THE ENLIGHTENED OFFICE

Premium IOLs and ophthalmic kismet

By better integrating these lenses into your practice, you will increase your self-pay revenue.

By Cynthia Matossian, MD, FACS

Toric and multifocal intraocular lenses (IOLs) reached the ophthalmic marketplace about 15 years ago, and their limitations, compared to today’s models, were striking.

For most patients, the drawbacks outweighed their benefits. The issues included limited cylinder power for the toric IOLs, and patients complained of glare and halos with multifocal models. Even though these IOLs corrected astigmatism and presbyopia, the Centers for Medicare and Medicaid Services considered these implants ineligible for reimbursement; monofocal implants and spectacles work just fine, CMS said.

A casual observer of this industry would think that with these facts, the advanced technology IOLs had no future. But no: Two things happened that started our practice on its successful road to partial self-pay.

BOOMERS AND TECHNOLOGY

It would be excellent dinner party fodder — would these IOLs have survived had they been introduced to another generation? Again, the first toric lenses had few power options from which to choose. As for multifocal IOLs, people needed to hold reading materials literally too close for comfort.

But these premium IOLs were arriving during the just-graying, mortality-awareness years of the baby boomers. Often financially comfortable, technologically astute and many holding the position of caregivers, some of my patients started to opt for premium IOLs.

I thought toric IOLs were very helpful for my patients. Yes, even though these implants required more surgical expertise with greater chair time, all of a sudden we were getting paid for performing cataract surgery and for advanced technology implants.

OPHTHALMIC KISMET

Another reason existed that kept the integration of premium IOLs low: there were few good diagnostic tools to identify appropriate candidates for the procedures. Because of this, unhappy multifocal IOL patients were fairly common.

But then diagnostic tools like corneal topography, axial alignment systems and OCT to detect subtle macular pathology became better — whether the timing was coincidental is fodder for another dinner party conversation — and these tools helped drive the success rate for the advanced technology implants. We could vet those with ocular surface disease, macular pathology, irregular astigmatism and more.

The better we could select, the greater our success with premium IOLs and the happier our patients. And it became clear that patients would pay out of pocket for services they want. We began adding more self-pay services, like oculoplastics.

BUSINESS PLANNING

Every year, the percentage of revenue generated by self-pay increases in our practice. In light of decreasing insurance reimbursements, my goal is to grow the self-pay segment of the business by continuing to increase the percentage of revenue it represents each year.

I never foresee a time when our practice will not accept insurance, as our practice is too large, but knowing we could grow self-pay is a tremendous feeling. OM

Cynthia Matossian, MD, FACS, is the founder of Matossian Eye Associates. Her email is cmatossian@matossianeye.com.