Hello Dr. Hayes, 

I am in negotiations to purchase an existing practice and want to use The Hayes 7 Key Expenses to to create my annual operating budget.  

Assuming I borrow the money to buy the practice, in which category would I include my loan payment?   

I really enjoy reading your blog.  

Sincerely,

Thea Shearer, OD

Thanks Thea!

This is a great question because it makes us step back and ask ourselves, “Do we approach this from a tax standpoint or as practice management question?” 

The answer is both. 

 Hi Jerry,

I wanted to ask your opinion on the practice of allowing patients to come in for a ‘refraction only’ without an eye health exam.  

Last week I had a patient who refused any part of an eye exam due to her religious beliefs. Our normal full exam fee is $100, but, we only charged her a refraction fee of $25.  

I did have her sign a waiver we made up stating that the eye health exam was not performed at her request.  

We also get an occasional request for refraction with patients who are seeing a retinal specialist for their eye health exams on a regular basis.  

We still have patients who sometimes complain about paying $25, so I hesitate to raise it a whole lot more all at once. My colleague charges $108 for his exam and $50 for the refraction. 

After my recent experience, I am considering not seeing patients for ‘refraction only’ without an exam.   

It hardly seems worth my time to see a patient for a refraction only visit given our current fee structure. What is your opinion on refraction fees? 

Thanks! 

Ranell Nobin, OD (name changed)  

Dear Dr. Nobin,  

There are really two questions here.  What should an OD charge for ‘refraction only’?   

And, are you putting yourself at risk to provide less than standard of care, even at the patient’s request?

 Dear Jerry,  

What are your thoughts about opening a second practice in a medium size city (500,000 population)? 

Our current practice location grosses about $2 million per year and we have an opportunity to purchase a building at a GREAT price about 3 miles away. 

I think it is a great location for an upscale boutique, but we are concerned that it may be a little close geographically to our current location. 

Thank you, 

Dr. Sherman (name changed)  

Jerry's thoughts:  

Sounds like you have a great practice in your main office!   

And yes, this is an absolutely wonderful time to buy real estate at rock bottom prices in many markets. But be careful

Dear Jerry,

Our mutual friend, Jim Thomas, the Editorial Director for OPTOMETRIC MANAGEMENT, recently sent out the following question to his editorial board.

“If we consider all the factors that impact patient care and practice management in optometry, which do you think will be most significant in the next one to three years?”

Are reimbursements about to decline?

In my opinion, the most significant change coming in the next one to three years is for independent OD’s who have come to rely on the medical portion of their practice for income. 

I think we are about to realize a negative adjustment in earnings.

Dear Dr. Hayes,

I read with interest your June 16 blog, “Staff Projects For When The Doctor Is On Vacation”. It was the one about having a staff member phone patients who don’t respond to written recall messages. (click here to read)

To be honest, I am not always comfortable doing that in my practice because I think it gives patients the impression we are out beating the bushes for business.

Your thoughts?

Best regards,

Dr. S. Terry (name changed on request)

Dear Dr. Terry,

This is a fair question and one that I’m sure many OD’s grapple with. Here is how I recommend you reconcile the matter in your own mind. 

 Dear Jerry,

I enjoyed the podcast you did on May 25 with Dr Richard Hom on the future of electronic medical records.  I have utilized a PMS since we opened our office in 1995.

Having all patient encounters documented with an EMR since 2000 I can not think of any case where an OD would not benefit from converting from paper records to electronic. 

I have helped numerous other Docs implement EMR/PMS and at this point in time can see no downside

Dear Jerry,

It’s me again. I am going to follow the advice in your June 2 blog and take some personal vacation time when my practice slows down in June.

What are some good projects for my staff to work on when I am gone? I am a solo OD and don’t plan to have another doctor in to cover for me.

Thanks again,

Megan Sumrall, OD

Dear Megan,

Good question, as many doctors don’t do a good job planning productive use of staff time while they are out.

Here is my favorite staff project when the practice owner is off for a few days. 

Here are some great insights I got from a recent podcast by Jill Geisler of the Poynter Institute on motivating employees. 

One, while the lack of adequate pay is a de-motivator, once an employee hits their personal level of ‘felt need’ for compensation, higher salary is not a motivator for most people.

Bonuses are a little different because they identify and target specific objectives.  We’ll talk about that in another blog.

Intrinsic Versus Extrinsic Motivation

At the point your staff member becomes satisfied with his or her compensation package, intrinsic motivation becomes more important than external motivation such as money.

Three components of intrinsic motivation are:

Dear Jerry,

May and June tend to be slow months in my practice. This year, I am considering spending some money on an ad campaign in effort to stimulate business. Does that make sense?

Or, would you recommend that I take some vacation time during my traditionally slow periods?