Reality Check: What's Actually Happening in Optometry Practices Today
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The conference speakers make it sound so optimistic. New opportunities everywhere.
Technology solving all your problems. Growth just around the corner. But when you're back in your practice on Monday morning, dealing with another staff resignation and a stack of denied claims, those conference promises can feel pretty hollow.
That disconnect between industry cheerleading and daily reality is exactly why we recently brought together nine industry leaders for an honest conversation about what's really happening in optometry practices right now, straight talk from people who live these challenges every day.
When Good People Keep Leaving
The conversation started with the elephant in the room: staffing. Everyone's struggling to find and keep good people, but the numbers behind this crisis are worse than most realize.
Ryan Williams, CEO of In Focus Eye Care, laid it out bluntly.
But it's not just about money. The job itself has become impossibly complex. Your front desk person needs to understand insurance benefits, collect payments, handle scheduling, and somehow maintain the people skills that make patients feel welcome.
Your techs are doing pre-testing, managing equipment, and often filling gaps wherever needed. Everyone's wearing multiple hats, and the pressure shows.
Dr. Dori Carlson, a past AOA president who owns multiple locations, has found a different approach. Over half her staff has been with her practice for more than 22 years.
Her secret isn't revolutionary. It's just rarely implemented consistently.
The practices that are succeeding have stopped treating staff retention as an HR problem and started treating it as a business strategy.
They're creating structured training programs, building recognition systems, and, perhaps most importantly, giving people the tools and authority to do their jobs well without constantly asking for permission.
Dr. Jonathan Andrews from Berlin Eye Associates took this systematic approach after getting tired of repeating the same instructions constantly. His practice now has comprehensive training courses for every position, complete with testing and advancement.
His team now knows exactly what's expected and feels empowered to make decisions. They rarely need to interrupt him with questions that should have been covered in training.
The Billing Trap That's Catching Everyone
While practices focus on staffing, a quiet crisis is building in billing departments across the country. Medicare and other payers are conducting widespread audits of modifier usage, particularly targeting the 25 and 59 modifiers that many practices use routinely.
Christine DeFrancisco, CEO of In Focus Eye Care, delivered a warning that should get every practice owner's attention:
The implications go beyond just claim denials. These audits tie up your cash flow for months while you respond to medical record requests. They require detailed documentation that many practices haven't been maintaining consistently. And if your documentation doesn't support the modifier usage, you're looking at potential paybacks and penalties.
The practices avoiding this trap have implemented systematic approaches to billing that don't rely on staff memory or guesswork. They have billing sheets that specify exactly how to code different scenarios for different payers.
They've also trained their doctors to document medical necessity clearly, and built processes to catch errors before claims go out the door.
Most importantly, they've stopped leaving money on the table through poor denial management. Too many practices write off denied claims instead of working them properly, missing opportunities to collect payments they've legitimately earned.
Technology That Actually Works
The technology conversation in optometry often focuses on the wrong things. Practices get excited about the latest diagnostic equipment or practice management features, but miss the fundamental question: Does this help me spend more quality time with patients, or does it create more distractions?
Travis Beaven, Global VP of Vision Care at Alcon, cut straight to the heart of it.
The most successful practices are using technology strategically to handle routine tasks so they can focus on building relationships with patients. They're automating appointment reminders, streamlining billing processes, and using AI to analyze patient data and identify opportunities.
But they're also remembering that sometimes the lowest-tech solutions work best. Dr. Carlson maintains identical setups in all her exam rooms so she never wastes time looking for equipment. It's simple, costs nothing, and saves countless minutes every day.
The key is choosing technology that amplifies your strengths rather than replacing human connection. Patients can get routine eye care in lots of places now. What they can't get everywhere is a doctor who knows their family, remembers their concerns, and treats them like more than a number.
What Loyalty Actually Looks Like
Patient loyalty has become more challenging and more important than ever. With retail chains, online retailers, and corporate practices all competing for your patients, the practices that are thriving have figured out how to make those relationships genuinely irreplaceable.
Dr. Carlson's approach is deceptively simple but rarely implemented consistently. She keeps detailed notes about each patient's personal life, their kids' activities, shared connections, and important events.
The investment pays off in ways that surprise even longtime patients. She recently had a couple drive two hours from their new home to continue receiving care at her practice, simply because of the relationships they'd built over the years.
But relationship building without operational excellence falls short. Dr. Andrews, whose practice generates $4 million in revenue without accepting vision insurance, has systematized the entire patient experience. His staff members introduce each other at every handoff, building confidence in the team.
His office environment feels more like luxury hospitality than medical care. And his practice offers comprehensive services so patients never need to go elsewhere.
The result is sustainable growth even in an increasingly competitive market. Patients choose to pay out of pocket rather than go somewhere else because the value proposition is clear and consistent.
Dr. Sara Shissias, Director of Professional Affairs at RevolutionEHR, emphasized that practice owners must balance both big-picture strategy and day-to-day operations. She stressed the importance of staying involved, building trust with staff and patients, and maintaining honesty and presence throughout the office.
The Road Ahead
Looking forward, the landscape will continue changing rapidly. Dr. Kelly Kerksick from RevolutionEHR predicts that AI will transform not just clinical decision-making but also many routine tasks currently handled by staff.
But technology advancement won't solve the fundamental challenges of running a successful practice. Those require the unglamorous work of building systems, training staff, managing finances, and maintaining focus on patient relationships.
The practices that will thrive in the coming years aren't necessarily the ones with the biggest budgets or the latest equipment. They're the ones that have built strong foundations, maintained financial discipline, and never lost sight of why patients choose them in the first place.
As the panelists made clear, the challenges are real and getting more complex. But the practices that are succeeding today prove that solutions exist. The question is whether you'll implement them consistently enough to make a difference.
The conference speakers will keep promising easy answers and revolutionary breakthroughs. But the real work happens Monday morning, one patient at a time, one staff member at a time, one system at a time. That's where practices are won or lost.
The Good News
The future of optometry will continue to be shaped by staffing challenges, financial pressures, and rapidly advancing technology. But as our panel made clear, practices that adapt, by investing in culture, training, efficiency, and innovation, will be the ones that thrive.
At RevolutionEHR, we’re committed to supporting that future. Whether it’s automating workflows, streamlining billing, or giving you back time in the exam lane, our solutions are designed to help you meet today’s challenges and prepare for tomorrow.
Contact us to schedule a free demo.
Thank You!
RevolutionEHR would like to thank our distinguished panelists for sharing their time, expertise, and perspectives during The Current State of Optometry webinar.
- Dr. Dori Carlson, Past President of the American Optometric Association and private practice owner
- Dr. Jonathan Andrews, Berlin Eye Associates
- Dr. Sara Shissias, Director of Professional Affairs, RevolutionEHR
- Dr. Kelly Kerksick, Vice President of Revenue Cycle Operations, RevolutionEHR
- Christine DeFrancisco, Vice President of RCM, RevolutionEHR
- Ryan Williams, CEO, InFocus Eye Care
- Travis Beaven, Global Vice President of Vision Care, Alcon
Their insights shed light on the most pressing challenges facing optometry today and offered a roadmap for practices to adapt and thrive in the years ahead.
Backed by deep expertise in optometry and a commitment to the success of eye care practices, RevolutionEHR offers insights and perspectives designed to help providers streamline operations, enhance patient care, and thrive in a changing healthcare landscape.