25TH Annual Contact Lens Report
Double Trouble on Fees
O.D.s feel the squeeze as both professional and materials fees trend
downward.
By MICHELLE BOYLES, Assistant Editor
Optometrists who dispense contact lenses are taking a big hit– actually,
they’re taking two big hits. Fees doctors charge for soft lens materials
are down significantly from our last survey in 1998. And it’s not
being made up in professional fees. In fact, average fees for services
are actually lower than they were in 1998.
It’s a dilemma confronting many optometric physicians. Says Indian-apolis
optometrist Joan Frank: “I feel like I can’t lower my contact
lens prices any more because patients are not willing to accept higher
fitting fees.”
Martin Gresak, O.D., of Moundsville, W.Va., sounds an ominous note for
the future of contact lens fees: “I could see contact lens prices
still dropping ... Our professional fees must increase.”
This month 12%, or 123, of our National Panel Doctors of Optom-etry tell
us where they think their contact lens practices are heading.
Professional Fees
In 1998 our panel reported the average charge for a comprehensive exam
was $63. Panelists now report their average fee for a comprehensive exam
is $77. That’s an average increase of 7.3% a year since our last
survey in 1998, or about double the rate of inflation over the intervening
years.
However, contact lens exam fees are headed in the opposite direction.
Doctors’ charges for a soft contact lens fitting are down about 3%
over the three-year period, to $87. Fees for a rigid lens fitting are
down about 7%, to $105.
The average charge for a contact lens follow-up this year is $25, for
which there is no comparative figure from the previous survey. Many doctors,
though, don’t charge a thing for these exams. It’s included
in the original fitting costs.
These trends could spell doom for the optometric contact lens practice,
speculates panelist Terry Bonds, O.D., of Jacksonville, Ala., “If
(and only if) professional fees increase to a more reasonable level, the
contact lens practice will thrive,” he says.
Service is the key. “Make sure to charge for your professional services
and keep them separate from product costs,” says Jerry Hollimon,
O.D., of Hammond, La. “We have gone to professional school for at
least four years; be proud of your profession and skills and charge for
[them].”
Material Fees
Fees panelists charge for soft lens materials vs. rigid materials are
going in different directions. Today, optometrists charge on average $31.40
for a box of daily disposable lenses. That’s less than half the average
reported in our 1998 survey. This may have something to do with the increased
popularity and availability of these lenses.
Here are the ups and downs in materials fees since 1998:
• Biweekly replacement soft, spherical lenses, down 47%.
• Monthly replacement soft, spherical lenses, down 56%.
• Quarterly replacement soft, spherical lenses, down 31%.
• Conventional soft, toric lenses, up 6%.
• RGP spherical lenses, up 14.5%.
• RGP toric lenses, up 5.7%.
• RGP bifocal lenses, up 20%.
“The materials have been made such a commodity,” says John Sienko,
O.D., of Wallingford, Conn. “The manufacturers wanted us to lower
prices and put the cost into services, but the services aren’t covered
by third-party [insurance] and many patients seek out non-doctor sources
to reduce cost.”
Specialty lenses may be the salvation, at least in terms of material fees,
says Minneapolis optometrist Claire Heinonen. “Certain lenses seem
more like commodities,” Dr. Heinonen says. “Specialty lenses
still require skilled practitioners to fit them well.”
Adds Sandra Barker, O.D., of Winter Park, Fla.: “For the practitioner
who understands how to manage it, there is still much demand for contact
lens expertise in the areas of astigmatism, presbyopia, post-refractive
surgery and keratoconus. To keep our simple fits from shopping their lenses
elsewhere, we need to provide fair pricing with ultimate convenience.”
Competition
When it comes to competition on contact lens materials fees, some doctors
think the worst is yet to come. “I believe private-practice optometrists
are in for a period of cut-throat competition with large discount stores,
mail-order and the Internet over contact lens sales,” says Shane
O’Brien, O.D. of Quarryville, Pa.
What’s wrong with a little healthy competition? The problem lies
with how some of these alternative dispensers operate. “1-800 Contacts
is currently trying to ‘slander’ our profession by saying we
are only retailers, not real doctors,” says one of our panelists.
“They have launched a campaign against optometry in New Mexico, Texas
and other states.” The company sent postcards to customers advising
they write to legistators in complaint of Texas O.D.s prescription practices.
The 1-800Contacts Web-site makes several erroneous claims against O.D.s
in that region. Previ-ously, the company was sued by the Texas Optometry
Board for violating the Texas Optometric Act. A company’s permit,
required in the state, can be revoked if it doesn’t abide by the
law.
“Contact lens distribution needs to be treated like drug distribution,”
says Blake Peterson, O.D., of Cleveland, Tenn. “The AOA needs to
pursue prosecution of companies filling prescriptions without authorization
from the prescribing doctor. They should be fined if they ignore expiration
dates or refill amounts.”
Still, 95% of our panelists release prescriptions to patients who re-quest
them, and 57% release to mail-order. Patients may choose to refill their
lenses outside your office, but optometrists are more concerned with making
sure the patient gets what he/she needs for proper eye health.
Says Robert Brooks, O.D., of Charleston, S.C.: “I think the future
of contact lenses will see more of us actively sending, through easy-to-order
channels and delivery systems, contact lenses directly to our patients
... It may be hard to admit, but the competitive nature of contact lens
pricing may ultimately be to our best benefit.”
What’s Next?
Are more changes in store for your contact lens practice? Many panelists
feel the changes that are still to come in their contact lens practices
are worth the hassles they’ve gone through already. A wave of technological
advances are fueling that belief.
“There is much excitement to be found in the new technology with
superior bifocals, torics and spherical contact lenses which will benefit
patients immensely as long as we differentiate their features and benefits
explicitly,” says Robert Fait, O.D., of Burlington, Wis.
Some practitioners will find other ways to supplement their incomes. “Primary
care fees for treatment and management of ocular disease will more than
cover for the loss of revenue from contact lens service and sales,”
says Phillip Jacobs, O.D., of Chester, S.C. There’s also the increasing
demand for and availability of refractive surgery as a means of vision
correction.
Most O.D.s are sticking it out though. Says Post Falls, Idaho, optometrist
Elwyn Schutt: “Surprisingly, with all the changes in the past 20
years, contact lenses have remained a solid and steady part of my practice.”
For most optometrists, this continues to be the case.
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