REFRACTIVE SURGERY CHALLENGES, PART 1 OF 3
Create Your Own LASIK Boom
A patient-centric approach promotes growth, even in today's tough market.
BY KAY COULSON

Have you had trouble adapting to changes in the refractive marketplace? Has the maturing market, increasing competition, constricting economy and changing technology frozen your enthusiasm? You're not alone. It's been a challenging few years for all of us. But I believe the shakeout in refractive surgery is positive. Patients were too eager, the phones rang too easily, and seminar chairs seemed to fill without effort. Fewer options made for easier decision-making through the '90s. In those early days, refractive practices could afford to be "surgeon-centric." Office procedures, schedules and staffing were set to please the surgeon. Early refractive customers were willing to endure long wait times, shuffled or canceled appointments and waiting rooms congested with a mix of ill and healthy patients.

But today's reality requires a different approach. The key to refractive surgery success today is developing a "patient-centric" practice, which I believe you can create by using the concepts that we've successfully initiated in our practice in Lafayette, Colo.

In this article, I'll separate some refractive practice myths, which will only lead you astray if you accept them, from 12 refractive practice realities, which can help put you on a growth path if you embrace them.

We Adopt a Growth Strategy

We opened the doors to our practice just 2 weeks ahead of Sept. 11, 2001. Metro Denver is one of the most competitive LASIK markets in the country, with more than 35 lasers serving our area. We had an M.D. new to the state and an O.D. unable to leverage his referral network due to a noncompete agreement. And we had me -- with no eyecare or medical practice experience. What I did have was 20 years of cumulative knowledge in advertising, marketing and entrepreneurship. My training was nurtured in the benefit-driven world of packaged goods and consumer durables. Identifying the customer problem and solving it was what I knew how to do.

We performed three procedures in September 2001 -- just three. We had a long way to go, and not a great deal of money to take us there. Today, we are one of the fastest growing laser centers in the country, performing more than 1,500 cases last year. Market Scope estimated refractive marketplace growth at 10% in 2004. Our practice grew 40%. Our fees are on the high end for the market, and we utilize the Alcon CustomCornea platform.

In those early days, we made a key decision. We would treat our practice as a business -- a medical retail business. And in doing so, we had to adopt the basic tenets of any successful business.

► genuinely care about our customers

► exceed their expectations

► deliver outstanding results

► price ourselves appropriately

► work hard.

Interest in LASIK was strong when we first started out, even if demand at that moment was low. According to our own market research, 65% of adults were wearing glasses or contacts, and 75% of those wanted laser vision correction. Yet only 5% had opted for refractive surgery. We knew that bad outcomes in our market were rare, even with three aggressive discounters. So we accepted that, regardless of laser platform or surgeon, LASIK was a great procedure. Could it get incrementally better? Absolutely. Could we become the preferred provider? Absolutely. But we had to motivate people toward "Why us? Why now?"

Ignore the Myths

Each person who calls or visits our practice is a potential customer, deciding whether today is the day to choose to invest $4,000 in improved vision. He or she is not yet a patient. We have not yet been chosen to perform the surgery. To earn patients' trust, we have an obligation to create an environment, an experience and an outcome that's personal, individual and enjoyable for them. Elective medical practices are at the forefront of change in the medical field. Our ability to flourish won't be dictated by insurance panels and Medicare reimbursements. We must attract customers and exceed their expectations in order to thrive.

I've learned that myths abound in refractive surgery. Refractive urban legend is rooted in inflexibility. "No one does it that way." Or, "We've always done it that way." Or, "We tried that several years ago. It doesn't work." These myths become barriers to change. At key points along our journey, we've tried to uncover myths and question their accuracy. You can find them in your own practice. Just ask why something is done a certain way. If the answer is, "Because we've always done it that way." Or, "Because that's how everybody does it." Or, "Because that's how Dr. ABC wants it done." -- you've found a myth worth examining. Take a fresh look at the problem and determine whether a solution exists that places the best interest, the optimal comfort, and the ultimate convenience of the patient at its center. This patient-centric focus will fuel your success.

Are You Patient-Centric?

So how do you evaluate whether you have a patient-centric practice? And how do you unwind the inertia that refractive practice myths can instill within your staff, your schedule and yourself? Following are 12 realities that can restore the focus of your practice on the patient. Embrace them, implement them, believe in them, and you'll see refractive procedures and profitability climb.

1. The Customer is Afraid. Repeat. Repeat. Repeat.

Every person who calls us or opens our door for the first time is afraid. We're used to measuring, poking, touching and testing eyes all day long. But for Mary Smith, who woke up this morning and realized she used her last left contact and has a prescription that's too old for an online reorder, or Bob Jones, who broke his glasses playing pickup basketball last night, calling us is a big step. They don't know what procedure they want. They don't know how to choose a surgeon. They don't know if you're a center that will love them only until you take their money. What they do know is they want to see. And they want to believe in you.

Start by dispelling fear on the phone. The first step is to actually answer the phone. No auto-attendant. No voicemail tree. A real person will put a human face on your practice from the very first contact. You must establish a connection with the caller.

"I'm Kay. I didn't catch your first name?"

Now we're two people having a conversation. Diagnose the caller's problem. Eighty percent of the inquiry phone call should be listening. If your staff is talking more than listening, retrain them. Answer questions with questions. "Our fee is $1,950 per eye. Have you been thinking about LASIK for a while?" Asking questions will uncover the fear. And use "either-or" techniques to close. "Do you have a best day of the week or time of day for your consultation? On Tuesday afternoon, we have appointments available at 1 or 3:30. Which would you prefer?"

Dispel fear upon the patient's entry into the office. Is it a calm, clean environment? Does the customer immediately receive a personal greeting or acknowledgement? Do you provide simple intake procedures? We treat the consultation as a time for the customer to interview us, which changes the entire dynamic of the interaction. And we provide 100% patient focus. The patient in front of you outranks the patient on the phone. And the patient on the phone outranks other staff questions.

Finally, dispel fear on surgery day. A great pre/post-op room, luxurious chairs, soft lighting, fleece blankets, gel squeeze balls and bottled water all reinforce the care and importance we place on their comfort and result. Calm patients don't move under the laser. They don't squeeze the lid-holder. They don't displace flaps. And this keeps everyone else happy.

2. The Economy Won't Get Better. You Must Get Better.

The "Economy Myth" is powerful in refractive practices. We're all waiting for things to get better. We all think our markets are saturated. There are too many lasers, and discounters have ruined pricing. What growing practices know is that most of the potential customers you need are already calling your practice, but you're not handling them well.

According to Market Scope, a population of 200,000 supports one laser. Below 200,000 per laser, the market is oversaturated and competition will be fierce. Above 200,000 per laser, there's still room for new entrants. Metro Denver's laser saturation was 150,000 people per laser when we opened. We didn't have the luxury of waiting for the economy to get better. The key was to figure out how many procedures we wanted to do each month, calculate how many patients that meant we had to schedule, how many consults were needed to fill those surgery slots, and how many calls were required to fill those consults. I often hear administrators say, "We need more calls." Yet after analyzing how many initial inquiries result in procedures, most practices find it's not more inquiries, it's better conversion that's the key to success.

3. There's No Difference in Technology. Sell Yours More Effectively.

The concerns people have about LASIK are very basic. "I have astigmatism." "What if I move?" "What about night vision?" "Will I go blind?"

All questions can be answered very simply.

"Astigmatism can be treated with the small spot laser." "Night vision troubles are improved with CustomCornea and large optic zones." "Laser radar tracking locks on so you don't have to worry about moving." While the debate about Fourier vs. Zernike may rage among you as surgeons, they mean nothing to a patient. Leverage the benefits of your laser platform to address real-world vision issues. If you get lost in the details, you'll lose the customer.

4. Your Outcomes are No Better than Another Surgeon's. Unless They Really Are. Then Prove it.

Patients ask, "How many procedures has Dr. Montgomery done?" But that's not really what they want to know. They want to know, "How many has he done just like me?" So we tell them. We update our outcomes daily using Datagraph-Med. We publish our outcomes by prescription range. And we publish our enhancement rates. There are 70+ surgeons in Colorado who have done thousands of procedures, but none can tell the customer specifically what their outcomes are. Most fall back on FDA clinical trial data. Procedure numbers are a poor measure of the quality of service. We wanted to raise the bar. Outcomes are the service we sell. Acuity is a patient-friendly benchmark of that quality. Patients appreciate this level of detail. They judge our quality in the statistics.

5. Patients Aren't Loyal. They Need to be Reminded.

Most of us think patients love us and will always remember us. Our wake-up call came when we performed LASIK screenings at a high-end mall near our office. Many people had previously had successful LASIK at another center, but a wife, husband, brother or daughter chose to have LASIK with us. Why? They didn't remember where they had gone or who had performed that other surgery! They loved their vision, but they didn't remember who gave it to them. They need to be reminded of who you are and why you're great.

Thank them for choosing you. A handwritten note from you and a survey that asks specifically about the center and staff performance is valued. Remind them of your expertise through awards you've won. And keep them updated with twice-yearly newsletters. Reward them for referrals. At least 25% of your surgery patients should come from past surgery patients. A great practice usually can't get above 40%. If you think 80% of your patients come from past patients, check the facts. And if your marketing expenditures really are only accounting for a small percentage of new business, you're not effectively reaching new customers.

6. Referring Docs are Fickle. Make them Feel Valued.

The O.D./M.D. relationship has never been more uncertain than it is today. If comanagement is a vital patient channel for your practice, you must nurture this relationship.

We provide twice-yearly O.D. newsletters focused on the clinical implication of emerging technologies. We found that our referral network was the largest source of volume for CustomCornea in its first year. O.D.s had many patients they were holding back until quality-of-vision issues were addressed. Newsletters, CE programs, and special exam lane cards that quickly summarize treatment indications jump-started these referrals.

7. Good Advertising Works. Now Define "Good."

There are three keys to good advertising, whether it's for packaged goods, automobiles, cell phones or refractive surgery. Know your audience. Address their problem. Solve it better than anyone else can. The problems that patients want solved through refractive surgery fall into three areas: frustration, finances and fear.

Good advertising will tap into the emotion the customer feels. They are ready to be rid of drops and solutions. Ready to feel comfortable driving the family at night, or seeing a menu in a dim restaurant. They want to see clearly when biking or reading the morning paper. They are ready to finance LASIK if they know the option exists. Or they're ready to participate in a study if it means reduced pricing for improved technology. Even if they're not yet ready to come in for a consultation, they might be ready to view a Webcast seminar if they know it's available. They're ready to hear how well other people, just like them, have done by choosing your practice.

Your credentials as a surgeon, the numbers of procedures you've done, and the equipment you use should only be promoted if they help solve these problems. Seeing your picture, or the picture of your equipment, or the picture of a laser beam probing the eye, doesn't address the problem. It doesn't alleviate fear. That kind of advertising is about you, not about the patient. And in today's market, it does a poor job of generating calls.

8. You are Retail. Create an Unforgettable Experience.

We all frequent stores or restaurants we enjoy. They carry products we desire, offer services that suit us, attract other customers that we feel an affinity toward. Yet how many of us would frequent this favorite store or restaurant or spa if we weren't greeted when we entered? If they made us fill out extensive paperwork before we'd chosen to buy anything? If they made us wait next to sick people or noisy people, or accept treatment from rude people?

Potential refractive customers choose to call you and visit you. They choose to spend their money with you. They're choosing LASIK instead of a new car, a new couch or a vacation. They're not sick. They expect to be waited on. And if your practice won't, the one down the street will.

9. Competitors are Smart. Improve upon Good Ideas.

None of us has a lock on original ideas. We can learn from other surgery centers, or vendors or similar "want-based" businesses. One of the best sources for new ideas is Refractive Adwatch. This monthly summary of refractive advertising from around the country often spurs new ideas that you can custom-tailor to your own practice for headlines, special promotions, or unique twists on fees or financing.

In addition, look at new products media vendors are offering. High-quality digital ads shown in movie theaters, awareness products offered by Yellow Pages reps, unique search-engine optimization plans, and targeted online advertising provide a wealth of affordable opportunities to reach an audience considering refractive surgery.

These ideas have proven successful in other types of businesses, and will allow you to look beyond what your immediate competition is doing. Too often, refractive practices just mimic what they see others doing, assuming that these marketing strategies must be working. Those types of assumptions could be dead wrong.

10. Redundancy Creates Perfection. We are in the Zero-Mistakes Business.

Every successful practice has one or two people it can't live without. And yet, we must create a practice that's successful and sustainable even in the absence of that person or persons. We must clone success, and we do that in two ways. First is coverage. At least two people must know every position and every task. From yourself as the surgeon on down, there must be staff redundancy so that when illness, schedule conflicts or worse occur, disruption is transparent to the patient.

Second is consistency. Every task must be done the same way, regardless of personnel. In refractive surgery, there's no room for variability. Phone intake, chart prep, testing protocol, surgery-suite sterilization and surgical technique must always be the same. Each task is critical to the success of the outcome. Having redundancy and consistency ensures that the practice is sustainable, predictable and profitable beyond the longevity of any single person.

11. Success is Mutual. Reward what's Important.

I'm a great believer in paying for performance. We all learned in 2001/02 how devastating procedure declines were on profitability. We've all had employees who weren't well-focused on the surgery goals of the practice. But the goal of a refractive center is to perform surgery. So we compensate employees based on our common goal. We all share the risk and the reward of practice growth. In my view, volume growth shouldn't disproportionately benefit the surgeon. This reinforces to all team members that they're critical to the success of the organization.

12. You Can't Win if You Don't Know the Score. Plan. Execute. Track. Improve.

This final reality becomes the checkpoint for how well you've done with all of the other steps. You must plan for success. You must pinpoint the issues. Do you need more calls? Do you need to convert existing calls better? Do you need to improve referrals, which may be a function of needing to improve outcomes? Do you need more staff, or to deploy staff in a different way? Do you need it all? You'll only know if you consistently and objectively measure your results while continually striving for improvement.

13. Small Steps Lead to Success

For all of us in refractive surgery, the myth we can least afford to believe is the "Magic Bullet Myth." The next great technology, the next great microkeratome, the next great accommodating lens won't help our practice if we haven't invested in the arsenal of small improvements necessary to increase procedures and profitability. We must embrace customer service because customer satisfaction will certainly follow. And most important, we must remember that refractive surgeons and refractive centers are changing lives and changing the medical profession. Be a pioneer.

Kay Coulson is the vice president and director of Practice Development at InSight LASIK in Lafayette, Colo., and director of the Alcon-sponsored course "Refractive Excellence in Business and Marketing." You can reach her at kay@insightlasik.com.

In the next installment of Refractive Surgery Challenges: point-counterpoint on the relative merits of Zernike polynomials and Fourier analysis for characterizing higher-order aberrations.