Photo courtesy of Drs. Miki Lyn Zilnicki and Jessica Licausi. The doctors, seen here with their practice team (first row; Dr. Licausi on left as you look at photo, Dr. Zilnicki on right), share how they leveraged specialized services, among other strategies, to overcome big challenges.
Surpassing challenges to build a thriving specialty independent practice
By Miki Lyn Zilnicki, OD, FCOVD,
and Jessica Licausi, OD, FAAO, FCOVD
June 11, 2025
As independent optometrists who have walked this path for nearly a decade, we want to share how we are managing the three major challenges our profession faces today: market saturation, low insurance reimbursement and economic fluctuations.
Challenge #1: Market Saturation
Finding a Niche in a Crowded Marketplace
Entering a market flooded with multiple ophthalmology practices and corporate chains seemed daunting. However, we made the conscious decision to overcome this saturation by pioneering a unique service: vision therapy and rehabilitation. By carving out this niche, we built relationships with our community and filled a void that was previously underserved.
Building Awareness
The initial challenge was informing potential patients about our unique services. To bolster awareness, we committed to forming relationships with referral sources, a challenging yet crucial step for any practice seeking to branch out into specialty areas. The cost of implementing these changes often comes in educational investments and necessary equipment.
Our initial investments for expanding into vision therapy were relatively modest, a few hundred dollars for education and equipment, which is typical. However, as we grow, there are ongoing costs involved in enhancing our specialty services.
The Long-Term Benefits of Continuing Education
Education and training for our team play a significant role in ensuring that the services we provide meet the highest standards. Empowering our lead vision therapist to pursue certification resulted in improved patient care and outcomes.
The nature of providing specialized services is not limited to vision therapy alone. We plan to incorporate additional treatments like syntonics to further elevate our offerings. Our commitment to innovation allows us to consistently meet our patients’ needs, something others may overlook.
Challenge #2: Low Insurance Reimbursement
Evaluating Insurance Options
Low reimbursement rates have been a persistent issue in health care, and we have seen this trend impact our vision therapy services. Amidst this landscape, it’s crucial to review the insurance plans we accept and continue evaluating whether they’re financially viable.
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Making Strategic Decisions
Being selective about the insurances we take has enabled us to maintain our profitability. Our conscious decision to transition to a more direct-pay model led to an increase in our revenue per session—about $62 more per session, making the case for focusing on private pay significantly clearer.
Training our billing staff to handle denied claims efficiently is essential. We encouraged them to work closely with patients to maintain clear communication around what their insurance covers.
Challenge #3: Economic Pressures
Finding the Balance Between Costs and Patient Fees
In the current economic climate, patients are closely monitoring their expenses. This presents a unique challenge for us as we work to keep our services affordable while mitigating our chair costs.
Tailored Solutions for Financial Concerns
To aid our patients and offset financial burdens, we implemented pre-payment discounts and interest-free financing options. Adjusting our operating hours as well has reduced payroll costs by 10%, allowing us to manage expenses without compromising our service pricing.
We noticed that our Wednesday doctor/vision therapy schedule was often slow with a lot of down time between patients.
To reduce costs, we cut the associate doctor’s hours by three, having her come in from 12 p.m. to 5 p.m. instead of 9 a.m. to 5 p.m. This ensured that her schedule was full with back-to-back appointments and no down time. As an associate, if she is not seeing patients we are losing money. We had a conversation with her about this and she was open and flexible with the change.
We should note that if one of the doctors is scheduled to be off, we will open up that schedule to ensure we have enough patient slots for the week.
The impact of these adjustments has been palpable—our scheduled initial evaluations have risen by 30% in comparison to last year. By listening to our patients’ needs, we established ourselves as a valuable and trustworthy resource for their eye care needs.
Conclusion: Embracing Growth Through Challenges
At the core of these challenges lies the essential insight that we cannot afford to become complacent. Continuous education and the incorporation of specialized services are vital to ensuring long-term success in an ever-evolving health care landscape.
If our journey taught us anything, it’s that profitability is not just a result of seeing more patients; it’s about creating genuine value for those we serve. Optimizing patient care and adapting our services has positioned our practice to not only endure the storm but thrive.
As we look ahead, our call to fellow optometrists is to find that niche area, invest in education and keep the lines of communication open with your patients. By doing so, you’re setting the foundation for years of successful, impactful practice.
Miki Lyn Zilnicki, OD, FCOVD, and Jessica
Licausi, OD, FAAO, FCOVD, are co-owners of Twin Forks Optometry and Vision Therapy in Riverhead, N.Y.
To contact Dr. Zilnicki: DrZilnicki@twinforksoptometry.com.
To contact Dr. Licausi: DrLicausi@twinforksoptometry.com
