Step 2. Getting started

Once you have decided to implement a regular monthly payment scheme you have some choices to make. These include whether to introduce a care scheme for spectacle wearers or just one for contact lens wearers. Practices that operate these schemes successfully at the moment all tend to give the same advice… that is to keep it simple to begin with. Remember, other schemes can always be added at a later stage, if required. Some practitioners decide to offer different schemes for various patient categories immediately, i.e. schemes for children, NHS patients, etc. This may cause confusion in both staff and patients, diluting the impact, as well as any initial success. So it may be better to keep it simple at this stage. This will ensure it remains straightforward and easy for practice staff and patients to understand.

For example, if your priority is to simplify the way the practice charges for contact lenses; begin with a contact lens scheme. When calculating appropriate fees for contact lens care you may also wish to consider how much you would charge for a spectacle wearers’ scheme. This will allow you to accommodate a realistically priced spectacle wearers’ eye care scheme in six month’s or a year’s time should you want to – once everyone has gained confidence with the contact lens scheme first.

Make a plan

The next stage, once you have decided to introduce a fee-based charging scheme, is to set a time plan. This will ensure that a realistic date is set to start your plan and that an adequate amount of time is set aside for each stage of preparation. Only you will know how much time you have available to spend on the planning and preparation required, however, you may have support staff that you can delegate some of the tasks to.

The following are some anticipated stages and approximate timings:

• Enter practice data into Professional Fee Template (see step 3) 1 hour
• Enter contact lens and solutions prices into template (step 3) 2-3 hours
• Approach bank and/or DD broker for advice and charges (step 4) 1-2 hours
• Discuss scheme with practice team to gain input and suggestions of how best to implement it and communicate with patients. (step 7) 2-3 hours
• Further staff meeting immediately prior to launch to agree how the scheme will be implemented, systems implications and any objections overcome 1-2 hours
• Modify text in practice brochure template and discuss needs with print company (step 8) 1-2 hours

Depending on how much time is available to prepare for the implementation of your scheme, it would be expected that the absolute minimum time period, from agreeing to go ahead to an official launch date, should be about six weeks. More realistically, practices have found that it is probably best to allow 8-10 weeks preparation time to ensure that everything is in place for a successful launch.

Set out when and how you will involve all those that will be affected by the change and include letting them know why you are changing to help solicit their support. This includes

• Business partners
• Employed optometrists, dispensing opticians, and contact lens opticians
• Optical assistants and receptionists
• Your accountant
• Your bank manager

These people will all have some influence on the success of your scheme so involving them at an early stage can be very worthwhile. Later steps in the journey plan cover this in more detail.

Key performance indicators

As any change in product pricing and fee charging will influence the performance of your practice, it is important that key performance indicators (KPI’s) are monitored and compared before and after any change is implemented. KPIs can be monitored through most practice management systems or manually if not computerised.

These indicators can be simplistic, to provide a quick and often crude overview of practice performance, i.e. turnover or number of appointments booked. They can also be more sophisticated, to provide a more meaningful understanding of practice performance i.e. income per eye examination. This is one example where you may initially expect to see a temporary reduction; as more people sign up to your eye care payment plan and receive a discount on any spectacles purchased, the income per eye examination may initially appear to drop slightly. However, according to those practices already operating such schemes, most patients will spend a similar amount to what they used to spend – in addition to the monthly scheme fee. So, overall practice income may be greater.

Some KPIs to measure include

• Sign up rate onto your scheme
• Turnover (Total income for the practice including NHS payments)
• Total number of eye examinations (Private & NHS)
• Sales (Total income from dispensing and contact lenses)
• Gross profit (Turnover less the cost of any goods purchased for resale)
• Net profit (Gross profit, less all practice overheads, including salaries, rent, heating, lighting, etc.)

More meaningful performance indicators include:

• Average dispensing value (Total dispensing income divided by pairs of spectacles provided)
• Income per eye examination (Turnover divided by total number of eye examinations)
• Contact lens business (expressed as a percentage of turnover or patients)
• New versus existing patients (as a percentage of all patients seen during the measurement period)
• Private versus NHS examinations (as a percentage of total eye examinations)
• Patient age profiles (percentage of patients in certain age categories)
• Eye examination cycle (frequency of patient visits)
• Reminder response (percentage response to 1 st, 2 nd & 3 rd reminders)
• Dispensing conversion rate (Percentage of t otal examinations divided by number of patients dispensed to)

Setting targets

An effective way of sharing expectations with the practice team is to agree realistic targets. For example, if your practice fits contact lenses to four new wearers on average each week, it would be quite reasonable to expect at least three of them to sign onto the new professional fee based scheme. For whatever reason, some may not wish to purchase contact lenses this way and you may wish to offer an alternative means of charging for this minority. See Step 8 for some suggestions.

When the practice team has gained experience offering a professional based pricing plan to new wearers, they will have the confidence to offer the plan to existing wearers. Some practices prefer to offer the new plan to existing patients when they come for a regular aftercare appointment. Others prefer to contact all existing wearers by letter, at the same time, to encourage them to switch as soon as possible. A letter template is available as a download in Step 8. The decision of whether to encourage all existing wearers to switch at the same time or gradually over the coming year will be influenced by factors in your practice and your competitive environment.