How Small Footprint Optometric Practices Can Maximize Profitability


March 08, 2022

3 minute read


Disclosures: Lensky Sipes declares to be a consultant for Lumenis.

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In a small practice, our success hinges on efficiency – the ability to optimize what we have, including our time. We don’t have a lot of space, doctors and staff to rely on volume alone.

I am the only full-time physician in my practice. With two part-time associates, we maintain two exam lanes to see 15-18 patients each per day (30-36 total). That’s a pretty high volume for a firm our size. Our staff is also small, with only four full-time employees and a few part-time office staff. The physical size of the practice is 1,400 square feet, including exam hallways, waiting/optical area, pre-test room, staff office, and contact lens storage.

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Kristyna Lensky Sipes

With declining reimbursements for contact lens exams and adjustments and limited space for expansion or large equipment, we had to maximize our profitability – not only per doctor or per patient, but also per square foot. Here’s how we managed to maintain a thriving practice.

Private paid services for dry eyes

Dry eye affects about half of the patients in my practice, so the demand for treatment is high. In my opinion, the best help I can give them goes beyond what is covered by insurance, so it’s a natural place to offer cash services.

We start with a comprehensive dry eye consultation, which has a cash fee. We review medications, health issues, environmental challenges, and makeup use, as well as what patients have tried and how it worked or didn’t work. This information allows us to put in place tailor-made treatment plans.

When the Lumenis light-based in-office treatment was approved by the FDA for the management of dry eye disease, we purchased OptiLight and began offering this fee-based procedure to patients with meibomian gland dysfunction and rosacea. ocular. OptiLight has a small footprint and we can use it in either exam room. Each patient has four initial 15-minute treatment sessions, which we have organized into blocks for efficiency (one morning and one afternoon per week). A technician helps me to speed up the preparation and cleaning, but I can also easily do it alone if necessary. In addition to helping our existing patients, our OptiLight has differentiated our practice and produced a revenue-generating number of optometrist and ophthalmologist referrals. Patients come from hours away because we are the only practice in the region to offer this treatment.

Along with these private paid aspects of dry eye care, we are looking for reimbursable tests and treatments that fit easily into existing visits. For example, we do manual expression after OptiLight and do a lot of anterior segment photography for dry eye patients. We are currently evaluating the possibility of using InflammaDry (Quidel) or the TearLab Osmolarity System (TearLab), which would not only help us make dry eye treatment more customizable and easier to follow, but would also provide a small reimbursement .

Lean optical strategies

Aside from dry eye, my practice derives the biggest cash income from a few key optical strategies. Overall, because our waiting/optical area isn’t the biggest in town, we have to be strategic in our choices. Our optical manager is brilliant at not only keeping up with trendy styles, but also those that are popular in our area. We sell many of the popular frames she selects. And she knows our patients so well that she can anticipate the schedule and ensure that we have the types of frames patients prefer in stock and ready for their visit.

We aim to sell several pairs of glasses to each patient – one general-purpose pair and one pair of computer lenses or sunglasses. Twice a year, we host an eyewear sale in partnership with a local medical spa for a pop-up Botox clinic (onabotulinumtoxinA, Allergan). We usually get new patients through this promotion as well as additional revenue. For contact lens wearers, we’re giving away a free pair of polarized sunglasses for every one year’s supply of daily disposables. We stock sunglasses in a variety of styles for men and women that we purchase from a preferred supplier at minimal cost.

Experienced staff

A smart, experienced staff is a small firm’s best friend. We couldn’t be profitable without them. In our patient flow, patients receive an email directing them to our patient portal to fill out preliminary medical and insurance information, reducing receptionist duties and shortening patient wait times. Staff also prepare ahead of time by checking the next day’s schedule, noting what each patient will need and who is eligible for new glasses. (Those who are not eligible receive a cash rebate.) When patients arrive, if they have to wait, the optician teaches them about frame selection before their exam. Then our technician does all the pre-testing and enters the data into our system.

By the time I see a patient, I have all the information I need. We chat about their goals and how they use their eyes all day, which allows me to personalize their prescription. I want to make sure they feel they are getting a good quality review and not rushed. We can even slip in urgent visits more efficiently because the scheduled exams are going so well. All of these strategies allow us to truly optimize our time and space for each patient, so that we can be cost effective while providing the best care.

For more information:

Kristyna Lensky Sipes, OD, is in private practice at Stanford Ranch Optometry in Rocklin, CA. She can be contacted at [email protected]


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