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Premium IOLs and the role of your staff
Chapter excerpt: Implanting premium IOLs is a team sport. The surgeon is the captain of the team. On the surgeon’s team are the patient and the surgeon’s staff. On the opposing team are fear and lack of education. The staff is a key element in winning with premium IOLs. Educate and reward your staff in order to succeed with premium IOLs. In return, your staff will educate your patients and promote premium IOLs.
The surgeon sets the tone. The surgeon needs to be confident, well-informed and prepared. The staff needs the same level of confidence and knowledge to educate the patient about the pros and cons of premium IOLs. For example, the staff must consistently achieve accurate biometry. The surgeon uses the biometry data to make an accurate premium IOL selection. The surgeon and the patient depend on the staff and benefit from this team work. A smart surgeon will make every effort to educate his or her staff and support them with the best equipment. This includes investing in staff education at regional and national meetings.
My practice began using multifocal IOLs in 1998. We did not call them premium IOLs, but we treated them like a premium service. We worked hard to achieve optimal outcomes with them. We also learned the importance of educating our staff and involving them in clinical decisions. Imagine the reaction of my staff in 1998 when I told them we were going to remove “clear” lenses and replace them with a multifocal IOL. They were afraid. There was a fear of acting inappropriately and harming the patient. They did not understand my decision. Once my staff understood the decision and they worked with the patients postoperatively, they were excited to be involved with premium IOLs. We also closely tracked our outcomes. I realized very quickly that contact A-scan biometry and manual keratometry were not going to be sufficient to make the most of multifocal IOLs. I discussed the situation with my staff, and I purchased a topographer and an IOLMaster (Carl Zeiss Meditec). We leveraged the investment in premium IOL services to improve the care for all of our cataract patients. I expect the best from my staff, and they deserve the best tools available to achieve my goals.
The staff requires three things from the surgeon to make premium IOLs successful: clinical education, appropriate tools and good outcomes. The surgeon provides the initial clinical education, buys the tools for the staff and creates the surgical outcomes. However, the staff is the key to the surgeon’s success with premium IOLs. In most cataract practices in the United States, the surgeon and the staff benefit from a general level of knowledge of the patients. The patients have multiple friends who have had cataract surgery with a monofocal IOL, and the typical patient knows the routine. It won’t hurt. There won’t be a patch. The patient will need glasses after the surgery. The insurance will cover everything. This is a blessing and a curse. It makes informed consent for cataract surgery with a monofocal IOL very straightforward. It makes educating a patient about the benefits of a premium IOL a deviation from the normal, expected preoperative consultation. The surgeon’s staff is the key to bridging this gap. I have been working with my staff to optimize this process for 10 years. We are good at it, but we still have room for improvement. The surgeon working with premium IOLs should recognize that it is a long journey, and the staff is a traveling companion to be treated with respect, support and education.
The patient needs to be educated about the pros and cons of premium IOLs to make an informed decision. This can be a lengthy, time-consuming process. Your staff makes this process efficient and productive for all concerned. The staff responds to the tone the surgeon sets and then communicates that tone to the patient. The message the practice sends to patients about premium IOLs begins with marketing materials and the initial phone contact. The message never ends. The surgeon should define the message, and the staff should deliver it consistently.
My own staff is very comfortable and confident with premium IOLs, and they know that we have the best interests of the patient in mind at all times. They are encouraged to speak to patients about the benefits and downsides of premium IOLs. We do not overemphasize the upside nor overlook the downside. My staff will look a patient in the eye and tell him or her that halos after premium IOLs are normal and expected. They will do this preoperatively and postoperatively, and they will not apologize for it because they understand that they are normal. Likewise, my staff is comfortable with our pricing for premium IOLs.
My practice does not make pricing decisions in a vacuum. The practice management understands that the added charges for premium IOLs are a significant investment of time and money for the patient, the staff and the surgeon. The staff must believe there to be value in premium IOLs for the patient. The staff works in a medical environment but also lives outside of the practice of medicine. They have to deal personally with theissues of covered and noncovered benefits in their own care and in the care of their loved ones. The staff is the toughest sell the surgeon will have with premium IOLs. Once the surgeon has educated the staff about the value of premium IOLs, the staff will educate the patient.
I strongly favor external professional education for premium IOLs for the surgeon and the staff. Educating the staff about premium IOLs is a challenging process. I have been lecturing on premium IOLs and providing external education to other practices for years. I still find it very helpful to send my own staff to outside educational programs on premium IOLs. It validates what I tell them internally, and they return with new ideas and enthusiasm. There is still a great deal to be learned about premium IOLs. Obtaining outside help and support in staff training is one of the cornerstones of the educational process.
Recognizing the importance of your team
Premier Surgeon recently spoke with Kevin L. Waltz, OD, MD, regarding the important role a practice’s staff plays in a premium IOL patient’s care.
PS: What has changed since writing this chapter regarding the role of a practice’s staff?
Kevin L. Waltz
Dr. Waltz: The No. 1 thing that has changed is the economic pressure that we all experience in our practices. There is a significant cost in taking employees to meetings, and that makes everyone a bit more cautious about doing so.
PS: Have there been any changes in routine for your staff and how they deal with premium patients?
Dr. Waltz: Over time, the staff just continues to get more comfortable with what they are doing. When we first started offering premium IOLs years ago, people were relatively uncomfortable with it because it was something new. But now it is kind of old hat in the office at this point.
One thing I have learned since writing this chapter and now do is that every time I have a very happy patient, I ask the patient to take a few minutes to speak with one of my staff members. I give them a chance to talk in private about how the patient is doing after his or her surgery because the cost of premium IOLs is a high barrier for my staff members to understand, and they need to be convinced as to how happy these patients are.
Quite commonly, the patients are thrilled and enjoy being able to tell the staff members who they originally met how happy they are with the decision and how well they can see. So when the next patient comes along, it just makes the staff member that much more enthusiastic.
PS: In your chapter, you stressed the importance of the staff being consistent in the message sent to patients throughout the entire surgical process. What is the message within your practice?
Dr. Waltz: Our message is one of patient choice. We try to make the patients happy with their choices. We give them choices and support them in those choices.
I do not want to have a practice where the patient feels like they got something less than the best lens when they choose a monofocal lens. A monofocal is a great option that does very well, and we want patients to be happy with that choice. Likewise, if they choose a toric or a presbyopia-correcting lens, we want them to be happy with that choice. So, we are trying to identify what the best choice is for each patient.
PS: Are there any areas in which you and your staff continue to make improvements to better the patient experience?
Dr. Waltz: My staff and I are always trying to get better. This is a two-phase process. It is happiness creation and problem avoidance, and we are always learning how to do that better. Part of that is that there is much more information out in the marketplace, so we have become much more sophisticated in how we look at it.
For instance, about 5 years ago I did a number of mix-and-match IOL implants because I loved the idea that it worked really well. However, what I found was that it took too long to achieve the best results for the patient, and it took too much time, effort and money on my part to make it profitable. I could take any combination of lenses and make someone happy, but it was too complicated for my staff because there were too many possibilities that someone would have when they came back. As a result, I now rarely do mix-and-match. Bilateral Crystalens (Bausch + Lomb) or bilateral Tecnis multifocal (Abbott Medical Optics) lenses are my two primary choices, and I find that this gets a quicker endpoint more consistently than doing mix-and-match.
What I have learned is that patients are perfectly willing to get almost the maximum benefit that they can if they can have it tomorrow. Let’s say the theoretical best possible outcome is 100% and it takes a year to get that. The patient is perfectly happy getting 95% of that tomorrow and just moving on. So that was something I had to learn, and it has made it much easier on my staff because we have only a couple of choices now: Do they get Crystalens, or do they get a Tecnis multifocal? There are two different sets of issues that come up in those patients, and the staff understands those issues and handles them very well.
PS: Do you have any suggestions for practices looking to improve their staff?
Dr. Waltz: I would encourage someone who is interested in getting better to ask another office for help. For example, if a practice was located in Illinois or Ohio, it would not be that hard for the staff to drive to my office for a day. We have done that intermittently over the years, and it is quite powerful. You get a real accurate, intimate look at what it takes to be successful.
What the staff needs is a mentor. There is a certain amount of mentoring that the surgeon can do by setting the standards and the goals, but surgeons think about things very differently than the staff. What would be most helpful would be for the staff of one office to visit staff of another office that is more experienced.
The biggest thing is to remember how important the staff is. As surgeons, we sometimes lose sight of how strong a team you need to do this. The thing I tell my staff is that our drive to make these premium patients better helps all of our patients. We strive to such a level to make them happy that it makes us better in everything.
Kevin L. Waltz, OD, MD, can be reached at Eye Surgeons of Indiana, 8103 Clear Vista Parkway, Indianapolis, IN 46256; 317-845-9488; fax: 317-579-7440; e-mail: klwaltz@aol.com.
Disclosure: Dr. Waltz is a paid consultant to AMO.