Reducing Redos and Remakes
Welcome to our continuing series of Credit Educations Courses for Opticians.
This course has been approved for one hour of credit by the American Board of Opticianry. No fee is required for ABO credit.
Learning Outcomes: At the conclusion of this credit education course, participants should be able to:
1. Identify key redo/remake situations
2. Take steps to correct redos/ remakes before they happen
3. Establish functional relationships in the eyewear supply chain that will aid in redo and remake reduction
4. Develop practice protocol for preventing redos/remakes
Test procedures: Read the article and then click on the "Take The Test" button at the bottom of the page. This will open a new window with a test consisting of 20 questions. To receive ABO continuing education credit, respondents must correctly answer 16 of 20 test questions. Simply click on the best answer for each question and click the submit button at the end of the test. Your test answers will be automatically sent to Seiko Optical and we will send your CEC or notify you of test failure within 7 to 10 business days.
Note: Some states do not accept home study courses for continuing education credit. Check with the licensing board in your state to see if this course qualifies.
Reducing Redos and Remakes: Preventing redos and remakes is good business.
Time and money are two precious commodities today. Redos and remakes (R&R) hit eyecare professionals, laboratories, both wholesale and in-house, and manufacturers where it hurts most by negatively impacting time and money. Time is lost at the ECP level in corrective appointments, doctor chair time, re-ordering and re-dispensing, causing additional stress on staff, the processing system, and with the patient. The patient may be lost due to error, apparent unprofessionalism, and time wasted in the correction process. Potential patients to whom patients speak may be lost, too.
Remakes and redos can clog the wholesale and in-house laboratory system and delay job output. Some labs report R&R percentages anywhere from two to 12 percent, and several wholesale labs say that up to 35 percent of their day is spent in callbacks to practices to go over questionable orders prior to fabrication. While remote order processing and computer software systems have helped eliminate many redos, even with foolproof entry, R&Rs still occur. Here, we discuss R&R dilemmas and give your practice ways to cope with the R&R "crisis."
ALL TOGETHER
Remake and redo prevention starts at the front desk and winds its way throughout office procedures and staff members. Unless every staff member is watchful for R&R situations at every station, mistakes and oversights can occur.
Front desk: Properly utilizing patient questionnaires is an important first step in preventing R&Rs. If your questionnaire is over a year old, revamp it to keep it up-to-date and review it and update it faithfully every year. Questions should address every aspect of the patient's health and visual life, including prescription and non-prescription drug use, occupation, leisure activities, visual complaints (poor vision at distance and/or near, dry eyes, light sensitivity, etc.), and what they like and don't like about their current eyewear.
Ask patients to bring in all their old eyewear when they come in for their appointment. That way technicians can check each pair for Rx, lens material, appearance, etc. If the patient also wears contact lenses, ask them to bring in all old contact lens boxes and their lens care solutions.
Front desk personnel should know at least the basics of each new lens technology on the market, especially those promoted by the practice. If there are brochures and demonstration units in the waiting room, front desk staff will likely be asked questions from waiting patients and should be able to answer those questions seamlessly.
Pre-test. Like front desk staffers, technicians should also be up-to-speed on current lens technology and visual problems and solutions. When pre-testing patients-such as using a lensometer to check Rxs, checking ocular pressures, or evaluating contact lens fit-techs should explain each test they're conducting on each patient, and why.
This increases patient comfort, and patients are more likely to volunteer additional helpful information to friendly, efficient techs. Techs should be able to expertly hand-off patients to the doctor and highlight patient concerns to the doctor prior to the exam.
Exam Room. In addition to conducting a thorough eye examination, the doctor should be able to discuss optical and health concerns with the patient and tie-in visual clues to eyewear solutions. Recommending or prescribing eyewear solutions from chair side goes a long way to making the rest of the patient's journey through the practice easier and more satisfying.
When a doctor recommends/prescribes something, the patient accepts and believes in it, and is ready to purchase what the doctor recommends, be it AR, high-index lenses, sunwear, toric contact lenses, or other optical solutions.
Dispensary. Once the doctor hands off the patient and prescription to the optician, the bulk of R&R avoidance rests on the shoulders of the dispensary staff. In addition to reviewing the doctors recommendations and discussing patient needs, opticians should be aware of red-flag R&R territory including: First-time progressive addition lens wearers; patients upgrading from traditional bi- or trifocals to PALs; changing lenses to a different lens material or design; dramatic changes in the Rx; and dramatic changes in the frame selection, especially size.
Discuss lenses first, then proceed to frame selection, since frame selection often depends on what lens material and design is best.
Checkout Ensure that the patient has an accurate, realistic delivery timeframe for all product orders. If there is a question as to whether a job will run well, at all, or on time, check with the lab before the patient leaves so that any possible fabrication delays can be identified and an accurate delivery time can be given before the patient exits. This will prevent the patient coming back after being informed that there was a "problem with making the lenses and you have to come back in to select a different frame."
Review each order with patients, pointing out in detail what they'll receive for their dollars spent. Try to collect payment on the day of the order, which helps create commitment from patients and eliminate completed jobs that languish in a tray with no pick-up. That costs the practice money. One way of doing this is to ask, "How would you like to pay for this today?"
MEASUREMENTS AND MODALITIES
Frame Fit. Before taking any lens measurements, pre-fit the selected frame or frames. The frame should fit as close to the face as possible without causing "lash crash" or touching any other features like eyebrows. Back vertex distance should be an average of 14mm with a range of 12 to 16mm from the eye. Adjust the frame for face form, then pantoscopic angle. Fit pantoscopic angle according to lens manufacturer directions, especially PALs. An average pantoscopic angle is 10 degrees, but pantoscopic angle can be from seven to 12 degrees.
Adjustable pads should be fitted comfortably at the right height and angle. Temple length should be adjusted. In other words, the frame should fit snugly, comfortably, and as the patient will be wearing it once lenses are inserted.
PDs & OCs. Pupillary distance should always be measured at every visit, not just with first-time patients, but even if the patient is a returning adult patient. Children's and teen's PDs are apt to change, and adult PDs can change as well. Always take a monocular PD with a pupilometer.
Be sure, too, to mark optical centers on demo lenses in a frame. This is especially important on PALs, challenging Rxs, high-minus and high-plus Rxs, Rxs with a significant amount of difference eye-to-eye, and with patients who may have one eye set lower than another, perhaps minutely. The easiest way to take accurate OCs is to make it a habit to measure and mark OCs with every patient, thus ensuring uniformity.
Cutout Charts. Many lab callbacks are due to orders that were placed without checking to see if the lenses placed properly in the frame. Manufacturer's supply cutout charts-also called centration charts or layout charts-for their lenses; use them even if you know the lenses will fit. Take an extra moment to ensure the lenses will work in the frame by using the right cutout chart for the lens design selected.
Seg Heights. For traditional bifocals, measure the seg height from the bottom of the eyewire to the lower lid of each eye. For trifocals and PALs, measure and mark the seg height at the optical center of the lens on each eye. Consider lens manufacturer directions on specific lens designs, including minimum recommended seg heights, and note patient bifocal/trifocal/PAL wearing habits if they are current wearers.
TECHNOLOGY BOOSTS
Using today's technology and establishing working systems geared to R&R control go a long way to helping a practice maintain low R&R numbers. By using a combination of common sense and top-notch technology, the "R words" can be virtually eliminated as a part of your business.
Online Ordering. Online ordering systems can help eliminate most common errors, such as forgetting to write in a PD or lens material, for example. Most online ordering systems feature built-in error recognition, meaning that orders can't proceed if they're incomplete or inaccurate.
Online ordering systems also prevent incompatible product-to-prescription errors. For example, if an order is typed in for a lens design or material that's incompatible with what's available in the current marketplace, the order won't go through. This eliminates lab callbacks and getting the patient back into the office for a re-fit. Since manufacturers update product online on a real-time basis, online systems are more current than catalogs and, therefore, more fail-safe.
By typing information into specific areas, online orders are uniform and readable, as opposed to being randomly filled out with possibly illegible handwriting. Online ordering also helps avoid voice-related misunderstandings on the telephone. Most online ordering systems offer free trials and some offer training.
Remote Ordering. Trace-and-transmit technology has also helped reduce errors by accurately tracing a frame shape-even rimless-and making lenses without sending the frame to the lab. Automatic frame measurement is more precise than a person using a PD ruler, and also faster. Frame shipping to and from the lab is eliminated, saving a day or two of turnaround.
Some labs offer trace-and-transmit systems that interface with their systems, often on a "try it you'll like it" basis. Some offer dollars off or dollars back with the use of their system, which can lead to paying off the trace-and-transmit equipment in a matter of a few months.
COMMON SENSE SYSTEMS
In-Office Systems. Create an in-office system to deal with jobs prior to ordering. Establish tray stacks-different color trays help for job differentiation. For example, red trays for rush, blue trays for special orders, yellow trays for AR, tan trays for frame to come, etc. This way, jobs can be grouped together for efficient ordering instead of ordering one job at a time, which is time consuming and unnecessary unless the job is a rush.
Place rush orders only if there truly is a rush to avoid "rush saturation," and on a "hot rush" ask for a "walk through," where one person sees that particular job through the lab from beginning to end. If you still write out job orders, write legibly. Don't let signs/words/numbers run into the box or line margins. A minus sign can look like a plus sign if it's written over the line of a box, for example. If you call in orders, speak clearly and be sure to listen to the read-back carefully.
When there are special considerations, be sure to write complete and legible explanations in the "notes" section of the order form and articulate those considerations clearly and concisely on the telephone. Take a few minutes before pushing the "send" button on the computer or faxing or calling it in to review the order one last time. You, or better yet, someone else, may catch an error or something that doesn't makes sense just prior to sending the order to the lab. It pays to have an office policy to review orders prior to the patient leaving the office, then again prior to placing the order with the lab. This helps correct errors, avoid R&R, saves the patient time before they depart, plus boosts practice goodwill.
Lab Logic. Ask your lab how you're doing on R&R, and ask what they'd recommend for improvement. For example, if one doctor is writing illegible Rxs or one employee can't grasp the difference between a PD and an OC, with the lab's heads-up you can take action at the practice to talk to the doctor one-on-one and get the employee some basic optics training.
Maybe someone at the practice is pushing the lab to do optically incorrect work or work that the lab knows will be unattractive upon fabrication. Instead of just going through with it to create a cycle of R&R, the lab should call the practice to discuss the problem and come up with a solution that both the lab and the practice can agree on.
Be Equipped. Some tips to help an in-house or any lab avoid R&R include: Calibrate equipment according to the manufacturer's schedule and maintain equipment according to the manufacturer's directions on a structured basis. Make sure the eyepieces on all lensometers are in good condition in order to prevent scratching lenses, and calibrate lensometers regularly to insure that they read on power. Double-check all measurements before surfacing and edging.
Doc Talk. Establish a good relationship with all the optometrists and ophthalmologists you work with. Discuss points that have caused remakes with a "say anything, no fault" tone. In the end, you all want what's best for the patient.
Create a policy to go over Rxs when necessary in a timely manner, be it by phone, fax, or E-mail. When something doesn't look right or make sense, don't just push it through; ask questions and expect answers. Sometimes this is easier said than done. Everyone has their way of doing things, and everyone is pressed for time. If necessary, meet on a monthly basis to go over ordering snags and work out solutions.
If your practice works with several different doctors, practice management can set up a meeting with each doctor-doughnuts and coffee, lunch in or out, or even diner-to hammer out a workable system each entity can embrace. If anyone in any step of the ordering chain continues to be a problem, you may have to stop working with that person.
Patient Protocol. Be sure to check the patient's previous Rx against the new Rx for differences that may create a problem. If the patient is a returning patient, review old records for prior history, especially R&R history. Always discuss likes, dislikes, and lifestyle information with the patient, even a previous patient, since lifestyles and work situations can change.
Be up-front with patients by discussing any visual differences or adjustments they may encounter with their new eyewear on their first visit, not during dispensing. Then they'll know what to expect and be more willing to work with and trust you.
Managing Incentives. Several labs and suppliers offer incentive programs for selling specific products. While these programs can be a boost to the practice and individuals in many ways, if they're mishandled they can create R&R problems. For example, while short-corridor PALs come in many different lens material and designs, certain designs or materials might not be what's right for a specific patient, and pushing them into that design or material because there's a coupon, cash-or-product back, or entry into a contest, is a poor way to do business because it's likely to cause R&Rs. Always keep the patient's best interest in heart and mind whenever recommending any product, and know what products work and don't work in certain situations.
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