Managing Margins Without Sacrificing Care

In 2023, I cold-opened my practice—Eyediology Vision—in Providence, Rhode Island. Starting from the ground up taught me that every dollar matters, and every patient encounter is an opportunity to deliver care that is both clinically excellent and financially sustainable. Roughly two-thirds of my patients wear contact lenses, so I quickly realized how decisions around rebates and inventory, as well as honest conversations about cost, directly impact margins and patient loyalty. From day 1, my goal has been to create a practice that delivers exceptional, customized care for each patient.

The Financial Pinch
Like many small, new practices, mine continues to feel the strain of inflation. Increased shipping costs, lab fees, and even small line-item charges add up quickly. On top of that, rebate structures—while beneficial—are often confusing for patients and burdensome for practices to navigate. These realities raise the central question: How do we balance practice management with patient-centered care when costs keep rising?

For me, the answer has been a combination of transparency, operational discipline, and patient-friendly programs. These strategies may not eliminate every financial pressure, but they allow me to manage margins without sacrificing the quality of my team’s care, which would erode our patients’ trust.

My Playbook for Margin Management
There are two pillars to running a practice with margins in mind: being transparent about pricing and continuously demonstrating the value of our services. Patients receive clear line-item breakdowns for every purchase, which not only builds trust but also creates natural openings to highlight annual supply rebates or bundling opportunities. When pricing changes occur, I explain them directly. Also, we place a sign at the front desk that informs patients about pricing changes, and the front desk staff will review this information specifically with affected patients. Too often, practice personnel shy away from these conversations, because they worry about patients’ sensitivity to cost. In reality, patients appreciate this clarity. They want to know exactly what they are paying for and how they can maximize their benefits.

Manufacturers’ rebates for patients, for example, can be a powerful sales tool, especially when the coordinator takes the time to explain how much the patient can save. Without that conversation: “Here’s the price, here’s how much your insurance covers, and this is what we can save you in rebates,” patients won’t perceive the value, they may lose trust, and practices risk losing the sale. I encourage colleagues to treat rebates as a teaching moment: walk patients through the savings step by step, and they will see the benefit of making their purchases in-office.

Operational Adjustments
Inflation also presents an opportunity for optometrists to step back and evaluate the efficiency of our office operations. At Eyediology Vision, I find it helpful to:

• Manage inventory proactively. This includes eliminating duplicate frames and closely monitoring supply levels. Twice a year, I do this with my staff, but they monitor inventory regularly. We do not maintain an inventory of contact lenses due to fast, direct shipping available.
• Negotiate with vendors. Simply asking for lower shipping terms can save real money. If you don’t ask, it won’t happen.
• Prioritize learning time. Often, when I make time to read optometric journals or industry updates, I learn about new in-office programs that pay back in dividends. I work with Vision Source (a network of optometrists in private practice), and I have learned so much from attending their meetings on how to improve office efficiency and streamline my practice’s operations to provide the best care for my patients.

I believe one myth of practice growth is the notion that seeing more patients equals more revenue. I have found that sometimes, the best investment is stepping away from direct patient care for a few hours to focus on business strategy and personal education.

These seemingly small wins free up time for my team to focus on patient interactions. I use Gemini, available through my Google business account, for its HIPAA compliance regarding patient communications (see the sidebar, AI As a Utility).

Patient-Friendly Savings Programs
My staff members are trained to consistently look for opportunities to save patients money at key touchpoints, such as at the front desk and checkout. FSA and HSA accounts are a prime example of a benefit patients often forget they have. I make sure to provide:

• In-exam and checkout prompts from myself and my staff remind patients not to leave benefits unused.
• Education on these accounts fills gaps, especially for younger patients who are unfamiliar with eligible expenses.
• Seasonal bundles (like lid hygiene kits or vitamins) make FSA/HSA funds stretch farther.
• Staff enablement ensures every team member can confidently remind patients at purchase moments.

Annual supply promotions are another cornerstone of my approach. For patients wearing daily disposable lenses, for example, we offer sunglasses promotions tied to annual contact lens supply purchases. For monthly contact wearers, we provide solution samples and highlight rebate programs. These add-ons not only add value but also foster loyalty. Patients see that our office goes the extra mile to make their purchases worthwhile.

30-Day Lens Modality Guidance
I enter each patient exam with the same desire: to fit each patient with the best possible contact lens tailored to their ocular health and lifestyle needs. It’s important to never prejudge a patient. Fitting lenses remains a clear example of how clinical and financial considerations intersect.

Monthly lenses tend to appeal to more budget-conscious patients; these wearers are often younger, such as college-aged or young professionals who are starting families. Daily lenses, on the other hand, become compelling when I clarify that monthlies are 30 days from opening, not 30 wears. For an intermittent wearer, five daily pairs can be safer and more cost-effective than stretching a monthly lens.

Cost remains one of the top three drivers of modality choice. While cost often dominates the conversation, lifestyle and convenience are also critical factors. By addressing all three drivers—cost, convenience, and lifestyle fit—I can guide patients toward a modality that best serves their needs. Numerous contact lens and small private companies offer software that generates quick quotes and per-lens breakdowns, which aid in having these transparent discussions with patients. These tools turn what could be an uncomfortable discussion into a brief, trust-building moment.

Looking Ahead: Competing on Convenience
Increasingly, we must match the convenience of ordering from online retailers, while reinforcing the value of in-office care, if we want to keep contact lens purchases in-house. At my practice, that means:

• Offering extended hours to better match patients’ schedules.
• Implementing 24/7 online ordering platforms.
• Sending automated ordering reminders so patients never run out of supplies.
• Bundling appropriate additional solutions or ophthalmic eye drops with lenses to simplify reordering.

Patients who feel their doctor cares about their vision and makes the purchasing process seamless are less likely to look elsewhere for their lenses and supplies. Education remains the differentiator. When patients understand their options and the long-term value of in-office programs, and they learn that we can often match online prices using rebates, they are more likely to purchase from us with confidence.

Closing Reflection
Since launching my practice, my greatest strategy toward profitability has been to simply focus on depth over breadth. Strong patient relationships, built on trust and value, deliver more sustainable returns than high-volume, anonymous care. Managing margins will always be a part of private practice; by combining transparency, operational discipline, and patient-friendly programs, I’ve built a practice that can withstand financial challenges while continuing to foster stronger relationships. That balance, to me, is the heart of sustainable optometry.