Practice Management

How We Reduced Our Exam-Onlys 10% & Are Poised Now to Increase Annual Revenues $100K+

Dr. Krivacic with his staff planning out the approach that will be taken to educating patients about the opportunity to buy new eyewear.

By Ken Krivacic, OD, MBA

April 5, 2023

How often do you feel like you’ve spent ample time with a patient – explained their vision condition, reviewed the ocular health of their eyes and then recommended the new Rx to get them to see better, only to hear them say, “I’m not going to get glasses today” or “I’m going to buy my glasses/contact lenses somewhere else”?

Frustrating. Yet this often happens in our industry. Patients have myriad options of where to purchase their glasses and contact lenses. How can we get better at having them purchase from us?

A recent e-mail I received from CLX noted, “On average, only 40 percent of contact lens sales occur on the same day as the exam. And once patients leave their eye doctor’s office, the likelihood of a patient purchasing their contact lenses from a third-party retailer increases significantly.”

One metric we improved by reducing over the past year is exam-onlys. What is our definition of exam-only? If a patient has a comprehensive eye exam or an exam with a contact lens evaluation, and then does not purchase eyewear or contact lenses that day, we call that an exam-only (EO).

So, what happened as we worked do reduce our EOs? Let me share some statistics:

Q1 2022 – EO 32.67%

Q2 2022 – EO 37.33%

Q3 2022 – EO 37.33%

Q4 2022 – EO 26.00%

What happened in that last quarter of 2022 that produced such a low EO? Part of the answer could be the time of the year, as November and December are two of our busier months and many patients want to use up flex-spending dollars before they lose them. However, I went back and looked at the last quarter of 2021, and our EO rate then was 32.50 percent, so it couldn’t all be that.

Our goal has been to get that percentage at 33 percent or less per month. In the past three months we have been in the mid-20 percent range for the metric. Prior to that time, we averaged 36 percent over the past year.

We made a concentrated effort in our practice to reduce EO, and I believe some of the changes we instituted eventually resulted in improvement of this metric. What changed? Let’s break it down by department.

The Doctor
In the exam room, I put greater emphasis on the importance of having more than one pair of glasses. Does the patient have a spare pair? Do they have a prescription sunglass? If they are presbyopic, would they benefit from a computer multifocal in addition to a standard progressive? I got in the habit of writing several scripts for each patient.

The Contact Lens Area
We have switched in the past few years to ordering our supply of contact lenses and shipping them to the patient. We want to make things easy for them.

We are also not afraid to price compare as we know we are competitive on price. We usually aren’t the lowest price, but we are in the ballpark, and we want to dispel the myth that a small practice has higher prices. We also make our price to the patient better per box on a year’s supply versus a smaller supply. Also, most manufacturers have a larger rebate on annual supplies versus smaller amounts. Take advantage of those rebates. To further entice a sale, we have a same-day instant rebate. That rebate is only available that day. This creates a sense of urgency for patients.

The Optical
To promote same-day sales in the optical, a few changes were instituted. The opticians were instructed to ask opened-ended questions and then listen to the patient’s response. What do you use your glasses for? How often do you wear them? Would you be interested in sunglasses if your insurance helped cover the cost? How many pairs do you have now? These questions help open discussion on what products are best for that patient. Most patients want to feel they are special, and not just settle for a cookie-cutter solution.

The other big change was quoting prices from top-down, not bottom-up. Most good sales people will try not to prejudge their customer and instead offer what they think is the best solution regardless of cost. Optometry is no different. We should offer the best solution first and then let the patient decide if they can afford that. Prior to initiating this change, we had started with the basics and then would include the add-ons after. In other words, we started low and worked our way up.

In general, what can we learn from other business on how to close the sale? Ross Knap in an article about the psychology of selling1 has three points we can all use:

1. Be Natural & Do Not Use Scripts
You should never use ready-made conversation scripts. These kinds of pre-written replies sound unnatural to the customer/patient and create a feeling of an unwanted sale process. Customers are more willing to buy if they establish an emotional relationship with a customer.

2. Ask About the Client’s (patient’s) Well-Being
If you want to convince people to buy your product, at the beginning of the conversation, while introducing yourself, ask the customer (patient) about their well-being.

Research revealed that sales increased significantly within the group of customers who were asked about their well-being. You can also start a conversation on a positive note this way.

3. Use Names While Talking with a Client (Patient)
Find out your patient’s name and use it from time to time. Psychological research shows that people like to hear their name and are much more likely to make a friendly relationship when the other side uses it.

A common denominator of Knap’s recommendations is people. All these techniques require having the right people in place, with the right sales skills, and, more importantly, the right people skills. In other words, hire right, train right and keep training.

Final Thoughts
Ultimately, why the big emphasis on having patients buy that day? There are several reasons. If they don’t buy that day, they are less likely to return and buy later. There are so many options available to purchase glasses and contact lenses, and many of those sources have larger marketing budgets than most of our offices do.

Getting patients to buy from you also furthers the bond between them and your practice. If they purchase once they are more likely to purchase from you again in the future provided they were satisfied the first time.

One of one the most important reasons to reduce EOs is to increase the revenue to the practice. In the small sample of our one-year goal to reduce our EOs there was an interesting correlation between the percentage of EOs and the revenue for that month. Below shows the year divided into thirds based on the revenue for the month.

Notice how as we reduced the number of patients leaving the office, the revenue increased. Yes. I know this should be a no-brainer, but it was nice to see that the numbers backed it up.

If you were to ask me which metrics are the most important to a practice’s success, I would rate revenue to the practice as number one. A high-revenue practice has leeway to make things happen – staff, inventory, equipment, etc. How you increase your revenue requires other metrics, but reducing EOs is a good place to start.

1. Ross, Knap, “How To Convince The Client To Buy? 10 Proven Psychological Tricks”

Ken Krivacic, OD, MBA, practices at Las Colinas Vision Center in Irving, Texas, now a MyEyeDr. practice. . To contact him:


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