How does your office handle requests for measurements for online purchases?

[lensmama]

Our office has seen an increase in requests for us to take pd's so that the patient can then purchase glasses online. So far, our policy has been to deny the request for liability reasons. Any feedback on what other offices do would be appreciated.

[braheem24]

$79.00, why deny?

[gemstone]

Please bring them in for the 79 dollar ajustment too.

[Frank V. Scallio]

Couldn't agree more. I only charge $50.00, but let's face without our PD they are getting anything.

[harry888]

Here in Massachusetts, pd is supposed to be routinely put on the prescription, it's in our board rules. Don't know what connecticut says.

We haven't had anyone request internet measurements in over a year. If we did the Rx we do the PD.

But we will do nothing beyond the PD because we don't want to have to waste our time verifying glasses from an outside source.

Harry

[cocoisland58]

I have a lot of patients from India. They all take their Rx and want the PD also. They are very apologetic about it. I don't really care since if they ever do buy anything here it's always the bare minimum anyway. I will check and adjust the glasses for them. They are my patients and they do come back for an exam every year and bring the entire family. That's good revenue.

[For-Life]

I would not do it for liability reasons, and that alone. If they are looking at buying online I have lost this sale. Most likely, if they were not looking online, I would have lost the sale anyways, because the store is not a low end price bargain place. If you want that, go to Wal-Mart. I understand a person's desire to save money, and that is fine. So I am not bitter toward the purchase.

Back to the subject and liability. People tend to not want to be responsible for their mistakes. Joe Blow goes to Wepayyoutomakeyourglasses.com and buys a piece of junk. Blowy Joe receives his glasses and cannot see out of them. The website says that it made everything to what Joey Blowy asked for, so now JB goes to you and blames you for the measurements.

[obxeyeguy]

The website says that it made everything to what Joey Blowy asked for, so now JB goes to you and blames you for the measurements. I agree, I will not be put in the position of who did what wrong.
Exception is a PD for safety Rx, and only if I made them eyewear in the past.

[DrNeyecare]

Please bring them in for the 79 dollar ajustment too.

Is this $79 fee your office fee for releasing a PD?
Or is this a law of some sort. I always thought that PD is part of the prescription. But I have never had a patient request a PD for internet purchases.

[Happylady]

I think in Texas the PD is part of the prescription. I take it and write a mono PD on the rx.

I have had a woman come in twice now and ask me to measure progressive heights on several frames. Her daughter is a frame rep but lives out of town. She gets her exam here and got some glasses here many years ago. She always waits for me, too. :rolleyes: I do it, but it bugs me.

[For-Life]

I never got how the PD was considered apart of the RX.

Opticians take it, and are supposed to take it all of the time, not ODs.

[motelska]

Personally I HATE giving out PD cos i feel like i'm taking responsibility... so I tell the patient that i'll give it to them... and that I'm not responsible for verifying and/or creation of the glasses. If I didn't make the glasses right I accept no responsiblity. I tell them that and I've been pondering making them sign a waver just so that I'm not held liable for an incorrect pair of glasses. Maybe it's jerkish for me to do that, but in this day and age, we have to COA (Cover our a$$es)

[For-Life]

Honestly, I do not think all of the waivers in the World cannot remove the blame from our sholders when dealing with idiots. And those who buy their glasses online are the textbook definition of idiot.

Waivers are not as legally binding as we may think.

[coupe]

What makes you think that all eyeglasses made online a crap. Lots of the optometrist sell eyeglasses online. Are you saying the only good optometrists are the ones selling from stores and all optometrists selling online are no good.

Now there is a good libel .....sorry.... liability question.

[For-Life]

What makes you think that all eyeglasses made online a crap. Lots of the optometrist sell eyeglasses online. Are you saying the only good optometrists are the ones selling from stores and all optometrists selling online are no good.

Now there is a good libel .....sorry.... liability question.

Yes I would

ALL glasses should be measured and fitted in person, and all good fitters will do this process themselves.

Anyone who sells glasses online should never be able to touch a pair of glasses with the exception of their own ever again. Probably some jail time too.

[Barry Santini]

For me, I'm glad the public has a choice between on-line and in store.

Those who are happy/satisfied with online Rx eyewear...GREAT!

Those who experience this and are not happy/satisfied...

are mine (and yours)...and will never go back to that way of purchasing eyewear!

What could be better, I ask?

Barry

[cocoisland58]

I think in Texas the PD is part of the prescription. I take it and write a mono PD on the rx.

I have had a woman come in twice now and ask me to measure progressive heights on several frames. Her daughter is a frame rep but lives out of town. She gets her exam here and got some glasses here many years ago. She always waits for me, too. :rolleyes: I do it, but it bugs me.


Now THAT I would not do.

[HarryChiling]

What makes you think that all eyeglasses made online a crap. Lots of the optometrist sell eyeglasses online. Are you saying the only good optometrists are the ones selling from stores and all optometrists selling online are no good.

Now there is a good libel .....sorry.... liability question.


Our doctor went to some convention a while back and we she returned she thought that making and selling glasses online was the next thing to sliced bread. In reality I explained that I would leave and bad mouth the business if she ever even considered that, and her response was very upset with me, but when I explained that she was supposed to have the patinets best interests at heart it quickly ended the conversation. For the doctors that are selling glasses online shame on you.

Here is a prime example of a "Doctor" who sells glasses online:
http://www.optiboard.com/forums/showthread.php?t=21411&highlight=crystal

didn't take long for this idiot to stop posting. Hopefully it won't take long before eyeglasses are not allowed to be sold online.

[obxeyeguy]

Here is a prime example of a "Doctor" who sells glasses online:
http://www.optiboard.com/forums/show...hlight=crystal (http://www.optiboard.com/forums/showthread.php?t=21411&highlight=crystal)
and I got bashed for not matching the price of this finely crafted and expertly fit eyewear.

[orangezero]

I think all you opticians can be a bit more settled knowing the vast majority of optometrists feel online sales of eyewear is a disturbing trend that leads to lots of patient problems. We are in total agreement here.

Legally, informed consent forms or waivers don't do much good. But it may make the patient feel the issue is slightly more important than they can realize. One of those, "sit back and think of what I'm doing" type moments. Although I'm sure most have their minds made up at that point.

I think a lot would depend on who it was, long established patient with family, or coming in off the street randomly. A fee should be acceptable and standard for someone coming in with an outside prescription, trying on your frames, and then asking for a PD.

Someone want to pm me a list of all these online optometrists? I'd hate to even slightly promote them by listing them publicly.

[HarryChiling]

and I got bashed for not matching the price of this finely crafted and expertly fit eyewear.

Yeah you did. The fact of the matter is in that thread you could run the business either way Discounts or No Discounts and still be sucessful. We discount in our office and at times I wish we didn't as it brings in those type of customers.

[obxeyeguy]

Yeah you did. The fact of the matter is in that thread you could run the business either way Discounts or No Discounts and still be sucessful. We discount in our office and at times I wish we didn't as it brings in those type of customers.
__________________
Yes, the replys were mixed, but the whole point with me was I will not compete with the internet. If it was you down the street and offered a lower price,same product,would I discount to save a patient?? I don't know. In my area the competition(no chains) use some of the same product, some diff than I do. I sell myself and my expertise to them.

[bt5050]

we have also seen an increase in these on line - pt wanting us to either repair - adjust - or even trouble shoot there problems -

as for when they ask for measurments - I decline - and explain that i do not perform this service -

i love it when PTs start saying it is THEIR PERSONAL INFORMATION (( IE - PD's ) -
where we are - it is not part of the rx - and if it is -- in some states - i would have who ever wrote that rx - take care of that -

anyways - when they try to push me agst the wall - i explain that it actually not part of their medical record - that these are company property used to fabricate your glasses - and it is not something that is to be released with any documents ( ie worksheets - calculations ) used to make the eyewear -

usually - this will stop them - from gong on and on - and maybe they just move onto somewhere else to have it done

for me - i don't work for free- and furthermore - i would not expect our company - to pay me for something they do get rec. anything in return -

this goes for fress prs - z87 jobs- anything - because i'll tell u 1 exp 1 had when we used to do these services with my old company - you would take a seg ht - not knowing what pal they where using - and the vendor says to the pt - we made them how you ordered them - go and get XYZ - to fix them since they made the measuraments like they are -
well let me tell u - only once did i remake a pr - for someone since i did nto want the headache - but i learned my lesson - even if you try to do something " NICE " - you get the stick in the long run - if something is wrong

[chip anderson]

Now we get to the crux of the problem. Are these (eyeglass and contact lens measurements) optical retail records or medical ones. If one had endless time and money for lawyers this could be decided over decades.

Chip

[steff]

the OAA (optom association of Australia) recommends that PDs are taken by the dispenser as part of the dispensing process.

I stick by that, thus no PDs on my prescriptions.

steff

[drk]

Now we get to the crux of the problem. Are these (eyeglass and contact lens measurements) optical retail records or medical ones. If one had endless time and money for lawyers this could be decided over decades.

Chip

Simple answer: who took the p.d.? If a medical or optometric provider as part of an eye examination, then it's medical.

If it's part of another professional service (e.g. lens design by a dispensing optician) then it is NOT a medical record by current definitions.

My opinion.

[drk]

I think it'd be illuminating to consider this: how many professional services are performed by opticians, and what is the relative value of each?

Medical visits have been deconstructed as such:
medical history level
level of examination
level of medical decision-making

Essentially, time spent interviewing a patient, time spent "doing physical work", and expertise applied devising a plan. Very straightforward.

Applying this to optical, interviewing/qualifying a patient can be done by a pre-designed questionnaire and amplified by questions and answers. Taking measurements, dispensing, adjusting, maintenance is a higher-level technical skill. Designing a lens is the highest cognitive process.

What would the relative value of each be? How about:
Interview services: 15%
Technical services: 50%
Lens design: 35%?

Then, let's assume that the retail price of an optical good is $1.00. Let's assume that the retail price can be broken down to a formula:

Retail price = Cost of goods sold + Professional fee

Let's further expand the formula:

Retail price = Cost of goods sold + 15% of professional fee for interview + 50% professional fee for technical services + 35% lens design services





So, let's think this out: Traditionally, optical customers have "package-purchased" professional services with their goods. Now, market forces are unbundling the process, whereby internet suppliers among others sell the good without the service.

It is laughable to assume that optical professionals will give away their services. Therefore an optical professional has the right to charge for their time.

The formula above is a simplified way of setting fees for professional services appropriately.




Note of interest:
A. It seems the vision care insurance industry has adopted the term "dispensing fee" to describe the professional services rendered in optical. I think that is an insufficient term, and barely begins to describe the level of professional service involved in optical.

B. Professional services can have a sliding scale based on complexity of case.

For example, I have three levels for about every professional service I do: "basic" (low), "specialty" (intermediate), and "custom" (high).

Applying this to the optical services I provide:
"Basic work" is low-power SV
"Specialty work" is progressives, multifocals, high prescriptions
"Custom work" is slab-off, fresnel prism, wrapped optical designs, loupes, individualized progressives involving multiple measurements, etc.



All this sounds mind-numbingly hairsplitting, but I think the exercise is quite necessary for multiple reasons! Not the least of which is a way to survive and thrive in the marketplace.

I throw this out for consideration and discussion:

Offer a package for those who walk in "Duh, for my pee dee so I can ordur online."

Optical services package: Lens measurements, lens design consultation, frame selection consultation dispensing and adjustments for life of the frame*

This would probably have two price levels, basic and specialty. Heaven help the patient that gets even a specialty lens online, but custom lenses online are impossible.


*"Warranty services not included. We are not responsible for breakage of your frame and lenses during dispensing or adjustments. That is the responsibility of the materials supplier."

[Andrew Weiss]

Wow, what a thought-provoking post, drk. Thank you!

I experimented with the idea of unbundling service charges from goods 'way back in the 70's. Back then, I encountered two problems:

1. Patients were so used to having the service fee bundled into the goods that they balked at the amount of the fees I'd reasonably have had to charge, even though the goods prices were lower (interesting, eh?).

2. Other opticians were really upset because the unbundling revealed the percentage of mark-up on the goods.

But in the 70's we didn't have the internet, and we didn't have internet providers selling eyeglass frames and lenses at a minimal markup -- basically charging for the cost of goods plus fabrication, and not for the in-office professional services.

So perhaps the old idea was just ahead of its time. I'd like to pre-test this idea; maybe another thread designed to attract the interest of consumers who check this board out, like a consumer-oriented poll. Steve, what do you think? Is this do-able and consistent with OptiBoard's guidelines?

Also, drk, while I like your idea of a fee package system, I get queasy with a single fee to cover all services on a pair of glasses that wasn't made through our office:

-- who is responsible for errors in fabrication? Clearly the internet provider. But what if the patient wants the height raised/lowered on the bifocal or progressive? or if I measured the PD accurately and the patient is more comfortable with the old, inaccurate PD (yes, that's happened)? Who pays for those re-dos, and who does them?

-- what if the frame breaks and the patient needs a quick fix because (s)he's completely dependent on his/her glasses and that's his/her only pair (yes, that happens too, right?)? What's my responsibility? and how will the patient feel about working with me if I say, as would be my right, "I'm sorry, we didn't make these, you have to deal with the internet provider who did"?

To some degree, whether this idea will work will, I think, depend on these factors:

1. To what extent do our patients see the optical services as medical services? In general, I believe people are more willing to pay for medical services than "retail" services.

2. How important is it to the patients that we offer "one-stop" services? How important is it to them for them to be able to get the goods separately from the services?

Let's keep this conversation going. I think drk is right: the answer to these questions will determine our ultimate success in a changing market.

[drk]

Thanks, Andrew.

Valid questions.

Seriously, I think that the provider of the materials is on the hook for:
1.) Defects and warranty work
2.) Professionals' changes

Whether they like it or not, all materials suppliers are currently playing by those rules:
Defective contact lens? 1-800 has to eat it.
Dr.'s change on an outside Rx? The optician and lab eat it.

[drk]

And to your other point: public acceptance of a licensed optician's professional services...why the heck not?

They just aren't used to it, yet.

Wear a tie or embroider your title on a golf shirt, hang a nicely-framed license over your shoulder, act the part and you're golden. (But NOT Richard Golden with your fat **** stuffed in jeans and cowboy boots doing a jig and jumping on a motorcycle...We'll miss such classiness, but I digress.)

With the rise of the McTician it is of paramount importance!
With the decline of the dispensing OD, it is of paramount importance!

What would a heavyweight like Darryl M or Steve or Shanny look like on an optical floor? It'd be sad for them not to get paid for their knowledge.

Not to further sycophantize myself, but how does Robert M. present himself? I'd like to know.

[Andrew Weiss]

I think you hit the key with education. If we are going to make this switch so opticians charge for professional services separately from goods, we will need to educate the public. That may take some time, but we have to start sometime, right?

As to professional demeanor: I used to wear a tie up north; down here, I wear a golf shirt or a nice silk Bahama-type. I know guys working optical in suits and ties who don't know a lens clock from a tire gauge. The key is to look professional and, more importantly, act professional. Let the patient have the experience of your knowledge and skill without being patronizing. I'd figure that folks like Darryl, Shanny, Steve or Robert M would impress even dressed in "business-casual."

The gist of my other comments/questions is to explore how to keep the service-fee optician out of the middle between the patient and the materials supplier. Opticians and labs are used to covering the cost of redos for Dr's Rx changes; will online materials suppliers be ok with covering the cost of a redo because the optician makes a measurement change -- in other words, will the supplier treat the optician with the same deference as the OD/MD? I don't know the answer to that one.

So, drk, when are we going to open this new optical establishment? :bbg:

[drk]

I think the onliners will vary in their backing up of their products. Not that I want them to succeed, but the successful ones that want repeat business will have to eat their customer satisfaction mistakes.

Plus, if an optician gets involved, I think their return rate is going down.


I liken this to CLs in the modern marketplace. We make just a little on the supply of materials, and it's a bigger hassle. The "living" is earned on fitting the things.


Agree on business casual.


My thinking is this:
If opticians enumerate and describe the services they provide "included" in the materials purchase without specific service fee itemization (e.g. the usual way), it raises awareness of the service. That's step #1.

Step #2 is to hit freeloaders up for service fees. That means outside adjustments and repairs, too. Yeah, some truly see the goodwill of a freebie as a promotional, but I think it takes away an important stepping-stone to professional survival. If you have to, give away a cleaning cloth with your logo and phone #, or something, but collect for the service!

Step #3 is gradual acceptance of professional fees over the long haul.



Sad fact is that Walmart, Costco, Glassesonline.com is cutting out professional service and selling materials only. They make the rest look expensive, because the average Jane doesn't realize the freckly kid handing them their glasses is an optician in title only: no professional on staff.

[RustyS]

I would never release a PD unless doctor wrote it on RX, If it wasnt my Doctor they will need to go to source. Right now online purchases are sketchy, however right now i can buy a basic real time 3d scanner with direct export to software that can render a CAD file down to .01mm for $2500.00 worth of hardware while subect is moving (a little). In 7 years these will be very common and i imagine someone like APPLE will incorporate this into their hardware much like the webcam. When this happens extrapolating a PD will be child's play compared to nose geometry measured at 50 points per inch. I imagine an online test and interaction guide with camera will determine segment/prog type and height very accurately and simply. Using 3d tech and having your inventory aligned and 3d scanned you could represent a walk around view of frame on face. Upon shipping the tech could even give you close to the right panto, temple bend and pad splay. Which is a scary prospect for the low end or middle of the road business because all those fees for services are moot at that point with the exception of fine adjusting and screw/nosepad repair. A kiosk will be able to let you try on 100's of frames quickly perfectly rendered from all angles with a T1 connection. The only thing a pt would have ot do physically is put about 7, four mm round disposable silicone stickers to their face
their face. A simple RFID (radio frequency) tag (applied before shipping) could track all customer history and identify repeat customers as soon as they walked within 3 meters of your kiosk. Im not just spitballing all this tech is here now and pretty cheap. After the kinks were worked out you could install these 500 sq foot stores way cheaper with better merchandise to see at all times than your average shop.

[Johns]

Wear a tie or embroider your title on a golf shirt, hang a nicely-framed license over your shoulder, act the part and you're golden. (But NOT Richard Golden with your fat **** stuffed in jeans and cowboy boots doing a jig and jumping on a motorcycle...We'll miss such classiness, but I digress.)




Awesome Digression!!:cheers:

[Johns]

I would never release a PD unless doctor wrote it on RX, If it wasnt my Doctor they will need to go to source.

I give them all the PDs they want!

The most accurate is to measure the distance between their eyes, going around the back of the head. That number might change depending on the lenght/thickness/cleanliness of the hair, but any good optician and compensate for that.

:cheers:

[DragonLensmanWV]

I give them all the PDs they want!

The most accurate is to measure the distance between their eyes, going around the back of the head. That number might change depending on the lenght/thickness/cleanliness of the hair, but any good optician and compensate for that.

:cheers:


Yeah, just use the wrap compensator!:D

[HarryChiling]

Just a simple NO has always worked for us, I often measure a PD before trying on frames to make sure that the frame doesn't hav an excessive amount of decentration (especially in the higher Rx). I have had patients ask and insist that I owe them that measure. I had one customer dig through the trash can for their PD funny thing was as I ripped the work order up I kept the PD :D.

I have had people come in upset at me because I did not take their PD and they had to get it from a wall mart or sears optician (not picking on either store, they are just the two closest) now keep in mind they are upset that I didn't provide the PD and they knew it would be more accurate with me than at these other stores. We have come out onto the sales floor to find people looking into the pupilometer like the thing was self serve and get upset when we ask them to stop doing that. They don't care to pay for our high priced services or professional fees, just try on your frames and hand them a PD so that they could have their glasses fabricated in bangladesh and come back to you for a fitting, nosepads, and adjustment.

[Barry Santini]

I have had people come in upset at me because I did not take their PD and they had to get it from a wall mart or sears optician (not picking on either store, they are just the two closest) now keep in mind they are upset that I didn't provide the PD and they knew it would be more accurate with me than at these other stores.

Unfortunately, this reminds me of so many *bad* things:

1. If I charge a reasonable fee for, or refuse to service *street-vendor* rimless sunglasses, "they" think I'm being difficult or contrary
2. If I'm very busy with a backload of clients all waiting to see me specifically, they'll get upset, and would rather go to *another* optical shop...where unfamiliar personnel and/or lower-skilled people will take care of them, instead of my partner of 25+ years, whose skill set easily matches or exceeds my own..

Go figure...

All I can chalk this up to is *no child left behind*....

Barry