Are You Ready For The Senior Boom?

These patients crave a safe, convenient environment — and some personal attention.

BY MICHAEL W. MALLEY

They're coming… and they're coming in droves. The question is, "Is your practice going to be properly prepared to handle the increased staffing and service demands that will come with the largest surge in cataract and refractive patients in ophthalmic history?"

But how can that be? The national media is telling us we're in the midst of one of the greatest economic downturns in history. Times are tough. As physicians and administrators, shouldn't we be more focused on staff reductions and cost-cutting than planning for the future?

That's probably how Noah felt when he got the memo to start working on the ark: His first thought was most likely "What's the hurry?"

Unlike Noah — whose forecasting measures were simply faith-based — our ophthalmic future is dramatically more predictable. According to the latest census reports, the future for anterior-segment cataract surgeons is lined with potential patients as far as the eye can see — and whose lenses are getting more opaque by the day. Approximately 150 million people in the United States are already experiencing the visually challenging years of age 50 or above. That's the largest single segment of the population, and they control 70% of all the wealth in the United States.

And here's the really good news for all the non-believers still drinking out of the half-empty coffee mugs they used to give away to patients: More than 90% of this aging segment of the U.S. population will visit an ophthalmologist to undergo cataract removal and lens implantation surgery at some point during their lifetime. The vast majority of them will also purchase prescription glasses, reading glasses or bifocals.

Unlike elective medical procedures, this business is coming to a practice near you whether we like it or not. It's recession-proof and that's why there's no time like the present to start preparing your practice for its promising future.

Still unconvinced? Need a little more proof than a biblical analogy and a few numbers from the census bureau? In this article, I will spell out why the senior boom is inevitable and offer some steps your practice can take to be a provider of choice for this huge and onrushing cohort. And by the way, if you think your competitors aren't yet gearing up to cater to seniors, a number of ophthalmology practices have begun to add onsite hearing centers in an effort to provide a complementary service for that same senior demographic that makes up a significant percentage of your practice.

Marking any change in elevation helps prevent falls.

Cataract Surgeries Continue to Increase

According to MarketScope (Jan '09), the cataract industry was virtually unscathed by the global economic downturn in 2008. While refractive procedures like LASIK, and some sectors of the general economy, were down as much as 30% to 40%, IOL surgeries grew at approximately the same rate in 2008 as they did during a very strong 2007. Worldwide IOL revenues grew at an astounding 10% rate in 2008, while laser refractive surgical products declined nearly 3%. Much of the growth experienced worldwide by our industry in 2008 (6.8%) was attributed to increased use of premium IOLs.

Therefore, as you prepare your practice for the next decade and beyond, it's important to understand the medical and physical requirements this patient base will demand. Now is also the time to determine how you will reach out and communicate with this massive sector of our population. Questions you need to consider are: (1) How does your practice communicate with — and cater to — an aging patient population, including their caregivers and decision-makers?, (2) What changes in your physical plant are necessary to ensure optimal safety for seniors?, (3) How do you earn and maintain senior patient loyalty, not only for them but for their friends and family members?, and (4) What additional training or services in medical emergencies will your practice require?

Where to start your preparation for the big boom depends on your practice. For busy anterior-segment cataract surgeons who are already familiar with marketing to Baby Boomers and beyond, your biggest challenge may simply be how to convert more of your current cataract patient population to premium IOLs. For conventional cataract practices — that have traditionally relied on patient and optometric referrals to grow your practice — you may want to engage in both internal and external marketing strategies to help educate potential patients on the benefits of recent advances in cataract surgery.

But regardless of the type of practice you have, be careful of putting the proverbial cataract cart before the horse. An increased number of patients will be undergoing cataract surgery in the next decade whether your practice is prepared or not. Their needs — and demands — are much different than those of a general refractive patient and the better prepared your practice is (before they get here), the more rewards your practice will reap.

Key Priorities: Safety and Convenience

Nothing in your practice should be overlooked. Is your exterior lighting adequate to allow seniors to not only find your practice, but to safely navigate their way in once they arrive? If you're not sure, do a comprehensive walk-through in the early morning and late afternoon hours to determine what areas could benefit from increased lighting.

Do you have elevated steps inside or outside of your practice that are clearly marked to avoid falls? During the winter months, is someone assigned to ensure that your steps and walkways are adequately cleared for easy passage? Simple painting and grip strips can go a long way in maintaining safety and avoiding preventable accidents.

An aging population base also encounters more driving challenges, especially with parking. Is your parking lot designed for easy senior access? Progressive practices are offering complimentary valet parking to not only make it easier for patients to get in and out of your practice, but to also avoid incidents with other cars in the parking lot. Young retirees (paid volunteers) are excellent for this type of work. It's good to check with your insurance provider before allowing employees to drive and park your patients vehicles.

Because cataract patients already have reduced contrast sensitivity and difficulty seeing under low-light conditions, ensure your lanes have ample lighting that can be adjusted for seniors. This is especially true when patients initially walk into the lanes and are exiting after their exam. Variations in lighting conditions will adversely affect their vision for tasks as simple as getting into and out of your lane chairs. Ensure staff is trained to assist them.

Staff should be properly trained in when and how to use wheelchairs.

Your staff should also be trained in emergency procedures such as CPR and physicians should be able to use defibrilators and epinephrine. Assign a member of your team to oversee the emergency procedures within your practice and maintain current training in these and other areas. It is easy to put off this type of training because it is not required on a regular basis. But remind them that it is not "if " this training will be needed, but "when" it will occur.

An area of the practice often overlooked for senior adaptation are the bathrooms. Do you have non-slip mats in your restrooms? Are there special handrails in the appropriate areas? Do you have emergency pull-cords for immediate assistance? Is someone checking the cleanliness and lighting in your restrooms? Seniors have greater rest room needs than younger patients, so your facilities may require staff attention more often than usual.

It's obvious that a greater number of senior patients will require assistance with wheelchairs, walkers and scooters. Ensure that your practice has an adequate number of wheelchairs available when needed. This is true not only for your ASC, but the general practice as well. You will also need to ensure your doorways and lanes have adequate room to allow proper navigation of scooters and wheelchairs. The same is true for walkers. Staff should be trained on properly assisting patients into and out of their wheelchairs, walkers and scooters. In some cases, special lanes should be adapted for those senior patients who cannot easily get out of their wheelchairs and scooters and into your lane chairs.

Something as simple as an adequate number of trash cans — and proper placement of them — should be addressed to avoid excess walking throughout the practice. Seniors generate a higher use of tissues and need an appropriate place to deposit these and other waste products (disposable coffee cups, napkins, etc.).

Staff will also need to be trained to understand not only what prescription (and non-prescription) drugs patients are on, but also ensure the information is properly charted. This often involves careful communication with caregivers and family members. Extended communication can also obviously result in extra time spent during the work-up part of the examination process, which should be addressed in the scheduling process.

Making Time for Patients

Proper cataract scheduling is a huge area of potential conflict for the next generation of cataract patients. Traditionally, cataract patients were often crammed into the morning or afternoon schedule based on traditional cataract reimbursement. That meant that if practices received a 6% cut in reimbursement for cataract patients, surgeons had to find a way to see 6% more patients in the same number of hours to break even. If a practice receiving a 6% cut wanted to actually grow 10%, they had to find a way to see 16% more patients.

This type of scheduling meant some patients received less time with their surgeon and less time with the staff, resulting in a lower quality of overall patient care. Fortunately due to advances in diagnostics and surgical techniques and technology, this did not result in lower surgical outcomes for patients.

Thanks to the approval of the Center for Medicare & Medicaid Services (CMS) ruling on presbyopia-correcting IOLs, physicians and their staff can spend more time seeing patients without sacrificing a loss in patient care or revenue to the practice. With more IOL options available to patients today, more time is required to properly educate and in-service patients on the risks, benefits and potential side effects of the new PC-IOLs. Fortunately, the CMS ruling allows surgeons the surgeons to bill patients for the additional doctor/patient chair time, extra testing, diagnostics and overall patient education required in the process.

Obtaining Premium Conversions

For the first time in ophthalmic history, cataract surgeons can see fewer patients in their daily schedule, spend more time with them and enjoy an increase in overall practice revenue. However, this is only possible if a certain percentage of patients choose to upgrade from a standard monofocal lens to a premium IOL.

This conversion process requires significant increases in staff training, patient scheduling, practice flow and overall patient education. You cannot continue to schedule the same number of cataract evals a day as you did during before the CMS ruling and be able to help patients make a more informed decision about their IOL options. Thousands of interviews with cataract patients confirm that it is still one of the most life-changing events. To force them to make a decision within a few minutes (of a very busy examination process) as the type of vision they would like to enjoy for the rest of the lives is simply unrealistic and unfair to the patient.

When not given the proper time, educational materials and interaction with the surgeon, techs and counselors, patients are forced to make rash decisions. This could lead to unrealistic expectations by the patients, and the inability of the practice to deliver the desired result. It is far better to allow more chair time and more office visits for cataract patients in the future, which will result in reasonable expectations, a full understanding of IOLs options and the risks, benefits and side effects associated with each lens.

Fortunately, ample training materials are available from the various IOL manufacturers, while products such as the IOL Counselor from Patient Education Concepts and detailed animation from EyeMaginations are readily available to assist practices in ensuring patients are properly informed.

The Opportunity is Here

As more than 150 million men and women prepare to face the visual challenges of presbyopia and cataract-related lens changes, we too should prepare our practices inside and out to embrace this growth. This is the largest opportunity your practice will face in the next decade, and even the best practices can do a better job of practice preparation for the future. Just ask the legendary cowboy philosopher Will Rogers, who said, "Even if you're on the right track, you'll get run over if you just sit there!" OM

Michael W. Malley is President and Founder of CRM Group (Centre for Refractive Marketing), an ophthalmic marketing and consulting firm specializing in cataract and refractive growth and development. Mike is a featured lecturer at many of the international ocular symposiums and has authored articles in several of the leading ophthalmic trade journals. He can be reached at: mike@refractivemarketing.com or in Houston, Texas, at 713-839-0202.