Physicians are not trained as salespeople — nor should we be. Our job is to provide patients the best possible medical care based on our knowledge, experience and the tools and technologies available to us. Unfortunately, insurance plans do not always cover the cost of innovative technology, even when the benefits are well established. This means that patients may have to contribute out of pocket to receive the benefits of the technology or service.

Many services not covered by insurance offer advantages that enhance patient care and outcomes. However, some physicians are uncomfortable discussing these options with patients because they feel it requires delivering a “sales pitch” or inducing a potentially uncomfortable conversation.

For the sake of our patients and our practices, we must change this thinking. Talking to patients about self-pay options is not only possible, but it is essential to fulfilling our obligation to provide the best medical care and help patients make informed decisions about their health.

LEAD WITH YOUR RECOMMENDATION, AND FOLLOW WITH AN EXPLANATION

Patients come to us for our expertise as physicians, not as financial advisors. So, when determining your recommendation, think first about what is best for the patient and take the price out of the equation. Make your recommendation based on the patient’s individual needs, medical history and stated desires or complaints. Do not assume an individual will be unwilling or unable to comply with a recommendation that might involve additional investment.

When you make a recommendation, explain why you believe it is the best option for that patient and what you anticipate the outcome will be. For example, if a cataract surgery candidate has expressed a desire to become spectacle independent and your recommendation is a premium IOL, start by explaining that the lens offers the best chance to achieve that goal. Lead with the outcomes, not the out-of-pocket cost.

Another example occurs when recommending a diagnostic test that insurance doesn’t cover. In this scenario, explain how it might help provide more information and to better assess their eye health. In the case of ultra-widefield (UWF) imaging, for instance, explain that a 200-degree view of the retina could potentially capture pathology that might otherwise go undetected. In a recent survey by Dhoot et al, 97% of ophthalmologists who use UWF technology reported that it has identified pathology in patients with no visual complaints; a statistic that patients will likely find compelling. Other benefits include a fast and comfortable exam, as UWF requires only a single capture that takes less than half a second and does not require dilation. It also provides documentation that can help with patient education, tracking disease progression and management over time.

DISCUSS OPTIONS AND BENEFITS

Once you’ve explained your recommendation and a supporting rationale, then you can move on to the cost, with an emphasis on available options for limiting financial burden.

In some cases, such as those involving refractive surgery, premium IOLs or certain ocular surface disease treatments in which the out-of-pocket cost can be significant, make sure patients understand that they don’t have to pay up front. In my practice, we offer interest-free financing options designed specifically for medical expenditures that allow patients to pay in installments over time. Available options include Alphaeon Credit and Care Credit. After the consultation, my administrative staff reviews the details and answers any questions the patients may have about such an arrangement. We often find that patients are familiar with these financing options, as they are common in other areas such as dental care and veterinary services.

While some financing companies charge a small fee charged to the practice for use of the service, we find the benefits to both practice and patient far outweigh this cost, as it helps our patients access the services they need and want and thus helps to ensure the best possible patient outcomes.

In cases where the additional cost is less substantial (less than $250) and therefore not a great option for financing, such as a diagnostic test, the typical model is for the patient to pay the additional cost at that visit. Again, it is helpful to explain the advantages of such testing and how it differs from what insurance covers. For example, electrophysiology testing is a way of objectively assessing optic nerve function that is easy to perform and easy for patients to understand, but it is only covered for glaucoma suspects. When we explain this to patients with mild to moderate glaucoma, many opt to pay the out-of-pocket fee for the test and appreciate how easy it is for them. They also like seeing how well their optic nerve is functioning.

OFFER ALTERNATIVES

If a patient is not comfortable with, or interested in, your initial recommendation based on cost concerns, reassure them that you understand. Suggest other options that will deliver good outcomes, but explain the tradeoffs.

In the case of IOLs, this may mean that a monofocal lens would deliver excellent visual acuity but may require them to continue to need glasses to see clearly at distance, near or both. I also document that the options were discussed and the patient understands and accepts their dependence on glasses for distance and near after surgery.

PROVIDE CONTEXT

Even if a patient is not a good candidate for a particular test, technology or treatment, it may be worth mentioning other available options to help put your recommendations into context. Whether it’s a diagnostic test that helps to educate them and explain the disease (UWF, electrophysiology testing) or a premium IOL, patients will share their outcomes and positive experiences with friends and family. Patients will appreciate your honesty and diligence and likely share their positive experience with others. Conversely, avoiding such conversations can cause some patients to become frustrated when they find out about other options that you did not offer.

GOOD FOR PATIENTS, GOOD FOR PRACTICES

The primary benefits of discussing self-pay options with patients are optimizing patient outcome and experience. However, there are additional advantages to consider. Offering the latest technologies and treatments (as well as options that make paying for them easier) can enhance a practice’s reputation through word of mouth. For example, many times our patients tell us we provided the most thorough eye exam they have ever experienced, often referring to the out-of-pocket advanced technology diagnostic tests that were never offered to them by their previous eye doctors. These patients will share their outcomes and positive experiences with friends and family as well.

CONCLUSION

We always want to gather the information necessary to make the most informed and effective decision, and we want to offer the technologies that provide the best outcomes. Our patients deserve these opportunities. Talking to them about diagnostic or treatment options that offer advantages but might require some investment on their part is both good medicine and good business. Patients deserve to know their options — regardless of cost — and are accustomed to evaluating these options and decide for themselves based on their personal circumstances.

We must not be shy about discussing patient-pay services. We simply need the right approach. OM

Ranjan Malhotra, MD, FACS, is an ophthalmologist at Ophthalmology Associates in St. Louis, Mo.
Disclosures: Dr. Malhotra is a speaker for Abbvie/Allergan, Bausch & Lomb, BioTissue, Glaukos, New World Medical, OSRX, Santen and Sun Pharma.