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Thread: Optician Mark Ups

  1. #26
    Excalibur
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    Quote Originally Posted by PresbyopicBiker View Post
    I left Ontario many years ago due to the strange rules set up by their College of Optometry. In BC we hire opticians in office, charge an exam fee that is appropriate, and we have our choice of dispensing fees or markup. Some practices are even more multi-disciplanary with ophthalmologists on staff.

    The government pays towards an eye exam for under 19 and over 64. The other age group the government pays towards any ocular pathology and certain systemic conditions like diabetes, MS, MD. Normally if it is an emergency or children I do not bill over and above.

    Hope this adds to the discussion for the left coast.
    Things are looking good in Ontario for optometrists. Optometrists in Ontario will soon be able to hire opticians. Optometrists here share excellent working relationships with ophthalmologists too. The government health plan here insurances children and seniors. Other patients receive coverage if they are referred by their family doctor for eye disease or problems where a patient may be at higher risk of eye disease such as diabetic retinopathy. Ontario optometrists will also soon be able to prescribe medicines for eye conditions, include oral medicines too. As for dispensing fees for eyewear, I think this regulation is progressive as it separates the cost of obtaining the good from the cost of providing the service -- very professional and justifiable. It also keeps the cost of the appliance reasonable to the patient.

  2. #27
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    Quote Originally Posted by Excalibur View Post
    Things are looking good in Ontario for optometrists. Optometrists in Ontario will soon be able to hire opticians. Optometrists here share excellent working relationships with ophthalmologists too. The government health plan here insurances children and seniors. Other patients receive coverage if they are referred by their family doctor for eye disease or problems where a patient may be at higher risk of eye disease such as diabetic retinopathy. Ontario optometrists will also soon be able to prescribe medicines for eye conditions, include oral medicines too. As for dispensing fees for eyewear, I think this regulation is progressive as it separates the cost of obtaining the good from the cost of providing the service -- very professional and justifiable. It also keeps the cost of the appliance reasonable to the patient.
    I think the cost-plus regulation is a joke and only encourages poorer services and products to consumers.

    My proof is in my competition.

  3. #28
    Excalibur
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    Quote Originally Posted by For-Life View Post
    I think the cost-plus regulation is a joke and only encourages poorer services and products to consumers.

    My proof is in my competition.
    Please demonstrate some verifiable examples that "cost-plus encourages poorer services and products to consumers."

    Please describe why a mark-up percentage on a name-brand frame must differ from a generic. Is any mark-up difference between the two types of products justifiable, and is it ethical?

    Thank you.

  4. #29
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    Quote Originally Posted by Excalibur View Post
    Please demonstrate some verifiable examples that "cost-plus encourages poorer services and products to consumers."

    Please describe why a mark-up percentage on a name-brand frame must differ from a generic. Is any mark-up difference between the two types of products justifiable, and is it ethical?

    Thank you.
    Mark up difference on a name brand frame should not differ from a generic. I never said that, so do not put words in my mouth.

  5. #30
    bilateral peripheral scotoma LandLord's Avatar
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    Quote Originally Posted by Excalibur View Post
    Please demonstrate some verifiable examples that "cost-plus encourages poorer services and products to consumers."

    Please describe why a mark-up percentage on a name-brand frame must differ from a generic. Is any mark-up difference between the two types of products justifiable, and is it ethical?

    Thank you.
    Actually I disagree with For-Life. If you know anything about business you would know that there will be a different markup.

    Generally, the markup on a name brand frame will be lower because the cost of acquiring it is higher and the availablity of comparison is higher. However, the value to the customer will be similar. An item should be priced according to value, not cost.

    Maybe Excalibur would gladly sell a name brand frame at a loss just to compete with Costco, but most businesses can't afford to do that.

  6. #31
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    Quote Originally Posted by LandLord View Post
    Actually I disagree with For-Life. If you know anything about business you would know that there will be a different markup.

    Generally, the markup on a name brand frame will be lower because the cost of acquiring it is higher and the availablity of comparison is higher. However, the value to the customer will be similar. An item should be priced according to value, not cost.

    Maybe Excalibur would gladly sell a name brand frame at a loss just to compete with Costco, but most businesses can't afford to do that.
    Yeah, that makes sense too. You make money off of the volume. Saying that, designer names are not driving the volume, so I keep it the same.

    Also, I know you did not mean anything by it, but be careful with using the line "if you know anything about business."

  7. #32
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    Quote Originally Posted by Excalibur View Post
    Please describe why a mark-up percentage on a name-brand frame must differ from a generic. Is any mark-up difference between the two types of products justifiable, and is it ethical?

    Thank you.
    Pardon me for interupting w/ my blatently American capitalistic views - but you charge what the market will bear.

    Frame companies make two identical frames, put the name-brand logo on one and no-name on the other. The brand name cost me more, because Ralph Lauren must get his cut. IF I mark up the Ralph more than the generic and the patient sees value in the brand they will buy. If they don't, they won't, so I have to reduce the price. If my margin on a name-brand doesn't justify the higher cost I paid, then I won't buy. This is customer choice, customer value, and supply and demand. Regardless of what your views are, supply and demand is a law of economics. It's like gravity, you can't ignore it. It's not an ethial question, it's a market driven question. Is it "ethical" to charge $400K for an Astin Martin, just because you or I don't think it's worth it? No, because someone else might think it's worth it.

    The answer to "What SHOULD that item cost" is always "Whatever the market will bear"

    BTW, If you are so good at providing a thourgh exam at a clip of 20/day at a fee below "recommended" rates, then I suggest you raise your fees, see less patients, work less and make more money. If you knew anything about business, that is.

  8. #33
    Excalibur
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    Quote Originally Posted by MarcE View Post
    Pardon me for interupting w/ my blatently American capitalistic views - but you charge what the market will bear.

    BTW, If you are so good at providing a thourgh exam at a clip of 20/day at a fee below "recommended" rates, then I suggest you raise your fees, see less patients, work less and make more money. If you knew anything about business, that is.
    With properly trained staff, tests that can be delegated this is more than attainable. I am actually raising my fees closer to the maximum allowable amount advised by our association, which should make the practice even more successful.

  9. #34
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by LandLord View Post
    red herring
    –noun

    1.a smoked herring.

    2.something intended to divert attention from the real problem or matter at hand; a misleading clue.

    Example of a red herring:
    LMAO :D
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  10. #35
    Excalibur
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    Quote Originally Posted by LandLord View Post
    Actually I disagree with For-Life. If you know anything about business you would know that there will be a different markup.

    Generally, the markup on a name brand frame will be lower because the cost of acquiring it is higher and the availablity of comparison is higher. However, the value to the customer will be similar. An item should be priced according to value, not cost.

    Maybe Excalibur would gladly sell a name brand frame at a loss just to compete with Costco, but most businesses can't afford to do that.
    We charge the patient our cost for the materials, and a flat fee for our service to dispense that device. Therefore, we are not charging below cost on the device. We make a reasonable profit, and the patient pays a reasonable fee for the item. There is disclosure on what the materials cost and what our service cost too. Fair and square. Costco is not our competition, as we are a busier high-end practice.

  11. #36
    Excalibur
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    Quote Originally Posted by For-Life View Post
    Mark up difference on a name brand frame should not differ from a generic. I never said that, so do not put words in my mouth.
    The question about pricing a generic different from a name brand was not directed to you alone but to the forum. I would not dare put words in your mouth, as you are quite capable of articulating your position. I think.

  12. #37
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Excalibur View Post
    The fee in my practice for a consultation varies with complexity, but is less than the recommended rate advised by our provincial fee schedule. The consultation includes retinal imaging, field testing, ultrasound, applanation tonometry, refraction, biomicroscopy, and several other procedures as required as well as an information package of topics relevant to their consultation.

    In fact, we routinely hear from new patients that their consultation was the most thorough they have ever experienced-- far more thorough than the doc-in-a-box that saw them beside the optical shop at their last visit.

    Ultrasound? Why would you need to do ultrasound?
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  13. #38
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    We charge the same markup for all frames. Except when we get more expensive frames in. As a rule, we don't like having many frames above $300 retail, so when our normal markup brings the frames above that, we actually round down. Is that unethical? I would say no.

  14. #39
    Excalibur
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    Quote Originally Posted by HarryChiling View Post
    Ultrasound? Why would you need to do ultrasound?
    a.k.a. pachymetry

  15. #40
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Excalibur View Post
    a.k.a. pachymetry
    :hammer:

    Quote Originally Posted by HarryChiling
    Ultrasound? Why would you need to do ultrasound?
    a.k.a. Why? Does your office perform LASIK? Does your office do IOL's? Do you work with a surgeon? Just seems unnecessary since you won't be doing much with the data.
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  16. #41
    Excalibur
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    Quote Originally Posted by HarryChiling View Post
    :hammer:



    a.k.a. Why? Does your office perform LASIK? Does your office do IOL's? Do you work with a surgeon? Just seems unnecessary since you won't be doing much with the data.
    Not to get off track here but low CCT is a risk factor for glaucoma.

  17. #42
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Excalibur View Post
    Not to get off track here but low CCT is a risk factor for glaucoma.
    You don't find that a bit over the top?
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  18. #43
    Excalibur
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    Quote Originally Posted by HarryChiling View Post
    You don't find that a bit over the top?
    Not at all. Measuring pachymetry is a necessary factor. I trust you are not familiar with the OHTS.

    http://www.nei.nih.gov/glaucomaeyedrops/

    you may wish to review this important study.

  19. #44
    OptiBoard Professional Ory's Avatar
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    Pachymetry is very useful Harry. It allows us to determine risk of glaucoma, candidacy for LASIK, etc.

    Cost-plus is crummy as there is increased risk and decreased compensation for high end products. Why would I sell Alize when CHC gives the same compensation. Or why AR at all?(yes, it is for my patients' benefit, but financially there is no incentive.)

  20. #45
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    Quote Originally Posted by Excalibur View Post
    Not to get off track here but low CCT is a risk factor for glaucoma.
    I don't mean to split hairs here (Actually I do). But I thought that CCT was not an actual risk factor but that a thick cornea can interfere with getting an accurate pressure and cause a high reading. Whereas a thinner CCT can cause the pressure reading to be higher than actual, Right?

    Pachymetry is now pretty much the standard of care if you are treating glaucoma. We also use it also for Lasik screenings. People don't like to drive 120 miles to the lasik clinic just to find out they aren't a canidate.

    Most insurance will pay for pachymetry once in a LIFETIME. So at $19 or so for the reimbursement; I can guarantee you that we aren't performing "unnessary" tests just to bill insurance. After 4 years of performing pachymetry, I still don't think we have paid for the instrument. Actually I know we haven't, because at year 3 we had to replace the circuit board at a cost of $1600.

    Oh, I just noticed. This is posted in the Canadian Discussion forum. Didn't mean to intrude. But when folks start talking mark-ups, I just naturally join in.

  21. #46
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    Quote Originally Posted by Ory View Post
    Pachymetry is very useful Harry. It allows us to determine risk of glaucoma, candidacy for LASIK, etc.

    Cost-plus is crummy as there is increased risk and decreased compensation for high end products. Why would I sell Alize when CHC gives the same compensation. Or why AR at all?(yes, it is for my patients' benefit, but financially there is no incentive.)
    exactly. Even think of it this way, why spend 15 extra minutes discussing the benefits of AR or photochromic add ons. You will not see a return for that (well you will hopefully in the long term, but not many people think about that anymore). It has cheapened our profession and has not provided the best resources to patients.

  22. #47
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Ory View Post
    Pachymetry is very useful Harry. It allows us to determine risk of glaucoma, candidacy for LASIK, etc.

    Cost-plus is crummy as there is increased risk and decreased compensation for high end products. Why would I sell Alize when CHC gives the same compensation. Or why AR at all?(yes, it is for my patients' benefit, but financially there is no incentive.)
    I am familiar with pachymetry and it's use and am familiar with the OHTS, but most offices rely on the goldman alone, I am aware of the fact that central corneal thickness of 555 is the norm and too thin could be a risk factor, but most offices would just use pressures of above 21mm/Hg as being a risk fcator or family history. So then comes the question how often does it gets used? Is it a necessity or a luxury?

    I just don't see how someone can equip their office to the brink, charge lower than the norm, and still complain about opticians having too high of a mark-up.
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  23. #48
    Excalibur
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    Quote Originally Posted by HarryChiling View Post
    I am familiar with pachymetry and it's use and am familiar with the OHTS, but most offices rely on the goldman alone, I am aware of the fact that central corneal thickness of 555 is the norm and too thin could be a risk factor, but most offices would just use pressures of above 21mm/Hg as being a risk fcator or family history. So then comes the question how often does it gets used? Is it a necessity or a luxury?

    I just don't see how someone can equip their office to the brink, charge lower than the norm, and still complain about opticians having too high of a mark-up.
    Pachymeters are not expensive. Approx 3-4k.

    Harry-- I believe that it the mark-ups I see being charged by retail optical shops is simply excessive, however, if that is what the market can be bear then so be it. You have given me an idea, and that is... raise my fees! That will give me an opportunity to upgrade from a BMW! :D

  24. #49
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    Quote Originally Posted by Excalibur View Post
    Pachymeters are not expensive. Approx 3-4k.

    Harry-- I believe that it the mark-ups I see being charged by retail optical shops is simply excessive, however, if that is what the market can be bear then so be it. You have given me an idea, and that is... raise my fees! That will give me an opportunity to upgrade from a BMW! :D
    That is because you are an OD who has the convenience of seeing many patients for eye-exams during th week. I can tell you that a private, independent dispensary cannot live off of cost plus.

  25. #50
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Excalibur View Post
    Pachymeters are not expensive. Approx 3-4k.

    Harry-- I believe that it the mark-ups I see being charged by retail optical shops is simply excessive, however, if that is what the market can be bear then so be it. You have given me an idea, and that is... raise my fees! That will give me an opportunity to upgrade from a BMW! :D
    Good, I don't think that opticians mark ups are excessive I think Optometry's fee's are too low, you guys cut your own throats every chance you get. If you raise your fees maybe you won't have to work so hard and then you'll have more time to see someone elses point of view.
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