Solving 5 Unexpected Problems of a New Eyecare Practice

I’ve spent my entire career working in private practice. Every doctor told the same stories: When you first open up, money is tight, so tight that the margins are practically invisible. I heard stories about doctors almost not making payroll because a woman returned a pair of glasses, about long sleepless nights worried about how they’re going to keep the lights on and second mortgages on houses to pay for renting their space.

So, when given an opportunity to help a friend open her own optometry practice, a wiser person probably would have said, “No, thanks.”

However, this was a different scenario than the other doctors I’d worked for in the past. An ophthalmologist had a surgery space that he used less than 10 days out of the year, and he wanted to expand his practice and bring in an optometrist. He already had two other locations, and he would supply all the equipment; we would just need to bring in the patients.

And my friend was a beloved local optometrist with over 15 years of patient base. So, with the initial hurdle of rent and equipment taken care of, I found myself asking, “How hard could it be?”

You can probably guess how the rest goes.

As I mentioned before, we were setting up our practice in a small surgery suite. The location wasn’t ideal, but the ophthalmologist had plans for a small dispensary—something to get us started—with additional plans to expand in a year or two, once our patient base was strong. Unfortunately, he didn’t read the lease closely enough, and another office in the complex had a propitiatory agreement that stated no other businesses in the mall could have a dispensary. A very wise addition to their lease agreement; I wish we’d thought of it.

It’s a common thing to have an ophthalmologist office without a dispensary, but an optometrist without a dispensary is almost unheard of. We read the lease agreement closely and found the best way out of a bad situation.

First, the agreement mentions glasses only, not contacts. So, we leaned hard into providing the fastest, least expensive contacts with reasonable fitting fees and as many extras as we could think of. This included giving away sample contact lens solution, an extra set of trials, and free shipping to their homes if they ordered a 6-month supply. But contact lenses don’t solve the glasses problem, so we got an optician.

As the second part of our solution, we solicited the help of a highly skilled optician to come to our practice once a week and sell frames out of her trunk. At first, it felt like putting a band-aid on a broken leg, but she quickly became a huge asset to the practice. We would schedule patients to come in for a consult with our “frame stylist. We had their picture on file, so she could get an idea of the person she was styling, and we’d ask a few basic questions, such as, “Are you looking for something like what you have, or do you want something different?” Then, she would bring frames to suit the patient.

What we found was that, though a dispensary with thousands of frames looks impressive, most opticians will tell you they sell the same few frames over and over. This meant she didn’t need to bring her whole selection, just the best, most popular frame options.

Buying frames online is becoming increasingly popular, but what it lacks is direction. That’s why online frame companies let people order three frames at a time: We don’t know what we want or what looks good. Rather than compete with online orders, we went in the entirely opposite direction— extremely high-quality materials and personalized care. And it worked.

If people wanted to buy their frames online, we’d give them their PD and attempt to advise them the best we could in regards to materials and frame style. Because we don’t have a dispensary, they weren’t taking business away from us, and we look accommodating.

The optician loves it because she gets practically guaranteed sales and our patients are taken care of.

The company opted to use a third-party, offsite billing company, which had worked well for them in the past. We were told to expect some bumps in the beginning but to expect it would all get ironed out. There were some minor issues; for example, outlandish costs attached to services like $700-$900 contact lens fits and $95 dollar refractions. However, we were reassured the billing department would adjust the amounts to be correct and the patient’s explanation of benefits would not have those amounts listed. The last thing we wanted was for our patients to think we’re milking their insurance companies for all we can get.

A much larger problem presented itself about 6 weeks after we opened. Our automated billing software was not properly set up, it was as simple as a drop-down box not being selected properly, and because of this none of our patient’s insurances were linked to their exams. What this meant was for the first month, our offsite biller processed everything as if the patient would be responsible for payment.

To make matters worse, they hadn’t fixed the outlandish prices as we were reassured they would. We received a phone call from the patient who had an appointment the first day we opened, asking about a $1400 bill. What followed was hours of phone calls and discussions trying to figure out how and why this happened.

As quickly as we could we attempted to get ahead of it. We printed the names and phone numbers of every patient we saw in the first month and called them to let them know there had been a billing error and disregard the bill that they would receive from us that month. It was an embarrassment for us, and needless to say, a tremendous amount of work.

With all the expertise they bring, offsite billers can be an excellent option, but they will never care about your new business the way that you do. They don’t have to be accountable in the same way you do. We would have thought 100% of our business, for a full month, coming through as cash pay should have been a red flag to the billing company, but it was not.

In retrospect, we should have kept a closer handle on the billing aspect, not only getting reassurance that things would be done but demanding confirmation.

We did not think this was necessary, being as it was an existing account, we were just another branch, but if we had it to do over again, we would have done several test patients.

I was tasked with setting up the office a week before we had our first patients scheduled. I was reassured everything was “pretty much done,” I just needed to “put things exactly where we wanted them.” What I walked into was a stark office with three mini boxes of tissue, one bottle of tropicamide, and a few reams of printer paper. No hand soap, no tape, no mydriatic glasses, no highlighters, no batteries; you get the idea. We continued to find things we were missing weeks into the opening. I would have appreciated a supply sheet.

I recommend spending a fair amount of time walking through a mock first day, every step of the process. Ask yourself what will you need and where will you need it. If you have the ability, take a notepad and walk through a friend’s office to jot down items you might be missing before going "live"with your own practice.

One last thing to consider is comparison shopping local companies before assuming an online retailer will be cheaper. One example: small bottles of water for our patients were $3.99 when I bought them locally, but when I went to order the same bottles online they were nearly $50. The high-quality tri-fold bathroom towels I had gotten from a local janitorial company were less than thirty dollarsfor the same product, I would pay $170 online.

Many janitorial companies offer huge discounts if you open an account with them, and they’ll negotiate their prices. They say that time is money, but so far I haven’t figured out how to pay the electric bill with it, so take the time to do your research. Also, that local janitorial company gets their eye exams with us now.

Drug and medical supply reps are often viewed as a necessary evil in offices, but that isn’t a productive mindset. When you’re opening a practice, you need them more than they need you. You need artificial tears, drug samples, contact lens solutions, and ways to get patients their medications when all resources have been seemingly exhausted. Treating them like you don’t really want them around isn’t the most successful method in obtaining those things.

There is absolutely no benefit to an elitist or combative strategy with drug reps. If they are selling something you don’t need or want, you should just tell them. Tell them they can contact you in the future to check in. Do not dodge reps. Beyond the fact that wasting a person’s time or treating them like they aren’t valuable is childish and unprofessional, from a business aspect, it’s bad form.

Reps change companies frequently, and the rep who sold something you didn’t need last year, very well might be selling something you’re in desperate need of this year.

That being said, you do not need an open-door policy in order to have a good relationship with reps. Be honest and straightforward, and set boundaries. This can look different for different practices. In this practice we stop seeing patients at 3pm, so we tell reps not to come in the late afternoon because they'll miss the doctor, but I have worked in offices that only wanted afternoon visits because that’s when they were the least busy.

Lastly, and this ties into the attitude towards reps, have some flexibility. I once watched a doctor make a rep wait 2 hours to see him because he didn’t show up on the correct day. The relationship between office and rep can be a symbiotic one.

COVID-19. Obviously. The decision to open a practice during a pandemic was another risky business move. But the optometrist brought a fair amount of patients with her from her first practice, this is a college town, and the space was already being rented out by the ophthalmologist for his occasional surgeries, so the risks seemed pretty low.

Due to the pandemic, walk-ins were not exactly welcome, but the optometrist had 15 years of loyal patients to follow her. We thought her over-booked schedule from the last location would at least translate to a healthy base at her new office. Sadly, we were less than busy after the first initial rush of patients when we opened. After about 3 weeks, we’d pretty much burned through her patient base for several reasons. One was simply timing: not every patient is due for their exam all at the same time.

Secondly, patients are resistant to change. Something as simple as having to fill out paperwork at a new office might dissuade them from scheduling. So, yet again, we had to brainstorm.

There is no one solution to bringing in new patients to a practice.

Even with an established base of patients, it takes an entire calendar year to build a healthy schedule base. Be prepared. Schedule in blocks so you can minimize the amount of time you spend sitting around the office, and spend your downtime networking to help get your name out there.

You need to surround yourself with smart, experienced people, but remember no one will care as much about your practice as you do. There will be surprises. Rather than go in thinking you’ve thought of everything, do your best to be prepared and be willing to roll with the unexpected. Be a positive and welcoming presence; there is no room for exclusivity when you’re trying to grow. Be creative with marketing when trying to get people through the door, but recognize it takes time to develop a base.