Driving Optical Referrals with the MD ‘Hand-off’

A successful dispensary takes commitment and management without compromising principles.

BY Brian P. Dunleavy

When it comes to patient questions regarding eyeglasses, Peter Wasserman, MD, defers — and refers them — to his optical department. But for the president and senior partner at Concord Eye Care in Concord, N.H., this isn’t because he lacks expertise in vision-correcting options, although he admits that it is not his specialty. Rather, this approach is part of a larger strategy to drive patient traffic to the practice’s optical, a strategy that some in eye care refer to as the “hand-off.”

“Our opticians know more about eyeglasses and contact lenses than I do,” he says. “My focus is more on the medical side. So, if patients ask questions about glasses, I always say something like, ‘That’s a good question; why don’t you go ask one of our opticians?’ I trust my optical staff to be up-to-date on the latest products, and to have those products in stock. And, it’s a great way for me to bring that to my patients’ attention.”

It seems to be working. Dr. Wasserman would not disclose specific sales figures. However, his optical is among the leaders in its market area in dispensing premium products, including frames from brands such as Calvin Klein, Coach, Georgio Armani and LaCoste, as well as spectacle lenses from Essilor.

Like most ophthalmologists, Dr.Wasserman, doesn’t feel comfortable “pushing” his optical on patients, but that does not mean he believes sales need to suffer as a consequence. Indeed, ophthalmology practices with in-house opticals, like Concord Eye Care, can strike a successful balance between maintaining professional integrity as a health-care practice and running a successful retail operation by implementing a few simple management strategies.

Perfecting the Product Mix

For example, practice management consultant Carolyn Salvato, director of optical consulting at Incline Village, Nev.-based BSM Consulting, says too many ophthalmology practices fail to properly balance the product mix for both frames and spectacle lenses in their opticals. Outfitting the optical with premium frame and lens products and making them the focus of your retail operation is one thing, she says, but having the right mix is another.

“Optical departments in private practices are facing more competition from chain retailers than ever before,” Ms. Salvato notes. “You can emphasize premium products. That’s fine. But just be sure you don’t price yourself out of your local market.”

Mazzuca Eye and Laser recently redesigned its optical to compete with the best high-end optical shops in the area.

The mix of frames on display should be based on patient demographics and fashion tastes and sensibilities

According to Ms. Salvato, finding the right product mix for the optical starts with a thorough assessment of the demographics of the patient base: age, income level and lifestyle. Optical managers should also routinely reevaluate the product mix and make adjustments based on changes in patient demographics and, in the case of frames, fashion tastes and sensibilities. If patients don’t see the current styles at prices that make sense for their budgets, they will look elsewhere.

Similarly, a good mix of spectacle lenses at a variety of price points is a must-have for an ophthalmology-based optical seeking to meet the needs of a diverse patient base. “An optical shop is only as good as the vendors it works with,” notes Giovanni Passamonti, an optician and the optical manager at Mazzuca Eye and Laser Centers, an ophthalmology practice with two locations in Pennsville and Swedesboro, N.J. “You have to work with vendors you can trust and who you believe provide the best products to meet the vision needs of your patients.”

Hiring Optimal Opticians

Mr. Passamonti also says a practice’s ability to dispense premium eyewear products depends on the optical staff. Practice opticians must be able to explain the benefits of premium lenses to patients, many of whom visit an ophthalmology practice expecting the best in overall vision care, he says.

“You have to have good people who have good patient communication skills and who study up on the latest products,” Dr. Wasserman adds. “They also have to have the right personality. We want our opticians to sell, but not over sell.”

Ms. Salvato emphasizes the importance of hiring licensed opticians with experience in the private-practice setting. Opticians who work in ophthalmology practices have a “different mind-set” than those who work in traditional retail operations, she says. In some optometry practices, for example, opticians are paid bonuses based on sales of specific premium products. However, this is a murky area for ophthalmologists, who must be careful to properly navigate local state provisions of the so-called Stark Law, enacted to combat vendor kickbacks to physicians.

In his practice, Dr. Wasserman advocates paying optical staff “competitive salaries” so that they remain with the practice and become part of the professional team.

“In the ophthalmology practice setting, opticians must walk a fine line between selling patients on eyewear and being too pushy,” Ms. Salvato explains. “You want opticians who carry on the level of professionalism the ophthalmologist has set in the chair.”

Executing the Hand-Off

Whether the optical is part of the practice or effectively a separate entity, careful consideration must be given to getting patients from the chair to the shop — the so-called “hand-off.”

Dr. Wasserman’s approach of referring all vision-correction questions to the optical staff is what Ms. Salvato describes as “credentialing the opticians from the chair.” This rather subtle touting of the optical staff’s experience and expertise in the exam room is often a comfortable approach for ophthalmologists, who as physicians are often reticent to engage in any activity that may appear to patients as marketing or salesmanship.

Ms. Salvato believes ophthalmologists have other options for the “hand-off” that won’t compromise their professional integrity. Dr. Wasserman, for example, says patients with prescription vision-correction needs in his practice must report to a computer bank located near the optical department in order to retrieve their prescriptions (which are generated by the practice’s electronic health records system) — a tactic Ms. Salvato endorses. “No one pushes them to use our optical, but they see it’s right there when they pick up their prescription, and it doesn’t hurt that I’ve already mentioned our optical staff to them during the exam,” Dr.Wasserman adds.

Premium Appeal

However, for this approach to work, the optical has to be appealing: In other words, to sell premium products, the optical has to be a premium facility, with clean and comfortable dispensing tables, attractive displays, and well-lighted and well-designed frame boards. According to Mr. Passamonti, Mazzuca Eye and Laser recently redesigned its optical to commemorate the practice’s 25th anniversary, and the optician says it now compares favorably with the best high-end optical shops in his area.

“The ophthalmologist — Dr. Douglas Mazzuca — has made a commitment to the optical,” Mr. Passamonti notes. “You can stock all the high-end frames you want, but if they don’t look good on the frame boards, patients won’t buy them.”

Carrying the hand-off one step further, some larger practices are able to allocate technicians to each and every patient as they pass through the practice. In these practices, technicians follow the patients from the pretest and history through the examination and checkout, explaining the process and the services provided along the way.

For practices that can take this approach, Ms. Salvato stresses the importance of “training the technicians to recognize certain triggers” for promoting the practice’s services, including premium eyewear offerings. “For example,” she says, “if the patient says, ‘I have trouble driving at night,’ train the technician to respond, ‘Our optical department should be able to help you with that,’ and then make sure your optical offers the best anti-reflective coating available.”

Staying in Compliance With Stark

Before passing along patients to the optical, however, ophthalmologists should be aware that the Stark Law might play a role here as well. According to the American Academy of Ophthalmology, for example, “the referral of a patient to a separately incorporated optical shop in which [the ophthalmologist is] wholly the owner or an investor may be a violation of … state law under some circumstances.” The AAO advises ophthalmologists to check with an attorney for specific guidance regarding “fee-splitting and anti-referral regulations” that may affect the optical.

Ultimately, ophthalmologists who have opticals and want them to succeed need to find a comfort level for integrating the retail department into the larger practice. “I believe that we have a great optical, and I believe in the products we sell there,” Dr. Wasserman says. “But even so, as a physician, I don’t push people to get glasses with us. Of course, we’d prefer that they did, but some do and some don’t. We believe we have found the right balance.” OM