Doctor Patient Relations

Develop People Skills to Serve Growing Number of Seniors

By Peter Shaw-McMinn, OD

The senior population is growing fast, and this presents growth potential for your practice. Doing well in serving the senior segment requires a new perspective—and a new set of people skills.

If your practice is located in an area with a high percentage of senior citizens, as mine is, you have the chance to serve these individuals with a practice niche or even a separate office devoted to their needs. In the case of our practice, Woodcrest Vision Center Optometry in Riverside, Calif., we founded an office especially for seniors in the nearby retirement village Sun City. A retirement community built by Delbert Eugene Webb, similar to the ones in Arizona and Palm Springs, Calif., Sun City is a small, mostly lower middle-class community in the desert. You need to be 55 to live there, though there are younger people living in the areas around Sun City, mostly on small ranches. According to City-Data.com, the median age for Sun City’s zip code, where our Sun City Vision Clinic is located, is 65.7 years and the average household income is $35,799. The average age of Sun City Vision Clinic patients is 77 years.

Opportunity to Create Long-Term Bonds with Patients
Serving an aging population offers not just a practice building opportunity but a chance to establish rewarding, long-term relationships with patients. Here is a story that illustrates this opportunity.

I have a weird last name that no one remembers, so early on in my career, when meeting a new patient, I would stick out my hand and say, “I’m Dr. Shaw-McMinn, but you can just call me Peter. May I call you Nelly?”

In 33 years of doing this, only two patients said no. The first was a prim and proper Southern woman who firmly replied, “No. You will call me Mrs. Mathews, and I will call you Dr. McMinn” (she screwed up my last name as usual). I agreed: “O.K., Mrs Mathews.”

And so began our relationship. Well, within a few years she was Ruth and I was Pete. She always came in dressed perfectly, with lots of perfume. (As we age, we lose the scent of smell. Some days I could barely breath in the exam room!)

After about 20 years, my staff came to me and explained, “Your next patient is Ruth Mathews. She is dying. I think she doesn’t really need an exam, she just wants to say goodbye.” I walked in the room and there she was. All dressed up with lots of perfume as usual, except this time she could barely keep her head up and her eyes kept closing. I took her hand in mine and said, “Hello.” She proceeded to say, “Pete, we had a lot of good times together didn’t we?” I replied, “Yes we did, Ruth.”

Ruth Mathews died the next day. But before she died, she wanted to say goodbye to her good friend, the optometrist. Do you know I never saw Ruth once outside of the office? To her, coming to see the optometrist was a major event. He was a friend she dressed up for, got her hair done for and put on her favorite perfume for.

I used to cry when I told this story, and even now my eyes well up in tears. We need to remember as healthcare providers that conditions such as cataracts are commonplace and trivial to us, but HUGE, scary conditions to the patient. Likewise, a visit for an eye exam may seem trivial to us, but to a senior it is a major event. We need to treat it like one.

Senior Patients = Profit Center
Seniors are worth much more income to us than younger patients. A diabetic senior can be worth over $500 just in diagnostic fees. Returning visits for dry eye and glaucoma add up. Because vision is compromised, they usually require premium lenses and AR. Since all have cataracts or had cataract surgery, they are good at wearing sun lenses. With increasing computer use, many also have computer eyeglasses. They replace one pair of eyeglasses every year, and occasionally two pairs a year. Even though we are in a lower economic area, they value their vision. They can’t run far, so they need to see far!

We have five ODs seeing patients, and the income per patient varies with each doctor. The main reason for this variance is one doctor might not explain the benefits of lenses to his patients and the opticians give up on explaining them to the patient too because the patient says, “Why didn’t Dr. X tell me that?” So, that doctor ends up making less per patient than the other doctors.

The doctors who receive the most per patient prescribe premium lenses as part of the treatment for eye disease such as AR for cataract patients and polarized sun lenses with Brown tints for AMD patients. I tell my patients to plan on setting aside at least $600 a year for eyecare.

Additional Testing Means Additional Fees
The best instrument I use to care for senior patients is an iTrace aberrometer. It is an aberrometer, corneal topographer, auto-refractor and puppilometer all in one. From it I get an idea of what to expect for best corrected acuity based on higher order aberrations. I can see if the HOAs are corneal or from the lens inside the eye. I can learn if pupil size affects the refractive error (many patients are on drugs that dilate pupils), and it has an opacity map which shows early cataract changes. The screen data is great for explaining things to the patient. Our fundus photos and OCT also help explain conditions to the patient. Most of the time, the retinal specialist has not shown them the results, so I go over the screens with them. Visual fields are self-explanatory, but I’m constantly amazed at patients who have been treated for glaucoma elsewhere who have never seen one. Our latest addition is the Diopsys Visual Evoked Potential tester. We use it to monitor glaucoma, as well as the visual status of stroke victims, traumatic brain injuries, dementia and amblyopes. The CPT code is 95930 and Medicare allows $114.31 per test. You get information from this that you can’t get anywhere else.

Move Seniors Efficiently Through Practice
When I first started seeing patients at Sun City Vision Clinic, I noticed that the patients wanted to talk a lot. I learned quickly that if I was talking they weren’t. So I talk throughout the eye exam. I tell them what I am doing and the benefits of what I am doing. I tie this information to their needs and possible treatment choices. The patients get more involved in the exam that way, recognize the benefits of the procedures and aren’t surprised by the final prescriptions. They essentially receive a case presentation throughout the exam. This approach has been so well received that I now do this with younger patients, too. My staff does aberrometry, autorefraction, visual fields screening and fundus photos before I see the patient, so I know a lot about them before I get into the exam room. I am able to review the data on computers outside the exam room.

Focus on Quality of Life in Optical
By age 75, all patients have chronic conditions. If nothing else, most have cataracts, dry eye or macular degeneration. Most are taking lots of medications for conditions such as high blood pressure, high cholesterol, diabetes and depression. An annual eye examination is part of their life; they look forward to finding out what is new that can make their life better, which lends itself to how we position our office. Our goal is to improve the lives of each and every one of our patients. Our theme is “Good Vision for the Rest of Your Life!” We came up with this motto after realizing these people came to Sun City to live out the rest of their years, so what they really want from us is to see as well as possible, be as comfortable as possible, and appear as attractive as possible until they die.

Encourage Seniors to Try On Lighter-Weight Frames
It took me 30 years to learn what my opticians have always known–that no matter their age, people want to look as attractive as possible. One problem is many seniors like the big eyeglass sizes. Besides being out of style, the weight of the lenses can be an issue. When a patient is hesitant to reduce the size of their frames dramatically, we reduce the size by a couple of millimeters a year until the eyeglasses get small enough to be fashionable. A big change is difficult for many seniors, but once they try on a lightweight pair of frames, they understand the difference not just in fashion, but in comfort, that smaller frames can make.

We show senior patients titanium frames and a couple of other higher-quality, lightweight frames. Even if they say they just want what their insurance covers, they will want the light titanium frame. Let them pick up the lighter-weight frames and try them on and they will feel like they own them. You could even say to these patients: “Your insurance plan also covers this nice light frame, for an additional co-payment.”As for lenses, it is easy to get the senior to purchase if the doctor explains the benefits during the exam process because patients are accustomed to paying for “medical needs” and are willing to pay more for a “medical need” than a non-medical need.

Prescribe Sunwear for all Seniors

Virtually all of our senior patients get AR on their lenses. All the sun lenses are polarized with Sunshield AR on the back. And most of our seniors have premium PALs because they require an add of +3.00D or more.

Contact Lenses Appropriate for Some Seniors
I have several keratoconic patients, so even at an advanced age, they wear contact lenses. Many patients want to be as young as possible, so there are a lot of monovision contact lens wearers in our practice. Simultaneous vision bifocal contact lenses don’t do too well because they already have lots of distortion causing HOA. Few of our senior patients wear contact lenses instead of eyeglasses, but many wear both.

Reach Out to Senior Clubs and MDs for Referrals
Word of mouth is still the number one marketing technique for healthcare providers. Let your present patients know you have the capability of helping seniors improve their lives. Make sure they know you accept Medicare and other common insurance plans. Encourage the nurses of primary care physicians to send you all of their patients and let them know that your office will then figure out who is covered by what vision insurance (a headache for PCP offices). Use national healthcare proclamations in your marketing. For example, for National Diabetes Month (November), offer a free fundus photo screening and explain to them what you look for in the photo. Do the same for high blood pressure month or high cholesterol month. Offer to give free lectures at senior club meetings on topics such as “What’s New in Eyecare.” You will discover there are hundreds of clubs for seniors, all looking for a little entertainment, such as sewing clubs, knitting clubs, bridge clubs and model train clubs. Note that the activities associated with all of these clubs require good vision. Interest in your practice also will be helped by the fact that nearly all seniors know someone who lost their vision to glaucoma, diabetes or macular degeneration. Offering free pick-up and delivery to your office could be the reason they choose you. Be open to offering personalized services. For example, giving select patients your cell phone number provides added comfort.

Understanding the needs of your senior patients and developing a geriatric niche or an office especially for them can be both rewarding as well as a great practice builder.

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Peter G. Shaw-McMinn, OD, is an assistant professor of Clinical Studies at the Southern California College of Optometry. He is the founder of Woodcrest Vision Center Optometry in Riverside, Calif., and senior partner of the practice’s geriatric-focused Sun City Vision Center. To contact him: shawmc1@me.com.

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