Profiles in Practice Success
Moving Forward in Tough Times
A surgeon and IOL designer maintains profitability in spite of managed care.

THE PRACTICE: Ronald M. Coburn, M.D., F.A.C.S., owns the Coburn Clinic, which opened in 1974. The Coburn Clinic currently has two offices: one located in Dearborn, Mich., and one in Berkley, Mich.

Dr. Coburn also co-owns the Cataract Specialty Surgery Center, an ambulatory surgery center (ASC) located on the same site as the Clinic's Berkley office, with Henry Spiro, M.D. The ASC opened 2 and a half years ago.

Dr. Coburn has designed posterior chamber IOLs for Alcon and Allergan.

PRACTICE SUMMARY: The two Coburn Clinic offices share one ophthalmologist, one optometrist, one ophthalmic technologist, one surgical technologist, four ophthalmic technicians, four ophthalmic assistants, a clinic administrator and six front-desk support staff.

The ASC staffs one internist, two certified registered nurse anesthetists, one administrator, five registered nurses and four support staff.

SURGICAL FOCUS: The practice specializes exclusively in cataract surgery.

PREFERRED INSTRUMENTS: The Wild operating microscope, Zeiss Humphrey Systems slit lamps, and the IOLMaster.

In addition, Dr. Coburn uses Alcon's 20000 Legacy Phaco. He says, "I appreciate how Alcon continually upgrades the machine without the necessity of replacing the phacoemulsification units. The reliability is exceptional."

Dr. Coburn also uses the Kelman mini-tip with a small aspirator port, and Alcon's ProVisc. "With ProVisc, corneas are consistently clear and material is easy to remove at the termination of the procedure."

PREFERRED MEDICATIONS: Dr. Coburn instructs his patients to apply one drop of ciprofloxacin (Ciloxan) OU, 3 days before surgery. Patients also receive one drop OU in pre-op holding.

Before and immediately after the procedure, Dr. Coburn places one drop of povidone iodine (Betadine) in the cul-de-sac.

Before the procedure, Dr. Coburn applies lidocaine (Xylocaine) jelly. Immediately following the paracentesis, 1% unpreserved lidocaine is injected. Lidocaine is also used for hydrodissection. "Less than 2% of patients require a block, and I prefer chloroprocaine hydrochloride (Nesacaine) because no patch is necessary post-op due to its short duration of action."

Dr. Coburn adds, "My phaco solution includes vancomycin, gentamicin sulfate (Garamycin) and epinephrine. At the termination of the procedure, I inject vancomycin into the anterior chamber."

SLOW SPOTS: "Patient referrals have decreased due to the proliferation of managed care, which has significantly diminished patients' freedom of choice. Increased ophthalmologist and optometric referrals have offset this slow spot.

"We work for patients, not insurance companies. We have no interest in managed care schemes."

GROWTH AREAS: "We expect the ASC to compensate for some but not all of the unfair fee cuts. Royalty income from intraocular lens design and engineering projects has produced funds for equipment and ASC development."

MANAGEMENT PHILOSOPHY: "Nothing is too good for my patients or for my employees. My welfare is a tertiary concern.

"For my patients, we tend to any difficulty they might have, such as transportation, application of eye drops, or assistance at home.

"For my employees, we have very flexible hours, excellent health insurance and a high pay scale with bonuses not tied to the profitability of the organization. We have almost no employee turnover."