What was your biggest challenge in 2022?

We tend to struggle with really understanding the profitability structure with optometry. I view it very simply. Profit is a byproduct of filling the gaps in patient care. We’re very fortunate in this field. We have the ability, when inflation, or other outside influences challenge us, to leverage those expanded services. This really helps us stabilize our profitability and our cash flow. Specialty care provides us enormous opportunities to serve our patients and build healthy businesses.

Post-COVID meltdown – people are concerned about a looming recession. They are looking for more value than they did just a year or two ago. They used to simply accept our recommendations at face value, now they’re looking for a little more justification for their spending and expenses.

How did you get past those challenges?

The question then becomes, how do we negate some of these challenges? First, we want to stay true to our mission. We simply ask, “what do we have, what can we do for patients, and where are we not providing opportunities for patients that we should be?” In my mind, the answer really lies in the specialties within optometry.

1. Specialty Lenses

There are a number of patients who can benefit significantly by managing their care with specialty lenses. That focus actually brought us an increase in our specialty lens business of 28% between 2021 and 2022.

2. Ocular Surface Treatments

Compared to our dry eye procedures in 2021, our procedures for these patients grew by 33%. These are not necessarily just our patients, they may also be patients referred to us by colleagues who have heard about our services.

3. Medical Diagnostics

There are other things that come into this equation. For instance medical diagnostics – are we caring for the whole patient? One of the ways we measure that is by our utilization of the OCT scan. A growth of nearly 9% in that OCT occurrence tells me that our practice is doing a better job providing full-scope care to those patients.

Ultimately, all of this leads into one of the key metrics in optometry. I like to look at top-line revenue and then break it down one level. We take the number of refractions that we’ve performed in that same period, and just divide the revenue by the number of refractions. The more comprehensive care we provide those patients, the more we’ll see it reflected in a higher number for this metric. This is what I mean when I say that profit is a byproduct of full-scope patient care.

According to your metrics, what went well in 2022?

A few other things went well. When we examine our topline number, we’re up about 9% over 2021, and we still have a little time left in the year. So, we’re looking at a pretty good year, particularly for an established practice. What is especially interesting is that when you look at the revenue per refraction, we’re seeing variations between locations. So that’s one of the things we’re looking at right now, trying to figure out what’s causing those differences. These are interesting metrics that we’re looking at right now, but some of them we don’t have the full answers to, yet.

Can you share some of the strategies you used to achieve this growth?

We’ve been thinking about some specific things when we want to decide how best to grow our practice. My philosophy is simple: Let’s take a look at some of the gaps in care, and see how we can fill those gaps. If we provide care efficiently, then we increase the numbers of encounters that we have.

1. Specialty Care

We’ve invested heavily, pre-COVID, into understanding specialty lenses and the ocular surface. So when COVID hit, we were already streamlined and ready to go in these specialty care services. Sometimes it gets difficult to address and build specialty care in your practice because you kind of get “caught up” in the routine exams. I think, looking into 2023, the best idea is to continue expanding into those specialties, with the expanded scope that optometry now has. We’re hoping to increase our specialty lens services as well as the dry eye and ocular surface services.

2. Optical Dispensary

We also need to discuss the optical, which is a significant portion of the business. We continue to do what we’re supposed to be doing in that realm as well, and we rely heavily on our optical staff to continue to make that portion of the practice successful.

What’s your advice to practitioners who are planning for 2023?

Every year it’s a good idea to stop at the beginning of the year and take a step back to evaluate where we are and recalibrate a bit. What I’ve found is that slow, consistent changes always beat out massive changes. Rather than saying “I’m going to purchase a piece of equipment so I can do dry eye management,” understand that the equipment isn’t what makes the provider “do dry eye.” There has to be a philosophical change or shift that creates the understanding and helps to build those sub-specialties. We have to think differently about how we diagnose and care for our patients, and create the routines that help us provide what our patients need.

My advice is to step back from your practice, and make three goals for yourself. Choose three things that are modifiable behavior changes you can bring to benefit your patient care. Regardless of what initiative you choose, it will actually lead to profitability. You take better care of patients by modifying the way you do it, and that will lead to profitability. But don’t go overboard with those goals. Make the easy, make them measurable, and make them crystal clear – specific – and you’ll see results in your practice.

About Dr. Brujic

Mile Brujic, OD is a partner in Premier Vision Group of Bowling Green, OH. This 4-location practice is home to seven providers. Across those four locations, the practice maintains 12 exam rooms and a staff of 24.

Dr. Brujic has been using metrics to manage his practice for about 20 years now, and the metrics he uses most often are Total (top line) Revenue, and Revenue per Refraction. He decided to begin using metrics because he believes that the simple act of measuring tends to create improvement. Every business owner wants to be more profitable, and he was interested in being able to identify those areas where the improvement was needed.

“We are always challenging ourselves to find the gaps in patient care and to discover ways to close those gaps, to better meet the needs of the patients.“