Why do we sell high-end lenses to mid/low income consumers? We're killing ourselves

[AngeHamm]

In my humble opinion, looking at what we do as selling products is the mistake, whatever our strategy. In an industry increasingly dominated by managed care, big box stores, same-day service, and online, the one thing we have the unique ability to sell is ourselves: our expertise, our customer service, and our customized products. I'm not selling eyewear, I'm selling a relationship with my practice. The money doesn't come from the initial sale, it comes from years of repeat business, from their family, from referrals.

Remember also that perceived value is possibly more important than actual value. Some patients want to leave the office feeling like they've outsmarted a salesperson and only paid the bare minimum. (Some of these patients are the wealthiest you'll ever see, incidentally.) Some want to leave knowing that they've been dispensed the latest and greatest technology known to humanity, regardless of the price. (Some of these patients will actually boast of the price they paid for their glasses at dinner parties.) Anyone who has ever nodded their head when reading here of the problem jobs that get put on the "magic shelf" and returned unchanged to a delighted patient know how much perception shapes reality in this business.

Be accessible to all kinds of patients with all kinds of needs. Have product available for a wide variety of requests. I find that the "good-better-best" model (with "fair" available for the very price-conscious) works exceptionally well. Don't make your patient's budget for them; recommend the best for their needs and give them options. Educate them and let them decide.

Know your own market and adapt to serve it. There is no one-kind-fits-all model in optics.

[Dr. Bill Stacy]

well said

[iD]

Remember also that perceived value is possibly more important than actual value. Some patients want to leave the office feeling like they've outsmarted a salesperson and only paid the bare minimum. (Some of these patients are the wealthiest you'll ever see, incidentally.) Some want to leave knowing that they've been dispensed the latest and greatest technology known to humanity, regardless of the price. (Some of these patients will actually boast of the price they paid for their glasses at dinner parties.) Anyone who has ever nodded their head when reading here of the problem jobs that get put on the "magic shelf" and returned unchanged to a delighted patient know how much perception shapes reality in this business.

Be accessible to all kinds of patients with all kinds of needs. Have product available for a wide variety of requests. I find that the "good-better-best" model (with "fair" available for the very price-conscious) works exceptionally well. Don't make your patient's budget for them; recommend the best for their needs and give them options. Educate them and let them decide.

Know your own market and adapt to serve it. There is no one-kind-fits-all model in optics.

The realest thing said so far.

[iD]

I used to get upset when a -10.00 wanted CR-39, I would explain the difference in materials and try to convince them that hi-index would be better. Sometimes they still chose the CR-39 option and I would make the script in CR-39. The client walked away unhappy that I made such thick glasses and I would end up in a confrontational situation explaining to the client that the choice was theirs.

You will always have that customer though. If every customer listened to us we wouldn't have made the "whats the dumbest thing a patient has asked you" thread. Sometimes a patient has to see it their way and once they see their way is wrong that's when you step in with a polite "I told you so." Well maybe in that those exact words. I have had the same problems you've had with a high myopic patient wanting plastic. They felt the heaviness of the glasses and the thickness touch their cheeks, since then they trust what I say.

[VisionAiry]

"I'm not selling eyewear, I'm selling a relationship with my practice"

^This is what every small grocery store in the country said before walmart put them out of business for good decades ago.

You can sell with friendship and service, but you can't sell anyone anything without product. Therefore, you sell product. And no one is going to pay you double for it not even your own mother

Quick story.
I had a friend have her eyes examined and buy contacts at my place. I was out of the office when she came in. She's a -13.00.
Later I saw on Facebook that she bought glasses online for $225.
I later asked her if she had even asked about glasses while she was at my shop.
She said "no I didn't even ask, I just figured they'd be really expensive".

^That is what we're up against my friends

This is the future:
1. Patient buys vision "insurance" through employer.
2. Patient is directed to our stores for exam and to choose frames and get measured.
3. We get $55 "service/exam/measurement fee" from insurance.
4. Patient buys frame and lenses online from Coastal(Essilor) who is reimbursed by, or probably owned by, VSP/EYEMED.
5. Patient gets sent to us for adjustments, maybe we get paid $20...maybe

There you have it folks. We just got $70 for a patient, at BEST. Plus we just spent $20 to bill for that $70...so we get $50

How do we prevent this, or something like it? My guess is that it has a lot to do with going after and cultivating cash patients and competing directly with the internet, and that means good prices and not over-selling.

We all know that, if un-subsidized, vision plans don't provide any financial benefit to the patient. They have to lie about the costs of our products to make the numbers work and sell their plan. Then they require us to go along with those lies (fake high prices) in order to be a provider. Has anyone ever seen the "savings comparison chart" on VSPdirect's homepage? Go down that list and replace their "without insurance" price with your real cashprice and add it up. They save....drumroll...nothing. We should REWARD patients for not buying or using this b.s. "pasteurized insurance product". I tell every patient exactly how much their insurance "pays" in real money, not what their "benefit" is. Don't let patients think that their "insurance" company isn't lying to them, they are on a massive scale.

Sorry, rant. I just got mad (again) at the fact that we're sucking up to these FAKE "insurance" companies. That's going to be the death of us.

It's NOT insurance.

Maybe I'll just start a business selling "insurance" for toothpaste and dog food

[Dr. Bill Stacy]

VSP is not entirely fake. I admit it has some big drawbacks and problems, especially for independent opticians.

For example, they get a comprehensive eye exam for 0.00 or 10.00 copay, That is real insurance. My comp exam fee is $150, and I agree (like all insurance providers) to accept their reimbursement (around 78) for the exam

They get a standard frame (anywhere from 100 to 300 retail, depending on the plan) for 0.00 to 25.00 plus 80% of any frame overage. Again, I accept something less than my full price, but not usually as low as 55.00.

They get standard lenses (CR39, sometimes poly, sometimes other extras) at no extra charge than their 0 or their material copay mentioned above.
There are many VSP plans, some low end some high end. Usually the employer pays for the premium, but sometimes the patient does.

I know I'd be unhappy with the state of affairs if I were an independent optician and thus can't join vsp, but I don't think I'd distort the facts out of anger. doing that could make it sound like you're just sour grapes.

And 75.00 for ordering an rx that you don't have to pay anything for the materials or do anything but select, measure and fit them, is not that bad, and the 20.00 for ordering is silly; it's all done by computer these days, or should be. Less work than doing a private job, for sure. I figure if I weren't doing exams, just filling Rxs I could knock out at least 3 or 4 an hour, maybe more; with a little staff help, a LOT more.

I am a vsp doc and do a lot of VSP work, and my vsp patients end up paying me anywhere from 0.00 to $500 or more in extras, upgrades, etc, for services and materials that my private patient pricing is anywhere from $300 to $1200. The vast majority of them realize that their insurance benefit is worth over $300, which is somewhat more than their employer is paying for the coverage. The vast majority of them love VSP.

It's a love hate relationship for most eye docs, but most of us know it's here to stay. We also realize it will never take over the entire market, try as they might. We still love private patients most of all.

[Barry Santini]

Well Visionairy: I'd say you're about as unwilling to hear a different narative as those ECPs you say are ripping the public off.

B

[Dr. Bill Stacy]

Oh, and that -13.00 patient? One of the best proofs that VSP is insurance is that she would be eligiible for MEDICALLY NECESSARY CONTACT LENSES, which boosts her benefit to $500 to $2500 depending on the type of CL actually used. (VSP it's -10 spectacle or higher, Eyemed is sadly 12.00 D. or more.)

[AngeHamm]

I don't know if the optometrist = grocer analogy really stands up to much scrutiny. Perhaps if the grocer met with you to give you a physical and discuss your dietary needs, then sent you to a private chef who gave you an extensive menu of main course, side, sauce, and spice options, and then the chef made you the meal of your choice from ingredients specifically chosen for your optimal health. And then you had that meal available every day for two years.

[Dr. Bill Stacy]

And if you don't see many -10.s VSP also approves and pays for medically nec. CLs for anyone with 3.00 D of aniso or more, as well as keratoconus and other corneal conditions. And many plans include "Primary Eyecare" coverage, which includes exams and treatments for various medical eye conditions such as foreign bodies, eye infections, etc. Now THAT's real insurance.

[MakeOptics]

You will always have that customer though. If every customer listened to us we wouldn't have made the "whats the dumbest thing a patient has asked you" thread. Sometimes a patient has to see it their way and once they see their way is wrong that's when you step in with a polite "I told you so." Well maybe in that those exact words. I have had the same problems you've had with a high myopic patient wanting plastic. They felt the heaviness of the glasses and the thickness touch their cheeks, since then they trust what I say.

Sure, but your goal and mine is to avoid letting our client experience those mistakes. I use every tool at my disposal, so sometimes I come across as a salesman, other times as a saint; usually with that type of patient it's either black or white. I am fortunate enough I can create my own tools so often times I can visually show them their lens represented virtually and they can see my point, if they still harp on it, sometimes especially in the extreme cases I decline service.

No shoes, no shirt, no trust, no service.

[MakeOptics]

She said "no I didn't even ask, I just figured they'd be really expensive".

^That is what we're up against my friends

That sounds familiar, try advertising specials or creating promotions to inform your consumers of your great deals. The reason I mention that is that all other competitors will advertise value most offices I know think that any sort of marketing is wrong and looks retail or cheap. I personally like having the ability to highlight value in the products and services provided without it dispensing and capturing the clients attention can become more difficult.

[VisionAiry]

Well Visionairy: I'd say you're about as unwilling to hear a different narative as those ECPs you say are ripping the public off.

B

I don't think most ECPs are ripping off the public. The public thinks they are. That is not my opinion. Let me repeat, the public thinks we're crooks.

They think that because you let insurance companies tell them that exam +glasses cost $664.00.
https://www.vspdirect.com/?utm_conte...015iPlan&pdv=c
That's a flat out lie and that's why people like my friend don't even consider buying from any brick & mortar location.

I'm well aware that VSP was started by optometrists, for optometrists. They helped you out. But look, now you have entire stores full of frames with fake prices that no one would pay, fake exam fees that the market would never bear ($150, are you kidding?) and have turned you/us into worse than Coastal or online companies. At least they use real prices, that people actually pay.

Maybe I was just sick of being forced to play a game. I wanted to do what I do for a living, not watch my industry turn into a mess where the price isn't the price. I hated that when someone asks me how much a frame costs, I had to ask them if and what type of insurance they have so I didn't get tripped up.

I heard a story, i believe on the optiboard, about an ECP's patient wanting an Oakley Frame. He had the real price listed on the frame. Not the fake inflated price. He was forced to either "honor his vsp contract" and discount the heck out of it and lose money OR violate his Oakley contract by selling it for below the allowed price. The patient complained to VSP. What a mess. Quit getting bossed around guys. Some of us seem to have so much pride in this profession but simultaneously accept the pricing "strategies" that seem more like racketeering than good legitimate business.

As far as vision plans equating to insurance. That ship has sailed in my book. Insurance is for catastrophic events, that's the purpose. Just because they cover medically necessary contacts which affect a minuscule fraction of people does not make the scam not a scam. This is just an example of saying something so often and for so long that it becomes true. If it were insurance then Blue cross wouldn't be farming it out to Eyemed and VSP. It's not insurance, they don't even want to deal with it anymore because they've realized that it's even more of a racket than health insurance, which is saying a lot.

If I sound angry, it's because I struggled with this for years. I'm not mad for me, I'm mad for you. Business is up and I take care of about 40% more people than I did 2 years ago. Now people tell me "thank you, you just saved my job, I didn't think I could afford glasses". I sell for the same prices that Coastal does...and it's profitable, but only when they don't have "insurance" to deal with. I actually sell lenses sometimes for the same price that I could get them from an Essilor Lab.

[Johns]

"I'm not selling eyewear, I'm selling a relationship with my practice"

Quick story.
I had a friend have her eyes examined and buy contacts at my place. I was out of the office when she came in. She's a -13.00.
Later I saw on Facebook that she bought glasses online for $225.
I later asked her if she had even asked about glasses while she was at my shop.
She said "no I didn't even ask, I just figured they'd be really expensive".

^That is what we're up against my friends

Certainly no offense, but part of having that relationship is being able to discuss all of their needs, including glasses, without them having to ask. The right questions would probably have prevented that patient from going online. Since contacts are usually a loss leader anyway, we use the patients time in the office to discuss their glasses and other issues they might not think to ask.

[Dr. Bill Stacy]

Well, I set my exam fee down to $150 from $160 about 3 years ago. I'm definitely not at the top range for comp. eye exams in this town, but then Folsom is an upscale California town near Sacramento, the capitol. There are bottom feeders at Costco who charge less, but I'm guessing they don't have the same overhead I do. I do know there are lower exam fees in Michigan, but I'll bet there are higher ones too. And then I include digital fundus photography in my exam fee, because I do it for every patient every exam. So I'm not kidding anyone that that is my fee. To be fair, I mentioned I accept less for insurance plan because I have to to stay on the panel. I also offer discounts to seniors etc. I accept medicare payment for the medical part of the exam, but still charge the patient $45 for a refraction if I do that, since it's not a medicare benefit.

As for frames, I charge $640 for a Lindberg, and I assume you know what those cost me. I think that's a reasonable markup. You do believe in capitalism don't you? I also charge $160 for an Altair frame. And I have some discontinued Rodenstock frames I sell for under a Frankie.

My base price for single vision finished lenses is 100, for bifocals is 160. Is that really inflated? I think I'm in the mainstream, if not a bit low.

Now I don't want to encourage you to raise your fees, but you might want to do some serious stealth shopping in your area just be sure you are not practicing in the past. It's happened to me a couple of times, and maybe it's happening again. I'm really concerned my PAL pricing is out of date after seeing some of my Hoya invoices...

[VisionAiry]

Well, I set my exam fee down to $150 from $160 about 3 years ago. I'm definitely not at the top range for comp. eye exams in this town, but then Folsom is an upscale California town near Sacramento, the capitol. The are bottom feeders at Costco who charge less, but I'm guessing they don't have the same overhead I do. I do know there are lower exam fees in Michigan, but I'll bet there are higher ones too. And then I include digital fundus photography in my exam fee, because I do it for every patient every exam. So I'm not kidding anyone that that is my fee. To be fair, I mentioned I accept less for insurance plan because I have to to stay on the panel. I also offer discounts to seniors etc. I accept medicare payment for the medical part of the exam, but still charge the patient $45 for a refraction if I do that, since it's not a medicare benefit.

As for glasses, I charge $640 for a Lindberg, and I assume you know what those cost me. I think that's a reasonable markup. You do believe in capitalism don't you? I also charge $160 for an Altair frame. And I have some discontinued Rodenstock frames I sell for under a Frankie.

My base price for single vision finished lenses is 100, for bifocals is 160. Is that really inflated? I think I'm in the mainstream, if not a bit low.

Now I don't want to encourage you to raise your fees, but you might want to do some serious stealth shopping in your area just be sure you are not practicing in the past. It's happened to me a couple of times, and maybe it's happening again. I'm really concerned my PAL pricing is out of date after seeing some of my Hoya invoices...

Bill, I hope you don't take offense to my balking at your exam fee. You said yourself though that you accept $78. To me that means that your fee is $78, in the real world. That's what I'm complaining about is that we don't operate in a world where numbers and prices mean anything at all. It's so fake it drives me up the wall.

Your lens prices, based on what reps tell you, are spot on. They all tell us that the next guy is so much more expensive than we are. They're full of it. I'm still transitioning out of the insurance game so it's still a bit complicated. While it's not my ideal sale, I happily take $35 for SV plastics and as low as $80 for progressives. I do my own finish work though and I know for a fact that if you're using most labs like Essilor or Zeiss or Hoya you can barely even buy lenses for that but I switch people from E and Z lenses all day long to my lab's house PAL and have no complaints, honestly. Even if someone wants Crizal I tell them it's not worth the $$ and charge them $40 for my lab's house AR or maybe 90 for their super hydro, which btw neither crazes or comes off, ever. I hate to give up my secret, and there are things about them that some might not like, but FEA saves me an actual pile of money every month and all their AR's are absolutely phenomenal.

As far as frames, I search very hard for frames that have actual value. Basically frames that are underpriced. A lot of optical-only brands. I think you know that you can't make a nickel on a ray-ban to save your life. You can buy nearly ANY ray-ban for wholesale cost on the internet, thanks to our friends at Lux. Frames are what they are. Lenses are where all the money can be saved primarily. I've stated before, Lens technology is well developed and there's no reason we need to pay what some of us are currently paying. I read through price lists now from E and Z and Cherry or Visioncraft for example (they're local to me). I just cringe. I can literally pay my mortgage and car payment with the money I save by not using them.

[Dr. Bill Stacy]

No offense taken. But I do think you don't understand the insurance system we have in the USA. If I were to lower my exam fee to 78 I would get about 50 from the insurance company, or less. Nobody charges what they accept from insurance companies for that reason. Our reimbursements from all insurers, including Medicare, are based on a discounted amount from our UCR (usual and customary, regular fee). If there is a better way, great, but I'm not sure what it is. Interestingly, Medicare, VSP and others monitor our fees surreptitiously and if I lowered my fees without telling them, they would lower my reimbursement RETROACTIVELY, the dreaded fee adjustment assessment.

[VisionAiry]

No offense taken. But I do think you don't understand the insurance system we have in the USA. If I were to lower my exam fee to 78 I would get about 50 from the insurance company, or less. Nobody charges what they accept from insurance companies for that reason. Our reimbursements from all insurers, including Medicare, are based on a discounted amount from our UCR (usual and customary, regular fee). If there is a better way, great, but I'm not sure what it is. Interestingly, Medicare, VSP and others monitor our fees surreptitiously and if I lowered my fees without telling them, they would lower my reimbursement RETROACTIVELY, the dreaded fee adjustment assessment.

This is my primary complaint. You see what they're doing? They control your fees because their "insurance product" IS a scam unless you play along. I'm a business person, I control my fees, my prices and every single decision with no intervention between me and the patient. I don't accept any insurances (anymore) that base their payments on my UCR fees. That means no medicare, no medicaid, no vsp, no eyemed. I happen to be somewhat lucky that I have a large group nearby that pays a flat fee and that's it. That's the only way I've made it through the transition. If I were dependent on vsp I would have been totally screwed. I offer huge discounts to vsp members regardless of whether or not I can get paid from them. I do a lot of O.O.N. reimbursements. I literally just decided to go so cheap that it makes their insurance look like a joke. Now that I've done this I see more non-insured patients than I ever thought existed. I think we get so used to seeing 90% insured patients that we think that that's a realistic cross section of the market. I think it's more like 50% out there. Patient-pay people don't even consider going to offices like yours or like mine used to be because of the reputation the industry has.

[ml43]

where's racethe1320 when you need him

[Dr. Bill Stacy]

I think you are giving away your lens finishing costs and profits, which is ok by me, it's a free country and you're halfway across it from me. Unless you have zero overhead by practicing in a shack with outdated equipment you're not going to make much profit while working real hard and making plenty of enemies. Ever consider moving to a communist country? Working at Costco or Stanton's. They all have the same idea.

[iD]

Sure, but your goal and mine is to avoid letting our client experience those mistakes. I use every tool at my disposal, so sometimes I come across as a salesman, other times as a saint; usually with that type of patient it's either black or white. I am fortunate enough I can create my own tools so often times I can visually show them their lens represented virtually and they can see my point, if they still harp on it, sometimes especially in the extreme cases I decline service.

No shoes, no shirt, no trust, no service.

I agree with you 100%. I'm on the same boat as you in terms of having an example of what an a -/+ 4 looks in each material all the way up to 1.67. So whenever I tell someone its double this thickness that usually gets a "wow" reaction. That's when they spring for the better material.

[VisionAiry]

I think you are giving away your lens finishing costs and profits, which is ok by me, it's a free country and you're halfway across it from me. Unless you have zero overhead by practicing in a shack with outdated equipment you're not going to make much profit while working real hard and making plenty of enemies. Ever consider moving to a communist country? Working at Costco or Stanton's. They all have the same idea.

I'm definitely giving away some profits but so far i've been making it up on volume. I took a $40k hit (10%) in revenue the first year. That's all back on the top line this year due to the volume and my net profits are actually up somewhat. Might be difficult to do without an on-site finish lab though. I still, for the life of me, cannot figure out how anyone survives without one.

That's why I created this thread. I truly believe that this industry is in for a very big "disruption" soon. I think we need to change. Think about what Uber has done to the taxi business. They found a way to literally slash 60-70% of the cost out of the system. They upset a ton of people in the process but that's mother nature as far as I'm concerned. If it isn't you that does it it's going to be someone else. That's the magnitude of the change that I believe is coming. I'm not sure what form it's going to come in but I'm guessing there's going to be another large consolidation. Probably involving Essilor or Lux and some combination of those combined with the likes of walmart and one of the big internet players. I think the on-liners are going to start paying us to take measurements and stock frames to try on. You might think no-one would go for it but they will find a way to make it worth your while, and then they'll pull the carpet out...somehow. They'll slowly make vision plans less and less relevant and once that happens, it's an unadulterated free market, which means whoever saves the consumer a nickel is gonna be the winner.

[Dr. Bill Stacy]

The vast majority of optometrists in this country don't have in office finishing. I did because I too know about stock lens buying and learned that trade working for an O.D. who had a hole in the wall in a discount center, for $1.60 an hour (yeah, cribbing and grinding glass on a stone edger in 1967). I put in a nice Santinelli set up in my new office when I found out VSP would let me (no wait, they ENCOURAGED ME), and here I am with my son who cranks out 12 or 15 pair a day.

But that machine with blocker and drill cost me over 60K. Did you figure any of the cost of something like that into your calculations? If not, hire yourself an accountant (the tax type) and an analyst (the psych type). Have your books and your head examined. Then report back here.

[OptiMon]

This is my primary complaint. You see what they're doing? They control your fees because their "insurance product" IS a scam unless you play along. I'm a business person, I control my fees, my prices and every single decision with no intervention between me and the patient. I don't accept any insurances (anymore) that base their payments on my UCR fees. That means no medicare, no medicaid, no vsp, no eyemed. I happen to be somewhat lucky that I have a large group nearby that pays a flat fee and that's it. That's the only way I've made it through the transition. If I were dependent on vsp I would have been totally screwed. I offer huge discounts to vsp members regardless of whether or not I can get paid from them. I do a lot of O.O.N. reimbursements. I literally just decided to go so cheap that it makes their insurance look like a joke. Now that I've done this I see more non-insured patients than I ever thought existed. I think we get so used to seeing 90% insured patients that we think that that's a realistic cross section of the market. I think it's more like 50% out there. Patient-pay people don't even consider going to offices like yours or like mine used to be because of the reputation the industry has.

The real problelem is not Zeiss or Hoya, it's the middle man. Cut the cord! Sell what you like!

I stopped taking insurance on 4/20/07 and business has never been better! We sell mostly Hoya Trivex with Super High Vision or better, they just work. Zeiss Trivex with DuraVision Platinum every day. You are the arcitect of their vision, don't lower your quality for their budget.

MakeOptics has the right idea. Offer your patients options but, ultimately it's your decision, as the professional, which lens style, material and coatings the patient should get. All of those decisions are based on Rx, patients needs and frame selection.

[Dr. Bill Stacy]

The real problelem is not Zeiss or Hoya, it's the middle man. Cut the cord! Sell what you like!

I stopped taking insurance on 4/20/07 and business has never been better! We sell mostly Hoya Trivex with Super High Vision or better, they just work. Zeiss Trivex with DuraVision Platinum every day. You are the arcitect of their vision, don't lower your quality for their budget.

MakeOptics has the right idea. Offer your patients options but, ultimately it's your decision, as the professional, which lens style, material and coatings the patient should get. All of those decisions are based on Rx, patients needs and frame selection.

I don't think you read this whole thread. Read the original post and every one that follows to get the discussion. The original poster (VisionAiry) is happy to churn out SV lenses for $35 a pair in his retail optical dispensary. I don't think you'll be doing that with Trivex and stay in business long, with or without insurance. For starters, what's your normal price to the patient for a pair of single vision, say +2.00 sph., lenses only in patient's frame or in a low end (for your location) frame?