Lessons in refractive patient retention.
By Michael W. Malley
A funny thing happened on the way
to the refractive forum: the 20/20 postoperative LASIK patient never
returned for all of his postop visits. Funny how that works. You reduce
or eliminate a patient�s dependence on corrective eye wear � and your
patient just might reduce or eliminate his dependence on your practice.
For a number of doctors in active refractive practices, that is actually
the status quo � and there is little that can be done. In their eyes (no
pun intended), they have done their job. If a patient is seeing 20/20
and does not feel the need to come back for his 1-year follow-up, then
it is the patient�s decision. After all, you cannot force a patient to
complete all of his postop regimen, can you?
Doctors may not like the fact that some of their most satisfied
refractive patients are not returning � but at least the patient has
achieved his/her desired result, and isn�t that what refractive surgery
is really all about?
As presbyopia-correcting intraocular lenses (PIOLs) and products like
NearVision CK (Refractec, Inc., Irvine, Calif.) continue to merge the
visual gap between LASIK and cataract surgery, a better question to ask
today�s refractive surgeon is this: �What is the official last step � or
office visit � for a LASIK patient?�
When Is the Last Step?
For some surgeons, the last post-LASIK visit after surgery might be 6
months. For others, a 1-year global follow-up is included in their
all-inclusive fee. Some surgeons offer a standard 2-year enhancement
period. Then there are those surgeons who offer a lifetime LASIK care
package. The question is � are they really monitoring patients that far
into their postop recovery period?
In terms of LASIK (refractive) patient retention and loyalty, should
there ever really be a �last� office visit? If we take a little less
myopic view of the average LASIK patient�s experience with a practice,
we would quickly realize the answer is a resounding �no.� LASIK should
represent a beginning in a patient�s eyecare program � not an ending.
Taking a more global patient view allows us to witness the great circle
of refractive life: from glasses or contacts to LASIK/PRK to CK to PIOLs
to cataract surgery to glaucoma management and retinal disorders. The
key question here for refractive surgeons is this: How do you retain a
LASIK patient for life? Short question. Not so short
an answer.
Discussing Future Needs
With an average age of 38, today�s LASIK patient will soon be entering
the visually challenging stages of presbyopia. Soon to follow will be
early lens changes and the eventual development of cataracts.
Age-related pathology will also become a concern. Unfortunately, most
patients are not reminded by the practice of future visual needs when
they are only there for LASIK.
For today�s refractive practice to do a stellar job of promoting and
providing LASIK, the perceived value of the LASIK product must be
raised. We need to let patients know their $4,000 investment is going to
give them the vision they have always wanted. If their perceived value
of LASIK does not match the asking price, then they usually will not go
through with the surgery.
Discussing long-term post-LASIK visual needs with a patient is probably
not a good idea BEFORE they have the procedure. While long-term needs
should be part of the informed consent process, do not present LASIK as
a short-term, fill-in-the-gap procedure.
Ideally, the best time to focus on future patient needs � and long-term
patient retention � is during the �active� postop recovery process. The
active period is the period within your practice where post-LASIK
patients are still keeping their appointments. An �inactive� postop
recovery period would be when patients are not keeping those
appointments.
Most postop LASIK patients still understand the need to attend their
4-to-6-week postop appointments, so this might by the ideal time to
introduce information regarding long-term visual needs. This does not
have to be a lengthy discussion � and it can actually be in written
form.
You should simply let patients know that the best way to enjoy a
lifetime of the best possible vision after refractive surgery is to
understand the various visual stages of life. Explain the stages that
they are approaching and what steps they can take within the practice to
ensure they make the most of their LASIK investment.
Giving Patients a Reason to Return
Even this seemingly simple first step requires a shift in focus within
the practice. In addition to preparing post-LASIK communication
strategies, your practice also needs to present a more comprehensive
eyecare front during initial patient interactions. Patients need to
understand that although your practice specializes in refractive
surgery, you are also uniquely qualified to help them enjoy a lifetime
of the best possible vision.
This needs to be presented as a benefit � not an afterthought. Here is
why. The corporate LASIK centers � which, at the current time, have
absolutely no long-term concern with their postop-LASIK patients (until
they start buying up ASCs and getting into the PIOL business model),
will inform patients that a center that specializes in LASIK is better
prepared to perform LASIK than a general ophthalmology practice.
The front your practice should be presenting to patients, if it is a
comprehensive eyecare facility, is that it offers more vision correction
alternatives than simply LASIK. It is important to remind patients that
not everyone is an ideal candidate for LASIK. This way, when the patient
discovers that he/she is an ideal candidate, he/she feels fortunate. You
should also ease patients� fears by letting them know that not only can
your comprehensive practice customize a vision correction strategy for
them based on their refractive error and their lifestyle, it will also
be there to help them enjoy a lifetime of the best possible vision.
Isn�t that what we all want from our physicians and medical specialists?
Someone who is there for us today, tomorrow and for the future? Someone
who understands our needs and is prepared to be a medical provider for
us as long as we need them? Voila! You have just planted the seed of
thought for patient retention and without compromising the perceived
value of your LASIK procedure. If you are really convincing in this
process, you may have actually increased the perceived value of your
product and your practice.
Promoting LASIK
Many large eye centers today that offer (and heavily promote) LASIK are
seen only as �LASIK centers� by their patients. And it is easy to
understand why. To effectively promote LASIK to the general public, you
need to:
- Advertise not only that you perform LASIK, but
- How you differ from your competition
- How your LASIK technology compares to what the competition has
- How your LASIK experience sizes up to what the competition offers and
- How your LASIK financing is more affordable than the competition.
The reoccurring theme here is the term �LASIK.�
With more than a decade of aggressive LASIK advertising under the
industry�s belt, it should not be surprising that a majority of today�s
patients think of comprehensive ophthalmology practices as LASIK
centers. It is not necessarily a bad image to portray � and may even be
necessary if you are engaged in heavy competitive advertising.
But again, if you are trying to build long-term patient loyalty and
offer patients additional services and surgery at a later stage in their
lives, then you must make sure patients understand the importance of
their post-refractive eyecare regimen today, tomorrow and years from
now.
The Need for Follow-Up
Once you establish realistic expectations regarding postop results on a
near and long-term basis, you have a perfect opportunity to introduce
the need for continued follow-up care. There is no need to get into any
detail, simply let the patient know that you will be available for all
of his/her postop eye care needs.
Your informed consent process should obviously include the aging process
of the eye and how it will affect the current refractive result they are
enjoying. A big misconception in the LASIK industry among patients is
that LASIK is a temporary fix for their refractive error � which in some
respects is true. What patients are really wondering about is the need
for reading glasses after LASIK and an eventual need for bifocals as
their lenses continue to age and harden. This misconception has probably
occurred due to a lack of detailed informed consent.
What they need to know is that LASIK/PRK is a permanent procedure to
treat their refractive error, but it simply does not stop the aging
process within the eye. This discussion helps prepare them for the need
for preventive eyecare measures as they age and lets them know how
qualified your practice is for their continuing care.
All patients should know that as part of the practice�s continuing
patient education process, your practice will be sending them
information in the future regarding general eye health, future office
visits, medical announcements and new developments in technology and
surgical techniques. Ask all patients what their preferred method of
future contact is and then gather all of their information while they
are in the office.
Marketing
If LASIK and cataract surgery are two of the biggest revenue generators
for your practice, then develop signage and internal collaterals for
LASIK patients that discuss long term post-LASIK care, including
cataract development. Design newsletters that keep in quarterly contact
with all of your patients, discussing not only refractive measures and
medical updates, but comprehensive eye care news as well.
Start the informational follow-up process early with all LASIK patients
so they get accustomed to hearing from the practice regularly following
their surgery. This will help stem the flow of the postop LASIK exodus
currently underway in many practices today.
Many LASIK practices fail to follow up regularly with LASIK patients
after their surgery because they are simply too busy trying to see and
attract new LASIK patients. They fail to develop not only long-term
relationships with their LASIK patients � which dramatically improves
patient referral percentages � but they also fail to educate patients on
the need for post-refractive eye care.
The additional follow-up communication and ongoing corresponding is
effective, but it can also be expensive (or at least the practice thinks
it is expensive). That is because to do an effective job, you might
actually need an additional person to �own� the patient retention
process. Instead of looking at it as an expense, let�s examine this
position a little more closely.
Patient Retention
If even 7 out 10 practices report that the majority of new patients
entering the practice are the direct result of a satisfied patient (the
actual rate of satisfaction is probably higher, unless your practice is
doing an abysmal job in the quality patient care department) then the
future of your practice depends on the continued satisfaction and
referring of your patient base. Now ask yourself this question: �Who is
the director of patient referrals/patient retention for your practice?�
If your practice has a marketing director, surely it has a patient
referral director. After all, if the majority of your future business
depends solely on how well you take care and nourish current patients,
you certainly cannot leave that responsibility to happenstance.
But believe it or not, most practices do not have a patient referral
director. If you find that hard to believe, call a colleague � or better
yet, a competitor � and ask for the director of patient referrals. If
they don�t have one, ask for the director of patient retention � or the
director of future growth and development. In the case of the latter,
you might get the executive director or administrator, so be careful.
If your practice is already doing a stellar job with patient referrals
and patient retention without such a person, imagine the growth
potential and the quality of follow-up care you could be generating
within the practice.
Investing in Retention
On the books, the director is yet another full time employee � another
employee to manage and another pay check to cut each month. But even at
$50,000 a year, it�s a small price to pay for the kind of future revenue
potential that could be generated. Whether you are a $2.5 million a year
practice or a $25 million a year operation, $50,000 is a lot less than
what many LASIK practices spend each month on unproven advertising
campaigns. It is a small expense in terms of return on investment and it
helps solidify the future of your practice.
One of the first steps my consulting firm takes with our larger
practices is to reduce their annual marketing budget by $50,000, which
initially is welcomed with open arms. Most marketing firms and ad
agencies want their practices to spend more � to increase surgical
volume � that�s actually how it is done in most cases. What we have
found, however, is that it is better to reduce the overall budget by
$50,000 and then use those funds to hire a killer director of patient
communications and referrals. If properly trained, it is one of the
wisest investments a practice can make.
In your practice�s quest to retain today�s new refractive patients, do
not be short sighted by immediate visual needs. Yes, help patients
achieve the vision they want today � but also help them understand that
to enjoy a lifetime of the best possible vision, your practice is
committed to forming a lifetime partnership with them for all of their
future eyecare needs � and those of their family members. It is really
as simple as that. OM
Michael Malley is president of Houston, Texas-based CRM Marketing Group.
He can be reached via e-mail at mike@refractivemarketing.com.
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