Practice Management

Solutions to Independent Optometry’s Toughest Challenges that Helped Us Grow 30%

By Jennifer Williams, OD

April 19, 2023

Three optometrists pose outside the practice they own together in Pelham, Alabama.

Dr. Seth Williams, Dr. Jennifer Williams and Dr. Jason Dickerson, the partners of Pelham Eye Center . Dr. Williams said pushing forward with expanded scope of practice, persevering through lower reimbursements from vision plans and competing effectively with online retail are keys to success as a modern independent optometric practice.

Independent, private-practice optometry can be one of the most fulfilling modes of practice, but it is not without its unique challenges. We have found a few key ways to address these challenges that have enabled us to grow 30 percent over the last two years in both number of patients and profitability.

Here are three daunting challenges and the solutions our practice is implementing to continue providing a high level of care for patients while becoming more profitable.

Push Back on Scope of Practice
More states are expanding optometrists’ scope of licensure, but push back from ophthalmologists, politicians, and others who fight against optometry, poses a major challenge to scope expansion. A good way to fight this is through personal relationships with both ophthalmologists and politicians.

At our office, we work closely with optometry friendly ophthalmologists for our surgical referrals. They understand our capabilities, and that scope expansion does not increase competition for them, but instead, expands access to care for our patients and relieves them of some of the burden of care. We refer patients to ophthalmologists who support us and keep our patients’ best interests in mind.

We also made an effort to get to know local politicians (some are patients), and our office, along with other local optometry offices, has participated in meetings that demonstrate the types of procedures we wish to perform to show politicians how capable we are. Personal relationships are crucial to winning votes in legislation.

Another simple way to aid scope expansion efforts is through American Optometric Association (AOA) membership and AOA-PAC contributions. The dues paid to these organizations help lobby for legislative change, and are crucial to keeping and expanding our laws. Our office covers these dues for each doctor, which costs the business around $6,000 annually. Surgical and laser procedure courses to gain advanced certification will cost our practice around $2,000 per doctor. One of our doctors has already completed this certification, and our other doctors will complete these courses within the next year.

Injections, removing lumps and bumps, SLT procedures and other advanced procedures will expand our services to patients and increase revenue by keeping patients in our office instead of referring out. We are hopeful more states, including ours, will gain privileges for injections, certain lasers and minor surgical procedures. While pushing for scope expansion is an expense to our practice, we feel it is necessary to not only drive the profession as a whole forward, but to offer our patients the best care.

Stagnant Reimbursements from Vision Plans
Another major challenge to independent optometry is stagnant reimbursements from vision plans. While our fixed costs, labor costs and cost of goods sold continue to rise, reimbursement rates have stayed the same or decreased over the years. The options to profit under these managed care models are bleak, with increasing patient loads becoming the only way to stay afloat.

Most patients do not understand just how little their vision plan reimburses us. At our office, we try to educate patients why we are not in-network providers on certain plans, and instead have implemented Anagram as a way to keep our patients in our office. Patients understand that they will pay upfront and get reimbursed directly from their insurance company. Most of our patients have accepted this concept because our staff explains it well and we make the process simple. Our cost for this program is around $3,500 annually, but is well worth the expense to keep our patients in our office and get reimbursed a fair amount for our services.

We are a heavy medical practice and have found that medical insurance patients can often be more profitable than vision insurance patients, so we utilize patients’ medical insurance when appropriate. Some offices have even implemented their own private “insurance” or “vision discount plan” loyalty programs for their patients as a way to get around stagnant reimbursements. We do not currently offer this, but we may consider it in the future as an alternative to traditional vision discount plans.

Stagnant insurance reimbursements is a multifaceted issue that will be complicated to overcome, but our office is combating this by limiting the plans we accept, providing a way for patients to get reimbursed when they have plans we don’t accept, and educating our patients on the truths about the actual value of vision discount plans. We always strive to accommodate our patients while still being mindful of how much we will or will not accept to provide appropriate care.

Online Refraction
Online retailers and the push for online refraction are a third threat to independent optometry. These modalities have concerned private practices for years, but in our office, we feel that most of our patients will continue to be loyal to our office because of the relationships we have formed over time. Consumers today crave convenience, and online retailers cater to this. Their strategies can be harmful to optometry as a whole and general public safety, though, because they devalue the profession and are not regulated enough to ensure safety.

Huge-volume companies advertise extremely low prices that most independent offices cannot match, enticing patients to order contact lenses and glasses online. This race to the bottom causes general confusion among the public by making it difficult for patients to understand the massive price differences between products. It also creates confusion between an eye exam and a refraction by misleading the public to think the two are the same. There is not enough regulation among these entities, and prescriptions are not confirmed in an appropriate manner, which increases risk to consumers. We have seen patients in our office who were given the wrong glasses prescription or ordered contact lenses for years even though their prescription was long-expired, and this unfortunately can have damaging results.

Our practice realized that we are not going to compete with online retailers on their advertised pricing, but we do try to beat them on convenience and quality. We have decided to focus on the things we can control: customer service, medical eyecare, patient education and high-quality products at a fair price.

We utilize manufacturer’s rebates for contact lenses and encourage annual supply sales to keep prices down for patients. We offer free shipping as well on annual-supply contact lens purchases along with discounts on eyewear. We stock some brands of contact lenses in-office, furthering convenience as patients can receive their product same-day. We plan to implement in-office product lines this year for eye drops, vitamins and dry eye products to ensure our patients are receiving quality products and instill that our office is the place for all things eyecare. The inventory cost of these products is an expense, but well worth it to know that our patients are receiving the correct items in a convenient, easy manner.

In the future, we may open our own online store, which will be curated and regulated. Online retail is not going anywhere, but our approach is not to compete directly with these companies; instead, we try to differentiate ourselves based on customer experience and quality.

Bottom Line: Independent optometry, along with any type of small business, will always face challenges. By focusing on exceptional patient care, and building lasting relationships, we can set ourselves up for long-term success despite the threats that come upon us.

Jennifer Williams, OD, is a partner with Pelham Eye Center in Pelham, Ala. To contact her:


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