It's getting more prevalent

[drk]

More people coming into our office with outsourced frames (from you know where).

I've instituted "the waiver" to hold us harmless, but I'm not going to let them buy these frames without a professional service component, and then expect me to provide the professional service component for free "with lens purchase".

I'm fixin' to apply the "patient's own frame" fee to cover the dispensing adjustments.

What says the 'board?

[Uilleann]

Give your pt the option. They can choose either to purchase from you for an appropriate fee what they willingly gave up when they went cheap and online - or they can skip the cost, and deal with the consequences of poorly fitting, possibly broken glasses. *shrug*

[Uncle Fester]

Seriously-
"I'm fixin' to apply the "patient's own frame" fee to cover the dispensing adjustments."

How much? $25?? More???

[drk]

I'm thinking:

[ChrisBowers]

If you can bear with me a little story… I started as a wholesaler in the 70s. The vast majority of profit was made buy selling frames. Our markup was unreasonable and soon frame makers went direct sale to retailers. We were making too much money on a “none valued product” By that I mean we did not add enough value to that part of the business. The same thing happened in finishing lenses. Again, we made too much money and retailers started to buy edgers and stock lenses. Today if you are a “reseller” you are at risk of economies of scale. Consider losers like the family hardware store or the corner drug store or the winners like the big box stores, Amazon and the like. Please don’t be offended here but people pay for “their” perceived value not yours. Most successful businesses I know make their money from the value added understood by their customers. Charge for your services that can’t be undermined.

[drk]

Good point, for sure.

If patients want to walk around with their glasses slipping down their faces, they don't have to pay.

If patients want me to order PALs for their stupid-@$$ "Pair Eyeware" that they bought on YouTube, then they're going to need me to adjust the mother before I can determine POW for designing and ordering their +4.00-2.00x153 +2.50 add 2^BO lenses!

IN OTHER WORDS, IT'S ABSOLUTELY POINTLESS TO WORK WITH LENS DESIGN WITHOUT WORKING WITH THE FREAKING DEVICE THAT POSITIONS THE LENS!!!!


Now I'm mad.

[drk]

[drk]

si·ne qua non

/ˌsinā ˌkwä ˈnōn,ˌsinē ˌkwä ˈnän/



noun

• an essential condition; a thing that is absolutely necessary.
  
  
  
  
  

[Uncle Fester]

"Consider losers like the family hardware store or the corner drug store or the winners like the big box stores, Amazon and the like."

They became Ace and CVS like we are now with venture capitalists and vertical integration taking over.

We know who is behind the curtain in Emerald City.

[Uilleann]

I'd suggest perhaps an intermediate tier as well. Something like this (per pair of outside frames):

$0.00: You recieve NO adjustments of any kind, no pre-measurements of segs/PDs, no aftercare, adjustments, or troubleshooting, and most importantly - NO REFUNDS! You take exactly what you get - just like the onliners do.

$20.00: You get sat down at the dispensing bench with all the tools in front of you, and a mirror. You get to do all your own measurements (again, same as online), and your own adjustments. If ancillary items such as nosepads, screws, lens liners, etc are needed, there is an extra charge on a per-case basis.

$50.00: The actual expert handles everything for you, start to finish, for a pre-determined and set period of time - such as 2 years.

In any case, there are no refunds for broken outside frames, or the cost of replacement lenses (if any) from you, or your wholesale lab.

Would that work for you?

[drk]

Hah. I like it. Would drive a point home.

[drk]

In all seriousness, I question the future of using outside frames.

Now, it seems senseless to not allow a patient to use maybe even a super-high-quality classic frame.
It seems hypocritical to not allow a patient to use an older frame from, say, their last doctors' office, but they can use one from your office.
It seems mean to tell the person that their internet-sourced (or purchased from elsewhere, or stolen) frames can't be used in your office.

What you'd be saying is:
"Old frames are too risky--I don't want to break them".
Or "Only complete jobs are welcome".
Or "We don't put lenses in frames we didn't supply".


But what are the standards in other fields?
"We don't service cars we didn't sell"?
"We can't repair furnaces we didn't install"?

I think a professional has to be able to work in comprehensive ways, and that means lenses-only situations.


Yet, you can't do the job right without taking control of the frame. And you can't take control of the frame without being paid for your services.


It seems like, in an easy world, that lens design, supply, and dispensing would cover the cost of frame adjustments. But it's not like that. It's a separate service that is embedded in the price of the frame "retailing'. (I wrote some dumb article about this, once. Can't find it.)

[drk]

Professional fee-based ophthalmic lens pricing


It’s illuminating to consider how many professional services opticians perform when providing ophthalmic lenses:

• interview of the patient and assessment of optical wants and needs
• interpretation of the written prescription
• evaluation of the previous correction
• lens design
• measurements
• supply of materials
• quality control processes
• dispensing and fitting of prosthesis
• patient education
• Aftercare such as periodic adjustments and maintenance, warranties and manufacturers’ defects, management of prescription non-adaptation and prescribing errors.

The vision industry has adopted the term "dispensing” to globally describe the professional services rendered by optical professionals. As can be seen, “dispensing” grossly under-represents the level of service involved.


In my opinion, optical professionals have the right and responsibility to charge for their time and expertise. In that regard they are no different than any other professional—plumber, personal trainer, or physician.


Physicians and the insurance industry have classified and graded aspects of physicians’ service for the purpose of establishing equitable third-party reimbursement. In general, the following division has been made:

medical history level
examination level
medical decision-making complexity


Essentially this means time spent interviewing a patient, time spent doing physical work,and expertise applied devising a plan—logical and very straightforward.

I believe this paradigm translates well to optical services:

• Interviewing/qualifying a patient is akin to medical history, and can be done, for example, by questionnaire amplified by interaction with an optician.
• Measuring, dispensing, adjusting, and maintenance is a technical skill not unlike physical examination.
• Interpreting a prescription and designing an ophthalmic lens is professional judgement and expertise.

What would be the relative value of each component of optical professional service? Consider this example:

Interview services: 15%
Technical services: 50%
Interpretation &Lens design: 35%


This represents a rough 50/50allocation between “technical skills” and “cognitive skills/people skills”.



Towards professional fee-based pricing for ophthalmic lenses


Let's further assume that an ophthalmic product’s retail price can be broken down to the simple formula:


Retail price = Cost of goods sold + Professional fee



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


The formula above is an appropriate way of establishing ophthalmic lens fees. It also is a formula that can be:

• directly adjusted for increase in labor costs not only cost of goods sold
• instructive in correctly setting fees for multiple pairs or promotions by analyzing amount of service involved

• helpful for analyzing profitability of vision care contracts

Traditionally optical customers have "package-purchased" professional services with optical goods. Newer market forces such as internet optical supply houses, low-service discount opticals, and low-reimbursing vision plans “unbundle the package”-- goods are often sold with minimal or sometimes no appreciable service. Perhaps the most critical marketplace advantage available today to the independent optician is professionalism and expertise.


While I’m not sure the consumer is yet ready for retail lens prices itemized as cost of goods sold and professional fees, I do believe there are strategic and even job-satisfaction benefits from internally quantifying professional fees when pricing ophthalmic lenses. In a future article, real-world application of professional fee-based ophthalmic lens pricing will be considered.

[Uilleann]

People aren't stupid. OK - let me qualify that, because obviously there are exceptions.

When people try to do an end around of any medical professional, they know precisely what it is they're giving up in order to get "the-cheapest-possible-product" - at least in their own mind, and without any sort of comprehensive understanding of the true, full scope of that medical profession. Online glasses. Online "braces" (invisalign, et al), online medications, online orthotics, etc etc etc.

It's cheap precisely because you are cutting the medical professional out of the equation. You should expect in every one of these scenarios, that your quality of care will be notably poorer than an in person visit with a healthcare professional. And you should expect problems, lots of back and forth, and perhaps even the likely return of the product.

That's the cost.

You expect things to work? You get to pay for the priveledge of either going to school/training yourself, or you get to pay someone else who did it for you. It's really simple.

I think you're very right in charging for your professional services.

[drk]

You speak truth.

Now, this is going to be a problem going forward.

I don't necessarily begrudge patients the choice to buy frames wherever they wish. I have a dang good frame selection, but nothing's for everyone.

In reality, I feel a little honored that they want our professional services on vision care, and even bother to use us when they can get DIY services online. They're not stupid, as you say. (The DIYers are stupid, though.)

So, there has to be a happy medium.

How, Optiboarders, can we establish the precendent that will go forward? This is an august group, here.

[drk]

I did monkey with a frame pricing structure that went something like this (much like the lens pricing formula paper, above):

Multiplier for retail aspect of maintaing frame inventory, sales staff, overhead, etc. (you choose the multiplier)

PLUS

Set professiona fee for professional dispensing.

So, it's "X" multiplier + "Y" dispensing fee = "R" retail price.

Then I'd simply in this case charge outside frames for the "Y".

[drk]

Good old Chris Ryser used to say the same thing with his "internet glasses service shop" concept. It's not a bad idea, overall.

[Kwill212]

Unrelated to the topic. But, how many cups of coffee have you had today doc?

[Uilleann]

It might be helpful to put up a very nicely laid out and printed sign/poster in a conspicuous area that anyone coming into the office can see and read quickly, outlining the professional scope of what "dispensing" actually entails, and why it requires a professional fee. Something to the effect of: "We are an office of medical professionals, and we deeply respect the trust you put in us to give you the best in quality healthcare, and material science. We do all we can to help keep cost reasonable, and as such we feel you will find the following professional service fees appropriate for the level of care you have come to expect from us." Etc etc, or however you want to lay it out. I cannot express how important a good layout and printing can be to the image you are wanting to convey. Have it professionally printed. Probably matted and framed also. Just make it accessible.

I think most individuals are both aware that the "online experience" has a cost with many otherwise person to person interactions, and if you clearly and openly explain those costs up front - and NEVER EVER EVER apologize to anyone for charging them - they will almost always be understanding and apreciative from the get go. Talk about the fees casually with them the same way you do their insurance copays, or shipping charges, or anything like that. It's a cost. You want the service, the knowledge, the expertise?

You PAY for it. And if we're doing our jobs right, they do so happily.

[DanLiv]

Re-using old frames, whether my own or from another place, or using crappy frames, require more re-adjusting, cleaning, nose pad changing, screw replacing, nylon restringing, etc. than good new frames do. I have a flat POF fee, now $34, for every lens pair sold without a new frame purchase. Side benefit, run a POF fee sales report any time to easily see how many frames you didn't sell. Second side benefit, makes frame costs seem lower. That $56 frame after VSP benefit includes that $34, so getting the new frame is really only $22 more than replacing lenses. I accept all but the most janky frames, and if I break anything I accept I'll replace it as well as I can. I'll even buy them a new WP frame if they want. The combined pool of 500 POFs a year gives me plenty of profit to spend on those few instances and avoid headaches for everyone.

[Barry Santini]

I don’t charge for these small things.

But, 8 times out if ten, people appreciate the professional service so much that they plop down $20 for “coffee.”

Fee received, at a price they set, not me.

And they return.

My philosophy: I am an optician. I am trained to make glasses and make lenses. That is what I do…all I do.

You want to use your frame, from wherever and whatever the reason, no problem.

Works for me.

B

[drk]

It's not a small thing, sir Barry. But otherwise I can dig it.

I like the simplicity of that approach, and it may well be the best overall.

We'll see what happens.

[drk]

Unrelated to the topic. But, how many cups of coffee have you had today doc?

I think we need to ask Barry! #jealousoffreecoffee

[juno]

My old corporate office charged a fee for COF, current private practice does not. I don't think a small fee is unwarranted or unreasonable. It can be used as a disincentive against frames you are concerned about but don't want to phrase it that way to the patient. $20 to $30 seems relatively fair. And if the patient is wearing a frame you have access to, you can waive it, or if they're just cool people, or you can just build it into the cost of the order and present it as part of the holistic quote ("lenses come to $XXX").

[KrystleClear]

I don't charge a fee but I will have them sign a waiver for any previously used frames that we haven't sold them within the 1 year warranty window and all outside frames. We are shipping everything out now through UPS to Cherry and I have seen how UPS crushes boxes. And with people using frames from the cheaper online "opticals," the frames are sometimes pretty shoddy. I once decided to order a pair of drilled rimless from Zenni Optical back before I got lasik. I wanted to see what the quality was. I attempted to adjust the temple, using my optician skills of course, and it instantly broke. The metal was just so crappy that it couldn't handle any bending.

I'm happy to still sell someone just lenses if they really can't buy a new frame but I make sure they know that if those suckers brake, they're on their own for finding a replacement frame. I also make them aware that even if they survive the edging process fine, if they leave with their complete pair and then two days later the frame breaks, we are not refunding them for lenses as we didn't supply the faulty frame.