Increasing Conversions to Premium IOLs

A software program can help patients make informed decisions about premium IOLS.

BY LESLIE GOLDBERG, ASSOCIATE EDITOR

Surgeons and surgical counselors now have access to a valuable tool that educates and clarifies refractive IOL choices for their patients who are undergoing cataract surgery. The IOL Counselor (Patient Education Concepts Inc., Houston, Texas and Eyeland Design Network, Vreden, Germany) is a patient education software program that enhances the counseling skills of surgeons and counselors. It has been proved to increase the number of patients converting from monofocal IOLs to premium IOLs, according to Bob Watson, founder and president of Patient Education Concepts, Inc.

"Practices have had poor conversion rates prior to adopting the IOL Counselor software because most surgeons were quickly delegating the task to their surgical scheduler," says Watson. "The scheduler's job routinely is to take down information and explain costs and preoperative instructions. We found that few 'cataract' surgical counselors have sales and closing skills similar to 'refractive' surgical counselors. The IOL Counselor provides the tools that teach these skills."

A Tour of the IOL Counselor

The IOL Counselor is a computer-based program that includes a vision assessment questionnaire created by Steven Dell, M.D. The IOL Counselor software includes a patient video and simulator, an IOL acceptance form and a "How to Use the IOL Counselor" tutorial video and printable training manual.

The vision assessment questionnaire helps quantify a patient's lifestyle and personality. When coupled with the patient's visual acuity (VA) and candidacy for an upgrade to a premium IOL, the vision assessment questionnaire assists doctors in recommending a particular IOL to best meet the visual needs of the patient. The IOL selection is then marked at the bottom of the questionnaire. Surgical counselors use this information to tailor their discussions about the IOL recommendation with the patient.

Patients are then able to see how a monofocal IOL compares to a presbyopia-correcting IOL by viewing simulator pages featuring scenarios at a supermarket, at a baseball field and on a city street (Figure 1). The surgical counselor has the ability to maneuver the scenes through normal, presbyopic and cataract simulations, showing the patient how a presbyopia-correcting IOL can provide the full range of vision vs. a single point of focus provided by standard IOLs.

Figure 1. A simulation of what a patient can expect to see with a monofocal lens.

Before viewing the various IOL simulations, a disclaimer page appears on the screen that informs patients that it is impossible to simulate exactly how anyone will see postoperatively. After the counseling session, patients are asked to sign an IOL acceptance form documenting that they understand that the simulations they were shown were not presented as a guarantee. The form also documents that the patient was given premium IOL options.

If a patient needs to finance his or her premium IOL, the counselor can immediately pull up the financing portion of the IOL Counselor, sponsored by CareCredit (Orlando, Fla.). Practices set up their fees on the frontend of the software, so that when the counselor pulls up the financing options page for the patient, fees are broken down according to that practice's specific charges.

"The ability to see the fee broken down into affordable monthly payments makes the personal expense more palatable to the patient," says Watson.

A Jump in Conversions for a Practice

Dawn L. Cavanaugh, chief operations officer at the Pepose Vision Institute in St. Louis, started using the IOL Counselor in October.

"Prior to utilizing the IOL Counselor, our clinic conversion rate averaged between 30% and 40%," says Cavanaugh. "Now that we present the IOL Counselor program after the patient has met with the surgeon, we are averaging a year-to-date conversion of 70%."

Cavanaugh says that her practice has committed fully to developing a cataract division. They started by training some of their refractive technicians to be cataract technicians. "Initially, our technicians didn't like the demographics — they liked working with the younger, hipper LASIK crowd. But the reality is that we are seeing cataract patients at a much younger age — more patients in their 40s, 50s and early 60s.

"We are investing significant resources and energy to ensure that our patients understand all surgical options and that our team caters to this patient base," says Cavanaugh. "All staff members can comfortably discuss presbyopic IOL features and financing. They educate patients on current surgical treatments and next generation technology that is being investigated by our foundation."

Technicians spend approximately 1.5 to 2 hours with each patient and then the patient meets with a cornea surgeon. "While we feel that the visual presentation of the IOL Counselor is very beneficial," says Cavanaugh, "the simulator is only a simulator. Our goal in implementing the IOL Counselor is to follow the guidelines of an effective educational tool for both patient and family members."

The surgeon will spend as much time as is necessary with each patient, averaging between 5 and 10 minutes, Cavanaugh continues. The surgeon determines whether the patient is a candidate for surgery and then recommends the best lens for the patient. After the patient has met with the surgeon, he or she is taken to a surgery-scheduling department. "In our clinic, technicians and surgery schedulers are trained to address billing questions and price. Surgeons do not discuss price," she says.

Pepose Vision uses the financing arm of the IOL Counselor. "Our patients find it easy to finance with CareCredit," says Cavanaugh. "We are finding that a lot of the baby boomers want to pay cash. We currently finance less than 5% of this patient population."

Cavanaugh says practices should focus on not letting patients be intimidated by price. "Cataract surgery is becoming the new refractive surgery," she says. "Our cataract program has increased over 200%. When we first started to focus on this program, we had a few goals in mind. We invested the time and energy to train our staff, we educated our patients with the IOL Counselor and our surgeons have taken time with each and every patient to deliver the type of surgical outcomes that quickly build a practice."

Cavanaugh says that clinics should have a plan to increase their cataract business. "The IOL Counselor has allowed our clinic to turn silver into gold. Clinics need to make the time to incorporate this tool into strategic management sessions," she says. "You need a management team that understands the plan and how to execute it."

Helping Practices to Work Smarter

Phil Jackson, director of refractive services at Associated Eye Care, Stillwater, Minn., has been using the IOL Counselor software since its official launch. Jackson says that there are several features he finds helpful in his position as director.

"The interactive bar at the bottom of the screen allows me and my patient counselors the ability to give a truly individual presentation to the patient," says Jackson. "Patients respond well to the visual representation." He says that the night-driving scene helps set realistic expectations with patients. "Even though the physicians cover these points during consultation, the IOL Counselor visual helps reinforce patient expectations and, in turn, helps eliminate postoperative issues" (Figure 2).

Figure 2. A simulation of what a patient might see at night immediately after receiving a multifocal lens.

Additionally, he can easily explain key segments of the surgery, such as limbal relaxing incisions (LRIs), if a patient wishes to understand more. "Although it is not common for a patient to ask about LRIs, I am not left looking for answers to his or her questions. The IOL Counselor gives me the ability to explain confidently what we will do to correct the refractive error," explains Jackson.

He says that the feature patients find most helpful is the visual representation of correction. "This is made even more powerful if family members are invited in on the consultation. Patients and their families can see the benefits of a premium IOL, and more often than not, it's the patient's family who helps in the decision-making process," Jackson says.

"The patient video on the IOL Counselor has become a critical part of our IOL program. Patients appreciate knowing their options. Since the patient video is played in the physician lanes for every patient prior to their cataract evaluation, we create an open mind to advanced IOL options," says Jackson.

Jackson reports that patients who are on a fixed budget jump at the financing option. He says it is the primary reason why many patients agree to the procedure. "Financing helps to overcome the financial shock by breaking down the cost into monthly payments," he says. Jackson has seen an increase in conversion of 17% to 20% with the program in place. He says that it is hard to verify how many converted because of the software alone, but that the IOL Counselor has certainly helped grow the practice volume.

Minimizing Chair Time With Doctors

Vicki Cureton, a counselor at SouthEast Eye Specialists, in Chattanooga, Tenn., has been using the IOL Counselor for the past 4 months. She says that the IOL Counselor helps to control chair time and has doubled her conversions in 6 weeks.

The practice performs more than 350 cataract surgeries a month. Cureton says that in 2005, the practice converted a total of 12 patients to multifocal IOLs. In 2006, with only a doctor and no counselor, the practice had an average of 6 multifocal IOL implantations a month. From August 2006 to April 2007, with a counselor added, the practice had an average of 12 to 15 conversions per month.

Prior to using the IOL Counselor simulations, Cureton, who has no sales training, found it difficult to explain the visual differences between standard and premium IOLs to patients. The IOL Counselor has made her much more comfortable with IOLs and has helped her to better understand what the patient is seeing preoperatively.

SouthEast Eye Specialists uses a lifestyle questionnaire produced by Advanced Medical Optics (AMO, Santa Ana, Calif.) and edited to reflect the practice's needs. The answers provide an idea of a patient's lifestyle, interests and career.

"The most important decision with any type of specialty lens is to make sure that the right type of lens is selected for the patient," says Cureton. The lens selection is made by the doctor explains Cureton, but she and the technicians counsel the patient on the premium IOLs. "Every tech in the department is trained on the IOL Counselor, so that everyone is on the same page," she says. "The IOL Counselor simulates the patient's options and the strengths and limitations of the lenses. The ability to show compromised vision right after surgery helps manage patient expectations in the early postoperative period." SouthEast Eye Specialists is committed to telling every cataract patient about his or her choices. "We are now doing 30 mulitfocal procedures a month," reports Cureton.

The practice also uses the CareCredit financing option and has not had a single candidate refuse to upgrade due to financing issues. "The IOL Counselor is a good way to use technology to make a positive change in someone's life," Cureton concludes.

Proper Training on the IOL Counselor

"It is imperative that practice administrators and surgical counselors spend time with their doctors and other staff members agreeing on exactly how the IOL Counselor should be implemented into the practice and presented to patients," says Watson of Patient Education Concepts, Inc. "While the LASIK market is flattening out, aging baby boomers are causing a surge in demand for refractive IOLs. Many of them want their vision corrected now with a refractive lens exchange to improve their lifestyles rather than waiting for cataracts." With the help of the IOL Counselor, the number patients choosing the IOL refractive option is sure to grow. OM

For more information on the IOL Counselor, contact Patient Education Concepts, Inc. at (800) 436-9126 or visit the IOL Counselor Web site at www.iolcounselor.com.