Laying out a medical practice's service fees can feel like an ongoing series of fraught decisions. That process is often misunderstood, poorly understood, or skipped entirely for some arbitrary construct provided by a third party.

Consider your education and ongoing training as a medical professional alongside your years of clinical experience; do your current usual and customary fees reflect your expertise in the marketplace? Think about what makes your professional services valuable to your patients – and how you add value to patient lives and outcomes.

To put it another way:

Other verticals

Keep in mind that many would-be optometrists would say their professional services and their corresponding fees carry even more business value than materials and the associated cost of goods. How do these considerations manifest themselves in other professions and businesses?

In dentistry, nearly all practice revenue comes from service; by contrast, cosmetology is primarily service based with products being offered but thought of more like “nice to have” revenue. Auto repair is closer to a 50/50 split but the services are never devalued considering a car is a complex piece of machinery we rely upon every day.

The process of “fitting” a contact lens is far more than baseline answers to the questions: “does the lens move a little bit?”, “does it center well?”, and “can the patient see out of it?” Practitioners also have to consider the patient's occupation (two or more computer monitors), activities, past contact lens experiences (hopefully without any microbial keratitis), and even the patient’s life stage.

So while we see and care for patients in a cross section of time, it’s really more about the patient’s everyday experience using their vision, accommodation, and blinking those thousands of times across the contact lens surface.

To that end, calling this service a “fitting” undersells the value and necessity of these services. Many would agree that the verbiage “Contact Lens Evaluation” more accurately describes the complete process. Patients are individuals that come with their own complexities, eye and systemic health histories, and visual performance needs that go beyond just seeing clearly on an eye chart and a well fitting lens.

Fee philosophies

There are generally two philosophies towards setting contact lens evaluation fees. One is more of a flat fee approach where it’s not the patient’s fault they have astigmatism or presbyopia and therefore shouldn’t be charged more than a sphere fit – keeps things simple.

Practices that do this tend to, or ought to, set their fees somewhere on the higher end of the three evaluation types (sphere, toric, multifocal) to generate more revenue and encourage doctors, staff, and patients to move into the right lens for them. Think of this as lowering the barrier to entry by keeping the pricing simple with the aim of fitting patients with the right product for them in the longer term, not the knee-jerk response to paying a lower evaluation fee that some patients may experience.

The other most common pricing model takes patient complexity and potential chair time into consideration and says more complexity should bring more revenue on the services side. Of course, there can be as few as one evaluation fee or up to 10 ranging from an established patient where nothing changes to a brand new orthokeratology or scleral lens fit that requires insertion and removal training.

Protip: Try to shift away from language that diminishes the value of what you’re doing.

Think about the difference between calling additional visits “follow ups” and saying something to the effect of “We will be evaluating the contact lens performance and your eye health again in 1 week.” Patients hear the words but they respond with emotion. What you say and how you say it has a significant impact on how the patient understands what’s happening and the value they assign to it.

Dollars and sense  

For many practices, adding wide field retinal imaging for an average $39 co-pay was a relatively easy and, some would argue, mandatory step to just about double revenue per exam when considering some reimbursements, even before any contact lens evaluation or additional services. Now how many of us could get away with doubling the $39 out of pocket tomorrow? Most patients would probably balk or not understand the value, even if it saves most of them the time and light sensitivity that comes with the dilation process.

Along those same lines, how many of us would be able to increase our soft sphere CL eval fee by 5 or 6x and be able to justify it? That’s where myopia management with daily disposable soft lenses comes in. There are over 300,000 children aged 8 to 12 years old wearing single vision contact lenses – they’re essentially in the wrong lens because it’s a medical device that is letting their myopia get worse. But even if you are starting a new patient in contact lenses, myopia control with MiSight® 1 day really only requires one additional visit compared to a simple single vision correction, the 6 month visit.

Even before the purchase of any materials, you’ve already met the average revenue per exam (~$350). Once you do factor in the materials, you’ve blown past the 99th percentile in revenue per exam.

Myopia management was declared the standard of care by the World Council of Optometry (April 2021). To keep it simple for your staff, make sure they know that as the doctor, “I will not prescribe single vision for kids with myopia that are growing.” Commit to not sticker shocking the parents in the room: your myopia management program costs about $4 per day for everything. Because kids grow fast, their myopia gets worse most quickly when they’re younger. So to drive some urgency, you can say “The sooner we start, the sooner we finish.”

Wrapping up

In today’s optometric practice climate, I don’t think any of us can afford to not follow the standard of care. Financially, we need this recurring revenue. Reputationally, it is imperative that your community knows of the existence of myopia management and that you're the doc to address these problems for the patients who need this level of care.

Building myopia management into your practice is not really a “nice to have” but just doing the right thing for the health and well-being of every child with myopia. In short, rethink your contact lens evaluation fees and how those are presented to patients while considering the economic climate in which we’re all working. It’s easy to forget that 2022 carried with it 7% inflation, the time to make these changes is now.