees. Using what you charge for medical visits of all kinds is a great way to determine what your chair time is worth. This can then be used to reverse engineer what you think a contact lens evaluation would cost based on time alone. Then combine this with a tier based structure of contact lens fees where a multifocal evaluation has the highest fee and sphere has the lowest fee to determine a general idea of where your fees should be. Chair time calculation is a great exercise for continued re-evaluation of your contact lens fees. Do you recommend that contact lens fees include a global follow up period or a defined number of follow-ups, etc.? What is reasonable to include in terms of follow-up and use of chair time? How is that presented to patients in your office? A general global follow up period is what our office utilizes and I find to be most successful. This is the best approach over a fee per visit model as it has a much better perception from the patient’s point of view. Patients want contacts, want them to work successfully and want to visit our offices as little as possible. Usually, when patients are returning for contact lens issues it is because they are having legitimate issues or concerns with their contacts. A fee per visit contact lens system creates a relationship which could be perceived as a frivolous and benefiting from the patient having issues from a product my office initially fit and evaluated. Contact lenses have become more commoditized over the last decade and I want patients to leave our office feeling like we did everything in our power to help them. However, setting your contact lens evaluation fee at an appropriate level initially is to ensure you are successful. If your fee is set at an appropriate level initially and the majority of your contact lens patients need between 0-2 follow up visits after their initial evaluation, then the chair time used will likely be covered by your fees. If your contact lens fees are too low, the global period approach will not work and you will lose money on your chair time. Finally, it is important that every patient leave our office knowing exactly what their contact lens evaluation fee entitles them to. At our office, our technicians review with each contact lens patient the advantages of the lenses we chose for them, the cost of a year supply of contact lenses, and the advantages our office offers when ordering from us.
Q: To what extent do you consider fees from other practices in your area when setting contact lens fees?
A: Many offices will consider other local practices’ fees when determining their own. While I do think this could be beneficial if your practice is new or just starting, I think this could lead to potential issues and create a geographical echo chamber (not to mention it could lead to collusion of fees). Also, there is no real way to ensure the other practices know what they are doing or just blindly setting their fees. We do not consider other practices fees when establishing or re-evaluating our own fees. I recommend basing our fees on other internal metrics including chair time and patient feedback.
Q: Do insurance plan reimbursements factor into your fee determination at all?
A: Our office does not typically use plan reimbursements when determining fees for most contact lens evaluations. The exception to this is medically necessary contact lens fees which is an entirely different structure and analyzed like our medical CPT codes and procedures.
Q: In your opinion, how often should fitting fees be re-evaluated and recalculated?
A: It is important to re-evaluate your fees at least once every 6 months. You should feel comfortable and confident with your fees and so should your patients. In order to do this a regular audit of all fees should be planned. In addition, you should audit the office procedures you have set to ensure the perceived value of each fees is received by each patient. Contact lens fees can be set and changed as you see fit but ensure you are equally if not more concerned with the value that brings to the patient. Our office regularly (if you were to ask my staff too often) audits our protocols in how we bring value to each patient. This will be overwhelming but look to your staff to for honest feedback on what they experience when interacting with patients.
Q: What other advice do you have for practitioners who are either setting their fees for the first time or reevaluating their contact lens fees?
Setting fees for your practice will be overwhelming. Like many practitioners you will have doubts and second-guess yourself. I recommend setting your fees higher than you initially anticipate. The key to successfully setting your fees is not the initial act of setting the fee but the consistent actions that follow to make the fee worth it to the patient. You could be the highest, lowest or average in your area, but what are you doing to make that evaluation worth it and keeping that patient coming back next year. Patients have more options than ever before for eye care with an expanding market and online options. In addition, contact lenses are now perceived as a commodity by most of the population. What are you and your team doing consistently to give each patient value for their fee and how does this help you and the product you fit stand out? Our office strives to be each patient’s advocate by reviewing insurance benefits, CL cost/rebates, reasons we chose a product and reasons ordering contact lenses from our office will benefit them. CL fees are important, but failure to create an experience where the patient feels comfortable and valued will not lead to returning patients or product sales. Lastly, be confident in your fees with your patients. Set your fees and don’t apologize. Expect some people to look for the lowest contact lens fee and determine your fee is too much for their budget. As painful as that can be, let it go. Don’t look to please everyone with your fees, but instead bring value to your returning patients who appreciate what your practice has to offer.