Doctor Driven Dispensing: Patient and Practice Success

Dr. Kehoe came to us from Galesburg, Illinois, where he currently has two practices. Previously, he was the past president of the AOA, and graduated from ICO, class of 1984. Today he not only runs the two clinics, but he is on the OPTOS corporate board, and works with Transitions Optical, dealing specifically with professional relations. When he was on the AOA, he would travel a great deal, and found himself asking, “has optometry lost our way?” as he would talk about “medical eye care, and vision insurance.” For example, in 2002, all employees in his town either had VSP or Eyemed vision insurance, and he knew that in his clinic, they had to get on and begin accepting VSP insurance to not lose the 1000 patients that were seen for other problems that were not simply refraction based. That was when he began to focus on optometrists “taking back the dispensary!” and trying to focus on more than just the eye insurance aspect. In his office, they threw out a few exams a day, and profits went back up because he was able to better listen to his patients. As Dr. Kehoe said, “the most important things as an optometrist is to: save sight, lives, and make things that matter to people better.” In writing that prescription, the key is to meet and exceed the patient’s expectations, which is the root behind “doctor driven dispensing.”

Dr. Kehoe then went on to discuss Opternative and why we should be aware of them in our profession. A Digital Vision Optimizer is a holograph that refracts the patient, and in some cases, has gotten the patient refracted so that they can see 20/8, and it does this by coming up with a bizarre prescription that does not follow quarter diopter steps. It follows the patient’s natural posture, and tells the patient to pull out their phone, and then proceeds to refract at that distance. It also can give the patient demonstrations as to what different lenses would do for them under different circumstances: such as polarized lenses. Ophthalmologists wanted to put these in malls to allow for a quicker and cheaper refraction process. There are a couple of current examples of this in use and in practice, one is called Blink, and this can be found in New York City. Another is called 20/20NOW which is an automated refracting lane, and also is equipped with a slit lamp, tonometry, and fundus. An ophthalmologist in CA signs off on these exams, and what they are promoting is cheaper. As optometrists, we must differentiate ourselves!

Today’s realities: patient satisfaction is key. For example, would you buy something that had 3 out of 4 stars or 4 out of 4? If we don’t deliver the 4 out of 4-star service to our patients, they are more likely to go back to other forms of eye care. However, if we keep patient’s satisfaction, they are more likely to come back to us. How you practice is key. Dr. Kehoe than gave us a real-world example of his daughter, who is also an optometrist practicing in Florida. When she first graduated from optometry school, her schedule was all over the place, and had her visiting 6 different practices on 6 different days. When she began working for Luxottica, on days that she was at that practice, the optical sales floor began to see dramatic increases in revenue. When they looked into why this was occuring, they saw that it was because she was prescribing 3 or 4 different pairs of glasses for each patient, and these patients were going to the sales side and purchasing all or most of the glasses recommended to them. The method behind her prescribing multiple pairs of glasses revolved around the fact that she listened to her patients, she listened to their needs, and prescribed glasses for each one of their necessities, ie: a pair of glasses for distance, and another for computer work, but also a pair that would allow the patient to see up close for reading, as well as even closer if they painted model cars in their spare time. The key is to be a good communicator, every successful optometrist is a good communicator, where we should say a little and listen a lot. The biggest disconnect in our profession lies in the prescribing and recommendations we give to our patients.

Studies conducted in 2014 asked 2900 patients who had had an eye exam in the last 6 months a number of questions. Only 71% of those 2900 adults remembered being asked about their general health, which is quite startling as this is part of a normal patient history taken at the beginning of an eye exam. A recommendation for optometrists could be to look at the health history and family history of the patient before they enter the exam room, and to comment on their health status, showing the patient that you took the time to read their file. More data from the 2014 study showed that less than half of the patients did not remember the doctor recommending a treatment or vision correction at the end of the exam. If doctors take that extra time to tell patients why they were prescribing, the patients are more likely to recommend you to their friends/family, because you demonstrated to the patient that you listened to their needs and prescribed according to their lifestyles. As the years have progressed, this number has unfortunately begun to decline, as optometrists and opticians began to decline in personalized recommendations. By 2016, this statistic was down to 14-15%. To grow and expand as an optometrist it is important to SOW (build relationships.) Knowing people is more important than knowing products, you will want to talk about patient’s lives, and build relationships with them. Another important key is to remember to use a patient’s name at least 3 or 4 times during the exam. Using their name, shows respect and caring on your part. It also goes a long way to display confidence and competence in and out of the exam room, as it only takes 3 seconds to make that first impression.

Another term Dr. Kehoe used was “Passion prescribing.” The largest complaint patients have about going to a doctor’s visit, is when the doctor does not listen to them, and does not address their chief complaint. It is important to listen to the patient, and address their particular needs. We are detectives, and it is necessary for us to gain patients’ trust in order for them to tell us what matters most to them in their lives. There are also ways of wording questions that can help us to get to the same conclusion, without coming across as “too pushy” or “not listening.” Instead of phrasing a question like, “Have you thought about trying out contact lenses?” ask instead, “is there a time you would prefer not to wear your glasses?” It is important to think about how you ask questions. Don’t ask, “What are your hobbies?” Ask instead, “What do you do in your spare time?” What are your patients passionate about? If it is important to them: we can make it better, and it shows that we listened. Pay attention to these passions: prescribe what patients can see best in, as they do things that mean the most to them.

A great way to ask about binocular issues, if you think your patient may be suffering from them, is to phrase a question that they can easily relate to such as, “do you like 3D movies?” It is also important to address skin care and sun protection. Instead of giving the impression that you are pushing your patient to purchase additional sun glasses, you could explain them the importance of skin care, and address that most skin cancer occurs underneath eyes, and the importance of larger, polarized glasses. When addressing the importance of the macula and its health to your patient, this is a great segue into addressing diet, appropriate eyewear, etc. It is also imperative to not call patient a “diabetic.” They are a “patient with diabetes.” Patients who have dry eye oftentimes do not know that, it is good to observe. You can always ask them, “do you find that when you blink more it keeps things clearer?” It is always significant to ask, “how much time do you spend on a digital device?” “One monitor or two?” Think field of view, how does that correlate with a narrow-field PAL?

With technology being an important placeholder in our everyday lives, it is vital to educate patients on the consequences of constant exposure to blue light. When comparing blue light versus UV light, the equivalency of 8 hours on a phone= 5 minutes outside (not in direct sunlight). Walking into the sun, this ratio becomes 500 times greater, decreasing that time to 2-3 minutes outside. Transitions are lenses that are clear inside, but darken as you enter more and more UV light. Indoors, the clear lenses block ~30% of blue light, and 80-90% of blue light outside, 100% of UV.

At the end of the exam, it is essential to do a case summary for the patient, restate the main points of patient’s needs. Together, you as the optometrist and the patient can determine the primary pair of glasses needed, and work together for any subsequent pairs. Talk about health, and when the patient should return to the clinic. When the optician comes in, the optometrist can again restate to the optician the needs of the patient, and the plan the two worked out together. This ensures that the patient hears the information twice, and with the doctor handing over the prescription to the optician, this shows that both members of the health care team are taking the patient’s needs into account, in the process termed: transfer of authority. The takeaway message is, if it is important to the patient: we can make it better, and it shows that we listened. Pay attention to these passions: prescribe what patients can see best in as they do things that mean the most to them.

Email for any additional questions: Pkehoe@Transitions.com

Congratulations on reading the entire summary! Enjoy some food pictures from our taco truck event afterwards, thanks to Baja Taco Truck!