When I first moved to Waco, Texas, I joined my father’s ophthalmology practice. Like many smaller cities, Waco lacked premium ophthalmology services such as femtosecond laser-assisted cataract surgery, intraoperative aberrometry guidance, next-generation topography/tomography and premium IOLs. The market potential was there, but no one was tapping into it — patients traveled to Dallas or Austin for premium care. Most local ophthalmologists weren’t even using basic premium technologies, such as toric and multifocal IOLs and excimer laser touch-ups.
Fresh from my fellowship in refractive cataract surgery and cornea at one of the most innovative practices in the United States, I was determined to change that. I insisted that Brazos Eye Surgery of Texas make the shift to a premium practice.
This proposal was met with considerable trepidation. Could Waco afford it? Could the practice afford it? Would it be successful? The answers came with the introduction of advanced technology, expertise, a willing ASC, a healthy practice culture and sheer determination.
Ultimately, what drives a premium practice is happy patients. The more people that leave your practice feeling cared for, the more they will sing your praises within the community. Here is how I introduced those ingredients to Brazos Eye Surgery of Texas to create those happy patients.
UNDERSTANDING WHAT IT TAKES
The biggest driving force behind a premium practice is the surgeon’s ability to deliver a premium product. A premium practice makes considerably more money than a general one —
but financial gain should not overshadow the ability to deliver high-quality results.
Advanced IOL technology, biometers and IOL formulas have made it possible for residency-trained general ophthalmologists to achieve excellent outcomes in most cases. But what about the misses? Patients paying thousands of dollars out-of-pocket expect top-notch results. So, if you want to have a premium practice, ask yourself: Do I have the surgical ability? Can I counsel patients appropriately on lifestyle choices and IOL selection?
Know that building a premium practice comes with a significant price tag. It’s challenging to deliver premium results with only basic technologies. At my practice, we have three topographers/ tomographers, two biometers, an excimer laser, two femtosecond lasers and a full array of dry eye treatment options. These include but are not limited to: intense pulsed light therapy, meibomian gland expression devices, osmolarity and serum tears. The cost adds up quickly, but commitment to your staff, product, patient experience and understanding of these powerful technologies is essential for success.
A basic practice can remove a cataract, implant an IOL, prescribe eyeglasses a month later and never see the patient again. A premium practice, however, must hold itself to a higher standard and provide superior customer service. We promise our patients that they will be happy with their visual and lifestyle outcomes. This requires the ability, expertise and know-how to deliver on that promise. It includes selecting the correct IOL for each patient, correcting refractive errors, being able to exchange IOLs for unsatisfied patients and holding their hand throughout the process.
INVESTING IN TECHNOLOGY
The first step to increasing your premium upgrades is to invest in technology.
In my case, adding a femtosecond laser package was crucial. This investment boosts your practice for three important reasons. First, the word “laser” sells itself. We are conditioned to believe that lasers are more precise, accurate and simply better. Second, the actual precision and accuracy of a laser leads to better outcomes with less patient discomfort and quicker visual recovery.1 Finally, adding a la carte laser to cataract surgery is an affordable option for many patients.
Femtosecond laser-assisted cataract surgery allows surgeons to correct up to 1.25 D of astigmatism,2 thereby increasing the number of happy patients. But that’s not the only technology critical to increasing your premium upgrades. Understanding the cornea’s condition is crucial for decision-making — and highly dependent on technology such as topography and tomography. Intraoperative aberrometry, although expensive, helps achieve precise outcomes, especially for toric alignment and post-refractive eyes.
NAVIGATING FINANCIAL REALITIES
Let’s talk about money. After all, the goal of a premium practice is to increase revenue while providing superior outcomes. However, as the late great Biggie Smalls said, “Mo’ money, mo’ problems.” With continuous cuts in reimbursement, there is a push towards the premium practice model. Imagine a typical premium patient willing to spend $2,000 to $15,000 out-of-pocket for a premium result. That patient is going to have high expectations — and meeting those expectations requires setting and delivering on them accurately.
Disappointment is where expectation and reality differ. What happens when, despite your best efforts at education, a patient is disappointed? Are you able to correct a missed refractive target, treat their dry eye appropriately, diagnose why they’re unhappy or know when you’re in over your head? Handling disappointed patients involves having the skills to address surgical issues or referring those patients to colleagues, which can come at a cost.
When sending a patient to another physician, you must be prepared to cover travel, exam and potential surgical costs. In some cases, this may result in a net loss. The crux of the matter is whether you are net-positive or net-negative based on your ability to provide premium services.
Success in a premium practice hinges on proficiency with advanced technologies and a willingness to support and educate patients. Ophthalmology is experiencing rapid technological advances, offering providers unprecedented capabilities. These technologies help offset declining reimbursement rates.
As Uncle Ben said in Spider-Man, “With great power comes great responsibility.” The learning curve for creating and managing a premium practice is steep. If you’re up to the challenge, invest in technology and learn how to use it. This can be achieved by doing a refractive fellowship or at minimum visiting a premium practice. Seek mentors, drop your ego and prioritize knowledge over financial gain. You may lose in the beginning, but that’s the price of getting over the learning hump to achieve the premium practice you desire.
LEARNING THE ART OF MANAGING PATIENT EXPECTATIONS
One of the biggest challenges in a premium ophthalmology practice is managing patient expectations. Premium patients are often willing to pay a significant amount for the best possible outcomes, and they expect results that match their investment. This makes it essential to set realistic expectations from the outset.
Clear communication is key. Make sure patients understand what the procedure involves, its potential risks and benefits, and what results they can realistically expect. Being upfront about these aspects can help prevent disappointment and build trust. Did you consider whether the patient is a truck driver, a professor or an engineer? These professions will come with very different lifestyle desires and expectations. Additionally, providing detailed pre- and post-operative care instructions can help patients feel more informed and involved in their care.
PROVIDING EXPERT, PERSONALIZED CARE
Related to patient expectations, another key aspect of running a successful premium ophthalmology practice is the ability to provide expert care and personalized patient experiences. Patients opting for premium services expect not just advanced technology but also a high level of expertise and attention. This means being able to counsel patients on the best choices for their lifestyle and vision needs, managing their expectations and providing comprehensive follow-up care. This requires ongoing education and training. Staying current with the latest advancements in ophthalmology ensures that you can offer the best possible care. This requires nothing less than constant reading, wet lab training at trade meetings and restraint. Whether it’s understanding the nuances of new IOL technologies or mastering the latest surgical techniques, continuous learning is essential. Additionally, seeking mentorship from experienced colleagues can provide invaluable insights and guidance.
BUILDING A STRONG PRACTICE CULTURE
A healthy and happy practice culture is another crucial factor for the success of a premium practice. This involves fostering a positive work environment where staff feel valued and motivated. When your team is engaged and committed, they are more likely to provide excellent patient care and contribute to the overall success of the practice.
Investing in your staff’s training and development is also important. By equipping them with the skills and knowledge to support advanced procedures and technologies, you can ensure that your practice runs smoothly and efficiently. Moreover, a well-trained team can help enhance the patient experience, making them feel more comfortable and confident in the care they receive.
ADDRESSING COMPLICATIONS AND ENSURING QUALITY OUTCOMES
Even with the best technology and expertise, complications can occur. How you handle these situations can significantly impact your practice’s reputation and success. It’s important to have protocols in place for managing complications and ensuring that patients receive the necessary care and support. Making sure that the patient knows you are on their team is vital. The default position is to be defensive of our skills and planning when instead we should recognize that the patient’s expectations were not met for whatever reason and do our utmost to achieve them.
Being able to correct refractive errors, manage dry eye symptoms and address other issues that may arise is crucial. In some cases, this may involve referring patients to specialists or colleagues with specific expertise. Having a network of trusted professionals to rely on can help you ensure that your patients receive the best possible care, even if it means your practice incurs additional costs.
COMMITTING TO CONTINUOUS IMPROVEMENT
Running a premium ophthalmology practice requires a commitment to continuous improvement. This means regularly evaluating your processes, technologies and patient outcomes to identify areas for enhancement. For instance, we run yearly reports on patient outcomes with the various IOLs that we use and constantly hone our A-constants, formulas and refractive targets. Staying proactive in adopting new technologies and techniques can help keep your practice at the forefront of the field.
Additionally, seeking feedback from patients and staff can provide valuable insights into areas that may need attention. Implementing changes based on this feedback can help improve the overall patient experience and outcomes.
EMBRACING THE CHALLENGE OF A PREMIUM PRACTICE
While transitioning to a premium ophthalmology practice is a rewarding endeavor, it is undeniably challenging as well. It requires significant investment in technology, continuous education and a commitment to providing the highest level of patient care. So if you’re up for the challenge, invest in technology and learn how to use it. Seek mentors, drop your ego and prioritize knowledge over financial gain. You may lose in the beginning, but that’s the price of getting over the learning hump to achieve the premium practice you desire. With dedication and the right approach, you can elevate your practice to new heights and provide exceptional care to your patients. OM
References
1. Roberts TV, Lawless M, Bali SJ, et al. Surgical outcomes and safety of femtosecond laser cataract surgery: A prospective study of 1500 consecutive cases. Ophthalmology. 2013. 120:227-233.
2. Salgado R, Torres P, Marinho A. Update on femtosecond laser-assisted cataract surgery: A review. Clinical Ophthalmol. 2024;18:459;472.
