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How to build a successful premium IOL practice
One practice has a formula for converting patients to premium IOLs — even in tough economic times.
Our practice is not in an affluent area, and 2010 was certainly not a banner year economically, but it was Southern Eye Center’s best year ever for premium IOL implantations. We implanted 915 multifocal, toric, accommodating and new-technology IOLs, with an overall upgrade/premium IOL conversion rate of 34.4% for 2010. That is more than double the national average.
We accomplished that level of conversions primarily through a careful process of patient education that begins with teaching staff how to communicate effectively. Excellent results certainly factor into the equation, too, because they help to drive referrals to our practice.
Ultimately, how you talk to patients about premium IOLs matters a lot more for your conversion rate than trying to guess who wants them or can afford them. When you offer the latest technology to everyone, give them time to make decisions without pressure, and make it easy for them to finance their choice, everybody wins.
Patient education
Our five-step patient education process has been honed during the 6 years since I began offering premium IOLs. It ensures that patients have multiple opportunities to learn about premium IOLs and digest the information before they ever meet with the surgeon.
Step 1. Every patient referred to us for a cataract consult gets an information packet in the mail that includes an IOL “menu.” The menu offers three choices: a standard monofocal lens, likely with the need for bifocal glasses after surgery; an aspheric IOL with limbal relaxing incisions (LRIs), with the goal of achieving excellent uncorrected distance vision so that only reading glasses are needed after surgery; and a premium IOL combined with LRIs and LASIK enhancement if needed, with the refractive goal of uncorrected vision for near and distance. Each option is explained in layman’s terms.
Step 2. When our scheduler calls the patient to set up the surgery appointment, she verifies insurance information and provides the patient with the total out-of-pocket cost for each of the three options.
Step 3. The refractive counselor calls the patient a few days before surgery to remind him of his appointment and ask if he has any questions about the lens options. She goes over pricing again, lets him know about financing options and can get him pre-qualified for CareCredit financing at this time. The majority of our patients choose to finance their premium IOL surgery.
Step 4. During the preoperative workup, the technician talks with the patient again about the options and answers any additional questions.
Step 5. The surgeon evaluates the patient and makes a final recommendation, based on the exam, testing and the patient’s refractive choices. By this stage, most patients have already had their concerns or questions effectively addressed, so the demands on my chair time are limited.
At every step, we strive to educate without overwhelming. Introducing the concept of out-of-pocket payment early and being straightforward about the costs are important. Most cataract patients’ initial response to the cost of premium IOLs is negative. We feel it is important at this point to emphasize that, unlike dentures or hearing aids, this implant will last the rest of their lives. In that light, most patients see the cost as much more reasonable. When they understand the implications of their choices for spectacle dependence, realize that financing is available, and have the time to discuss things with family members without any pressure, many come to view premium IOLs not as a shocking upcharge, but as a once-in-a-lifetime opportunity to correct their vision.
Staff training
The success of the process I have outlined is highly dependent on a well-informed and well-trained staff. I have spent a lot of time running through clinical scenarios with the technicians so that they can anticipate my preferences and counsel patients appropriately. For example, although my lens of choice is the Tecnis multifocal (Abbott Medical Optics), my staff knows that if a patient has severe dry eye or 3 D of cylinder, I might make a different recommendation, so they can start preparing the patient.
Similarly, if they are doing a workup for a 58-year-old at our LASIK center, they are well aware that I will be looking for evidence of cataract and may recommend cataract surgery or clear lens extraction with a multifocal IOL instead of LASIK for that patient. That is an easy conversion because the patient is already interested in spectacle independence and already willing to consider an out-of-pocket procedure.
Some of my happiest patients are those who did not receive the lens or procedure they thought they wanted. The technician may say, “Mrs. Smith, I know you are interested in lens A, but based on [your condition], lens B may actually be the best choice for you. Dr. Nelson will let you know for sure.” It is reassuring when I come in and validate that information. So even if Mrs. Smith is not a good candidate for LASIK or a multifocal IOL, she leaves knowing that we did not just take her money and perform a procedure that was not the best choice for her.
By practicing with my staff how to communicate with patients, they feel empowered in their discussions with patients, and I am confident they are giving accurate and appropriate responses to patient questions. Good staff training helps us work as a team to maintain a smooth flow through the clinic, manage patient expectations and provide the best care.
Technology choices
Over the years, I have implanted several types of multifocal and accommodating IOLs and achieved success with each. But my current lens of choice, the Tecnis multifocal, has made it much easier. Based on our data, the majority of patients who elected to have the Tecnis multifocal lens had improved near and distance vision when compared to those who received the Crystalens HD lens (Bausch + Lomb). The Tecnis multifocal seems to offer patients the crisp distance vision we experienced with the Crystalens, plus the excellent reading ability of the ReSTOR (Alcon), without complaints of poor quality of vision. This combination makes it easier to deliver on the implied promise of our marketing, which is good uncorrected vision at all distances.
When it comes to choosing the right technology, it is also critical to include astigmatic correction and the ability to perform enhancements. The reality is that many patients need LRIs, and a small percentage will need a LASIK enhancement to achieve their best vision. I know one factor in our high conversion rate is that I can look the patient in the eye and tell him I will do everything possible to achieve the refractive result he is paying for, and if that means I have to take that patient over to the LASIK clinic for an enhancement, so be it. Knowing that the cost of a LASIK enhancement is included and that they will not face any additional charges is an important factor in patients’ decision to upgrade to a refractive package.
That attitude and willingness to use all the technology at our disposal pays off in satisfied patients and referral sources. I believe plugging the right technology into a process that emphasizes patient education and communication is the secret to building a strong premium IOL practice in any community.
Kiper C. Nelson, MD, can be reached at Southern Eye Center, 1420 S. 28th Ave., Hattiesburg, MS 39402; 601-705-0078; website: www.southerneyecenter.com.
Disclosure: Dr. Nelson has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.