June 3, 2019
By Gary Gerber, OD
Co-founder, Treehouse Eyes
Vision Therapy (VT) works great when the right therapy is prescribed correctly to the right patient by a skilled practitioner using the right technology and protocols. Yet, why have so few doctors successfully integrated this important optometric discipline into their practices? Why is it the best VT practices only practice VT?
Similarly, for years, we have heard the term, “Dry Eye Center of Excellence.” Yet, in my entire consulting career, with our team having stepped foot into literally more than 2,000 practices, we have yet to see ONE. There may be a handful, and again just like VT, if there are, why so few?
Just like recommending pencil pushups isn’t practicing VT and giving a patient a handful of artificial tear samples isn’t proper dry eye patient management, myopia management – done right, with outstanding clinical results, is more than handing a parent an Rx for atropine and seeing them back in a year, “to see if your daughter’s glasses need to be made stronger.”
As a consultant, we have seen many doctors attend clinical conferences where they learn a new skill and leave the event with newfound energy and excitement to incorporate something new for their patients. Unfortunately, we have also observed that most of these same practices never get these initiatives off the ground. To this day, we still often find practices with a piece of new technology sitting with a dust cover on it that is rarely if ever used. Doctors tell us, “I tried it when I first got it, but I just could not get it to work in my practice. My practice is different from the guys who use it all the time.”
Newsflash – it is not different. To the contrary, what these practices ALL have in common is the one single barrier that prevents most practices from getting things done in their practices. It is the same thing that ALL entrepreneurs, OD’s or not, struggle with. That is life. Professional life and personal life – the day to day things that consume all of us, get in the way of the doctors’ best intentions to execute something new.
In the above case, what happened was this. While they were at the conference, their staff back at the offices was putting about three post-it notes per day on their doctors’ computers. Topics were everything from, “The air conditioner vent in the second exam room still does not work right” to a note from the optician, “I cannot work next Saturday because my third cousin from Iceland is visiting.” These post-it notes and the thousands of others just like it on practitioner screens around the country are the entrepreneurial reality that makes all practices the same. In fact, the only difference is the content of the notes. Their effect of inhibiting doctors from implementing something new is precisely the same.
What happens next is critical. While doctors slog through the day-to-day minutiae of running their practices, they start to pick off some of the seemingly more straightforward things they learned at their conference. This approach to only attempting the (seemingly) easier tasks is what ultimately leads to failure and the return of dust covers. At the end of the month, the doctor looks at their production reports and profit and loss statement and discovers, “Hmmm… I did four extra cases this month, but there are $8,300 fewer dollars in the checkbook.”
Further analysis reveals that the cause was a loss of some of the practice’s core revenue drivers, usually eyeglasses. In the case of myopia management, what likely happened was, while the doctor was discussing the nuances and proposed myopia management treatment plan to a parent who was likely hearing about it for the first time, the doctor kept two other patients waiting. They waited so long that after their visits they had to get back to work and were unable to spend the $1,200 they would have spent for premium PAL eyeglasses. To sum things up in this case, by not first working on a viable scheduling template (because that’s harder and more time consuming than talking to a parent about myopia), the doctor had likely doomed his myopia management program before it even started. Worse, the kid who really needs treatment will not be getting it.
It comes down to this essential point, and our consulting experience with VT proves it. Most doctors who wanted to bring VT into their practices and failed, stopped trying because their primary care practices suffered financially. The “mothership” that drove the referral engine for VT suffered from lack of food, water, and attention. Most docs who attempt VT without this critical global practice perspective eventually stop because they LOST too much money trying to add the service! Bringing myopia management into your practice can suffer the same fate if you are not careful and very analytical in your approach.
To help get past this, here are the three essential first steps you MUST do before you do anything else.
- Start with your scheduling template and initially leave yourself more time than you think is necessary for the initial visit. This “initial visit” will vary with different practices and needs to be tested. For some practices, it will be added on to the comprehensive examination, and for others, it will be a separate appointment at another day and time. There is no universal solution for every practice, and this needs to be tested and tracked. Using one or the other (same or different day) depends on your current volume and patient demographics.
- Our Treehouse Eyes scheduling data of a few hundred kids shows that on average when office systems are running STREAMLINED and EFFICIENTLY, which can take months to figure out, it takes a total of about 3.5 hours per case during the first year to properly treat these patients. That means that after the first visit you must carefully plan out timing for subsequent visits. If docs are not careful and attentive to appointment templates, chair costs, fees, and margins, the time commitment (the equivalent of about eight primary care exams) will mean they will eventually lose money doing myopia management.
- Once the above has been tested, titrated, and tweaked for maximum efficiency, you must ensure you have the right staffing requirements in place. If you are committed to doing myopia management, this means having at least one staff person who can function as a practice-parent liaison to help with the myriad of questions that are sure to come up from parents and patients.
If you put the same study, thought, analysis, energy, and budget into the mechanics and logistics of myopia management as you do to the clinical aspects, you will succeed. Similarly, skimp on either and you will not.