PS250 Survey

Issue: July/August 2011

Which type of IOL do you prefer to implant after LASIK or PRK?

Perspective

I tend to choose a monofocal or accommodating implant in patients who have had LASIK or PRK. I find that the changes to the cornea induced by the excimer treatment render the optical system differently than that of the virgin eye. There can be excessive spherical aberration, irregular astigmatism, other higher-order aberrations and multifocal properties depending on pupil size and the treatment done. Implants with aspheric optics and a single refractive power seem to provide a more stable and higher quality of vision in my experience. Other LASIK-induced changes to the cornea such as dry eye syndrome also can impact vision and further necessitate careful IOL selection. Fortunately, we have several choices of optical properties in our current arsenal of implants, and the ability to preoperatively perform wavefront imaging and corneal mapping to match the corneal spherical aberration with that of the aspheric implant is helpful in achieving high-quality vision. — Robert J. Weinstock, MD

Would you ever consider giving patients the option to pay a premium to avoid having to wait in the waiting room before their appointment?

Perspective

In today’s climate of falling reimbursements, the most logical approach to maintaining a lucrative practice is to increase patient volume. As patient volume increases, there is a need for more staff to help with patient flow, which further increases overhead. There is also a decrease in the amount of time that can be spent with each patient. There’s nothing worse than waiting an hour or more for your doctor only to feel like you’ve been rushed through the exam like nothing more than “a number.”

Charging a premium to be seen immediately is a good solution for both physician and patient. Patients will spend less time in the waiting room and more time in front of the physician. They will actually feel as important as they truly are. The physician will be able to offset the loss of volume from the premium service payment, which will allow longer visits with potentially more lucrative patients. In my experience, when I’m able to sit with a patient and carefully explain the risks and benefits of premium IOLs, my conversion rate is much higher and the outcomes, both true and perceived, are much better.

Patients will pay for an extraordinary experience. The difference between a cheap hotel and an expensive one is not just the price but the service, and it’s worth every penny. — Christopher L. Shelby, MD

Perspective

It’s one thing to charge people extra for something different, like a premium lens; it costs us more. But to me, it seems like [charging patients a fee to not wait] could be a public relations nightmare. It’s almost like the grief the airlines have gotten over charging for bags and nickel-and-diming people. A fellow doctor once said to me, “People don’t appreciate a wallet-ectomy.” Charging patients because your schedule is poorly planned and you are so far behind that people are willing to pay extra so they don’t have to wait is a very poor reflection of your practice. Either you are taking on too many patients, which means you need to cut back or hire another doctor, or you just aren’t running a very efficient and professional practice.

In my practice, ideally patients are called back within 5 to 10 minutes of their appointment time, and our cutoff is 20 minutes. If a patient ever has to wait longer than 20 minutes, the visit is provided at no charge, or if the patient’s insurance was going to cover the exam anyway but not their refraction, we will give them their refraction for free. It’s something to say, “We’re sorry. Your time is just as valuable as ours.” Of course, the doctor may sometimes get behind, but at the very least, the technician can get patients back and start working on them so they don’t feel they’re neglected. — Larry E. Patterson, MD