Adapt your practice to feature this option.
By Kay Coulson
Many surgeons I work with are excited
about the new presbyopia-correcting lenses and the promise of reduced
dependence on glasses for those older than 50. However, I field many
questions from cataract surgeons unaccustomed to providing counseling
and private-pay services to their patients. You have certified
clinically with the lenses. You have told staff you will begin to offer
them. And then �nothing. You have tried squeezing in the upgrade
conversation in the exam lane but find few people signing on for these
lenses. So what is the problem? Is patient demand weak? Is upgrade
pricing a barrier? Does the technology not deliver?
In my experience, none of these reasons represent the true problem.
People want to be glasses-free at all ages. Customers have demonstrated
over and over through LASIK, cosmetic dentistry and cosmetic surgery
that they are willing to pay for elective procedures that improve their
quality of life. And patient satisfaction with the new presbyopia-correcting
lenses is extraordinarily high.
Patients implanted with the ReSTOR lens (Alcon, Fort Worth, Texas), with
which I have the most experience, overwhelmingly say they are satisfied
with the result and are glasses-free 80%+ of the time. The real problem
lies within our practices. If you are looking to succeed with upgraded
lenses, ask yourself, �What do I need to do differently within my
practice?� This article will address the major elements of change
required to succeed with these new lenses.
Key Steps to Success
Three steps are key to incorporating upgraded lenses:
- Designate
- Counsel
- Deliver
First you must designate a procedure goal. Within a standard
insurance-driven practice, it is uncommon to set procedure goals.
Determine how many cataract procedures you are performing, or want to
perform, and set a target for how many should be elective.
I have been amazed at the number of patients aware of their cataracts
and leading a compromised lifestyle but unwilling to move forward with
traditional cataract surgery. However, when the option of glasses-free
vision is presented, they take action. They want the cataract removed
and they want maximum spectacle-independence. In practices that have
embraced upgraded lenses and incorporated education throughout the
patient process, 25% of total cataract patients are opting for upgraded
lenses. In practices that have added direct marketing to cataract
patients in addition to improved practice flow and education, we are
seeing upgrade percentages as high at 40% of total lens volume.
Consider how may exams you do today for cataract evaluations, cataract
rechecks and annual exams for people over 50 with visual complaints
consistent with cataract. Most surgical ophthalmology practices find
this is three to eight patients per day. Averaging four exams per day,
you should be performing more than 100 lens surgeries per month, but the
average cataract practice performs just 30 surgeries per month. Using
Figure 1, quantify how many of your patients are actually moving on to
surgery today. Patients may tell you that they will schedule surgery,
but it just does not
happen that often. Instead, many patients end up in recheck mode for
several years because you have not given them sufficient reason to take
action now. The reason they need? Many patients will say glasses-free
vision.
Wednesday is �Lensday�
One of the simplest ways to guarantee success in converting more lens
patients to an upgraded IOL is to block
1 day per week for lens evaluations. In most practices, the appointment
calendar controls you, rather than you controlling it. Shaping the
practice so that you see more of the visit types you want, and less of
the visits or conditions you do not want, requires diligent review of
your scheduling system. By setting aside 1 day per week, and booking
appointments every half hour, you will see 15 complete exams on that
day.
By focusing on one appointment type per day, the entire staff shifts
into a counseling/scheduling mode and the potential patient feels better
served. These uninterrupted blocks allow you to remain on time, a factor
critical to a patient making an upgraded IOL choice. We schedule
evaluations for 1 hour, allowing 5 minutes for check-in, 35 minutes for
a technician to do the work-up and dilation, 15 minutes for the surgeon
being with the patient reviewing options and answering questions, and
the final 10 minutes for the scheduler booking surgery and answering
financing/insurance questions.
Designate an Appointment Protocol
One key step in improving conversions is to minimize the number of staff
members the patient sees. Three is the maximum, in my opinion. This
sequence is illustrated in Figure 2. They see the front desk to check
in, check out, schedule and review finances. They see the technician for
a clinical work-up. And they see the surgeon for interpretation,
diagnosis, recommendations and questions. Patients should not be moved
through four different rooms, nor should they be shuffled through six
different people. Rather than be parked in front of a video for an
extended period of time, patients should have the chance to visit and
bond with you and members of your practice, where they feel attended to
and personally served.
We reviewed and updated our informed consent and ASC protocols. How many
years has it been since you looked at the packet given to cataract
patients? Many that I have reviewed contain 12 to 15 different
loose-leaf pages, poorly reproduced, with typographical errors, that
list every scary, horrible complication that could happen based on
language appropriate for cataract surgery in the 1970s. Duplication of
such forms leaves many of your own staff unclear as to why some pages
are included. Review this packet of information. Consolidate to one
informed consent (ours is four pages), a financial responsibility page
(two pages that clearly outline the standard IOL vs. upgraded IOL fee
components) and pre/post-surgery instructions and eye drop schedules
(two pages).
Review the changes with your ASC staff. Examine what is being done in
their protocol that could be more patient-friendly. Are you stacking up
seven patients at a time so you can turn them every 8 minutes? The
upgraded IOL patient will not feel comfortable paying an extra $2,000
per eye for an assembly line. And because this patient is younger, I
suggest you examine the need for medical clearance. While this may be
necessary based on your malpractice coverage or personal preference, it
is a hoop that causes every practice to lose surgeries weekly because
patients do not comply. Now is the time to put yourself in the patient�s
shoes, read the forms, go through the process, and re-examine whether
your methods and communications can be improved.
Designate Staff Protocol Changes
Does it ever happen that you return from a meeting excited about a
procedure or technology, pull your staff together, tell them you want to
add this to the practice and then nothing happens? A key element to
ensuring success with upgraded lenses it to provide your staff with the
specific steps they must take. It is not that they do not want to
comply, they often just do not know how.
We now book all annual exams for patients older than 50 and all cataract
evaluations (our own or referred in from O.D.s), to a lens consultation.
This is a new appointment type added to our calendar, and is the only
visit scheduled on our designated evaluation day. This way, we ensure
the surgeon sees every patient older than 50 and has a chance to discuss
the new lens technologies.
We require two visits prior to surgery, each slightly different in the
practices I advise. Either we provide 1 hour for the lens consultation (nondilated)
followed by a 1-hour dilated exam, or we counsel as part of the 1-hour
dilated exam and then have the patient return for a brief 15-minute
biometry confirmation. Many experienced upgrade surgeons advocate a
biometry confirmation visit because the poking and prodding during the
dilated visit may alter biometry results slightly. This �measure twice,
cut once� method will be invaluable with multifocal lenses.
We schedule both eyes 1 week apart for patients before they leave the
evaluation appointment and we group elective patients together. For
example, standard cataract patients are booked from 7 a.m. forward and
upgraded patients are booked from 11:30 a.m. backward. This addresses
the health concerns that are generally present in the older, standard
IOL patients and keeps the younger, elective patients together later in
the day when we slow down and spend a bit more time with them.
Your insurance person will not want to determine benefits for a patient
too far in advance of surgery. She will view this as extra work,
especially if the surgery falls into another month, as benefits
sometimes change at the beginning of a month. However, we all want to
know what we are going to pay for something, especially large-ticket
expenses. The main reason patients fall off your surgery schedule (other
than lack of medical clearance) is that they are told of their copay/deductible/fee
obligations just 1 to 2 days before surgery and the grand total is
unexpected.
My suggestion is to immediately pre-qualify all patients considering an
upgraded lens within 24 hours of their exam. Your pre-certification
person notifies the counselor/scheduler. The scheduler then contacts the
patient with a set fee, explaining this may change slightly if the
surgery is more than 1 month out. If this is impossible in your setting
because volumes are too high, I suggest your insurance person determine
who the top five insurance providers are for your practice and develop
an �average� copay and deductible fee chart, so the patient has some
idea of what the final charges will be with the upgraded lens. Not
addressing the critical element of �how much� in a timely manner will
absolutely cripple your ability to convert a monofocal lens patient to
an upgraded lens patient.
Additional Tests Help Qualify Patients
We added an IOLMaster reading and a backlit acuity (BAT) test to our
consultation form, which is currently a nondilated exam. This gives us
an idea, based on acuities and the BAT, whether the patient likely has a
cataract and should be counseled to lens options rather than laser
options. It also allows us to verify that the lens power for this
patient is available. You may also consider adding a Potential Acuity
Meter (PAM) test to this visit to make sure there is not something odd
in the visual system that might present a red flag for a multifocal
lens.
The Counseling Process
Once you have figured out what you want to do, you must execute well.
Execution falls into three phases of counseling � on the phone and at
the front desk, in the lane and when scheduling surgery.
We have found that the education process must begin before the patient
visits our office. We ask four questions of patients to determine
whether they should be slotted into one of our lens evaluation
appointments:
- �Have you been told you have a cataract?�
- �When was your last dilated health exam?�
- �May I ask how old you are?�
- �Are you noticing recent changes in your vision?�
One to 2 weeks ahead of the lens consultation appointment, we mail
patients an information packet with a brochure on our upgraded lenses, a
vision preferences checklist and intake forms. This provides patients a
chance to understand what we might be discussing at their visit and to
reassure them that cataract surgery is a normal, safe and common
procedure.
Once they enter the office, we make sure they have filled out our
�Vision Preferences� checklist. This is a psychological screener that
allows us to determine the type of vision this person desires, and how
flexible and adaptable they will be if the vision is not perfect
post-surgery.
While the patient is dilating, we show a short information video on the
upgraded IOLs on a personal DVD player. By the time the surgeon enters
the lane, we have had five points of education contact with the patient
about lens surgery. They are over the hurdle of cataracts and well into
the decision-making process of which lens they prefer.
The format I have found successful for the surgeon discussion with the
patient follows the following sequence:
- �What are you hoping we can do for you?�
- �What problems are you having with your vision?�
- �Your lens has hardened and clouded. We need to replace it. The
standard lens option will provide you good distance vision, but you will
need readers.�
- �How do you feel about wearing glasses?�
- �The new multifocal lenses provide a good range of distance and near
vision. In clinical studies, more than 80% of patients reported never
needing to wear glasses.�
Asking how the person feels about wearing glasses is a critical step in
the surgeon interview. It is only when a patient expresses frustration
with glasses and says he or she would like to be glasses-free, that the
conversation continues on about an upgrade. You will likely convert 25%
of patients to upgrades, so you do not need to oversell their benefits
if the patient does not have a problem. If the patient desires
glasses-free vision, then continue on with the potential selection
criteria that can prove problematic with multifocal lenses.
- �Tell me about your work or hobbies that involve having good near
vision.
- �Tell me about time spent reading, doing paperwork or on the
computer.�
- �Tell me about your night vision � driving at night.�
Finally, the most important step, and one that is often overlooked, is
the surgeon recommendation.
�I recommend XX. I believe this will best suit your concerns about YY.
Now, what questions can I answer for you?�
At this stage, the surgeon generally transfers the patient to the
scheduler and she sets up the surgery appointments and answers questions
about fees and insurance. We have added a financial disclosure page to
our informed consent so that patients are clear as to what will be
covered by insurance and what they will pay for directly on the day of
surgery.
Delivering Good Outcomes
The final step in ensuring patient satisfaction with upgraded IOLs is to
deliver the outcome they expect. To be certain that your practice is
poised for success, move methodically from the innermost circle of
program buy-in from your staff, outward to communicating with your
existing patients, new patients who come directly to your practice via
advertising, and finally, to referring optometrists and their patients.
Provide staff buy-in by making sure staff members can answer these
questions:
- Why might an upgrade lens be a better choice?
- How do we talk about it?
- What does it cost? Who can have it?
- How will our consult/exam protocol change?
Let patients within your practice know these new lenses are available
through these three key programs:
Send an announcement letter on practice letterhead or a newsletter
with a lens feature story, announcing the availability of full-vision
lenses for those over 50. The call to action is to schedule a
complimentary lens consultation to see if the lens is right for them.
Set an end date (60 days forward of mailing) to guarantee quick
response. Select those patients age 50 or older, by diagnosis if
possible, in your practice database. Expect a 10% to 15% response rate
and tailor your mail drops to ensure your front desk can adequately
handle calls. Better yet, include a back-line phone number that can be
answered by your lens counselor and let her handle all scheduling during
this initial period.
Develop a simple bookmark that you attach to a customized clipboard
handed to each patient when they fill out their intake forms. This 8.5�
x 2� bookmark and informative clipboard encourages the patient to ask
you about lenses today and will stimulate interest for patients and
other family members when they take the bookmark home
Develop a breakfast, lunch or dinner educational seminar. Have a
poster in your office, near the front desk and in your building lobby if
possible, announcing the seminar and offering sign-up at your front
desk. These should be 1 hour, hosted by the counselor with the surgeon
available for questions.
The final step in delivering happy patients with good near and distance
vision is to diligently track your outcomes. Track every patient, every
visit, no exceptions. The difference between �happy� those who need
enhancement is only 0.5 D. Patient expectations with upgraded lenses are
high, similar to the expectations of LASIK patients. Your margin for
error is small because these patients want to minimize any use of
glasses. Make sure your biometry is excellent, your surgeon factor solid
and your surgery skills pristine.
Is it Worth It?
Some surgeons wonder whether the increased counseling and chair time
with potential upgrade patients is worth it. I ask them, �What person
does not want improved vision, with more range of vision, as they age?�
And second, �Why would you not want to provide a lens for every single
person who wants it when your effort can increase surgical revenues in
your practice between 50% and 100%?� (Figure 3.)
Presbyopia-correcting lenses answer both questions. But the revenue is
not free. You can refuse to change your insurance-oriented methods, and
see very few patients choose the upgrade. Or you and your staff can
spend an extra 15 minutes with these patients and garner 50% or higher
extra revenue. The choice seems clear. OM
Kay oulson is founder of Elective
Medical Marketing and Course Director for the Alcon-sponsored
Revolutions in Laser and Lens Surgery Practice Development program. She
can be reached at
kay@electivemed.com
![]({"src":"/media/bv5na5lg/12007.jpg","focalPoint":null,"crops":[{"alias":"thumbnail","width":1110,"height":700,"coordinates":null}]})