ASK THE CAREER COACH

Paving Your Way to Premium IOLs

Part 1: Start by honing your clinical and communication skills.

By William B. Rabourn Jr.

Q: If I want to start offering premium IOLs as part of my cataract surgery practice, how would the business model have to change?

A: As a cataract surgeon in training or relatively new to practice, you're working at a time when anterior segment ophthalmology is experiencing what I call a "game-changing" advance. Premium IOLs, in particular those indicated for the correction of presbyopia, are the latest in a series of game-changing technologies and techniques that include IOLs in general, RK, PRK and LASIK. Your question is right on the mark because whenever such an advance occurs, change is always necessary.

To integrate premium IOLs successfully — in other words, to ensure that they're a winning proposition for you, the practice and your patients — you must adapt in four key ways:

1. Clinically, you have to become proficient with the lenses. This includes gaining a solid understanding of how they work, their benefits and limitations.
2. You must be able to educate your patients so their experiences and visual outcomes meet their expectations, and you must be able to discuss the cost of premium IOLs. It's also crucial that you're able to identify appropriate candidates.
3. You must ensure that the practice's day-to-day operations are properly organized.
4. You must ensure that all staff members are equipped to foster success with premium IOLs.

Taken together, these areas require a significant amount of work and change.

Start Off on the Right Foot

Your first step is to become clinically proficient using the lenses. Once you're in practice, you should take advantage of the clinical programs offered by IOL manufacturers. The programs are designed to help you understand how each lens works, how to calculate for the best visual outcomes and how to identify which patients make good candidates. IOL manufacturers can provide you with a medical monitor, who oversees a set of surgery cases to ensure that the surgeon is using the IOL correctly. Manufacturers also may provide in-depth outcomes analyses for your first cases.

At this stage, it's very important to take your time. Consider the adoption of premium IOLs as a marathon, not a sprint. In the clinical learning process, focus on determining how to select your first patients wisely. The best patients are those well within the manufacturers' parameters for lens performance and who have appropriate expectations. (More on expectations in the next article in this series.) Analyze your results meticulously to see what you did well and where you could improve. Make the necessary adjustments before implanting your next set of lenses.

Like anything in life, going too fast at this stage of the game can lead to mistakes. Even if you don't make a mistake, a 20/20 result and a 20/30 result can be the difference between a happy patient and a very disappointed one when you're talking about premium IOLs. As you become more and more comfortable, you can begin implanting premium IOLs in more of your patients. Taking your time to reach that point is ultimately what's best for you, your patients and the practice.

You must be able to educate your patients so their experiences and visual outcomes meet their expectations.

Communicate with Confidence

If you've carefully educated yourself on the clinical aspects of premium IOLs, you'll be confident in your skills and the outcomes you're able to produce. This puts you in the best position to communicate with your patients about the lenses, the second item on our list of key areas.

Patient education and communication surrounding premium IOLs are major reasons they represent such a shift from how most practices are accustomed to providing cataract surgery. If you want to be a successful player in the premium IOL business, you must, in effect, enter the free market.

You'll be asking patients to pay out-of-pocket for the portion of the procedure that Medicare or other insurances don't cover. You'll have to explain why patients must pay for you to perform a premium IOL procedure. This process is more like sales or marketing and unlike anything you learned in school. Initially, you may be uncomfortable in this new marketing role.

Furthermore, when people pay for something themselves, they have much higher expectations. It's up to you to set realistic expectations and determine which patients "get it." Patients who expect too much are poor candidates for a premium IOL procedure. You shouldn't recommend a premium IOL for patients who don't understand why you can't guarantee total spectacle independence. While many patients achieve that result, others still need eyeglasses for some tasks and may not achieve youthful vision at every distance. In other words, some visual trade-offs are involved, and every patient must understand this up front.

The IOL manufacturers, as part of their education programs, can help with patient communication and selection. You also can consult with a more senior physician in your group or a trusted colleague or mentor. They may be able to share their strategies for handling these crucial components of the premium IOL patient communication process.

Some practitioners have developed detailed questionnaires for screening patients based on their expectations. Professional ophthalmic trade publications and Internet education sources also address this topic regularly.

Armed with clinical proficiency and a patient communication strategy, you'll be able to initiate change in the other key areas: day-to-day practice operations and staff-related issues. In the next issue of New Ophthalmologist, I'll provide advice for facilitating those changes. nMD