Fifteen success factors affect premium IOL implant rate

An expert offers pearls to help you launch a premium channel practice or elevate your current premium IOL conversion rate.

This little piggy went to market.

This little piggy stayed home.

This little piggy had roast beef,

This little piggy had none.

And this little piggy went wee wee wee all the way home.

John B. Pinto

In 1962, when he was just 30 years old and a professor of sociology at Ohio State University, Everett Rogers published Diffusion of Innovations. In the book, Rogers synthesized hundreds of prior research studies and created a unified theory for the adoption of innovation, which is now a core principle of marketing.

Each new procedure or technology introduced in ophthalmology follows Rogers’ classic market diffusion pattern, with early adopters, middle majority adopters, laggards and non-adopters. Think LASIK. Phacoemulsification. Electronic health records.

We are seeing this play out today as we slowly enter a mainstreaming phase with accommodating, multifocal and toric IOLs.

Since the first premium IOL was approved by the U.S. Food and Drug Administration just over 8 years ago and the premium channel was opened, market penetration has steadily increased and is in the range of 15% of total case volumes today. At present, a majority of surgeons employ premium IOLs to one degree or another. Some have a 5% premium IOL implant rate and fear they may be too aggressive. Some have a 50% rate and are still pushing hard for upward gains.

If your goal is to launch a premium channel practice or elevate your current premium IOL implant rate, here are 15 success factors.

1. It is important to get formal initial and ongoing training, especially with colleagues you personally respect who are boosters for the technology. Peer-to-peer support provides an inoculation of confidence that is necessary to get you through the first year of doubt and the occasional misadventure.

2. You must have a practice with a sufficient baseline of overall cataract case volumes. In typical settings with an early conversion rate of less than 10%, it is going to be difficult to develop new habits on the clinic floor if you are only performing 10 overall cataract cases per month, which might yield only one premium IOL per month as you get started. There is no magic cutoff number, but developing a robust premium IOL practice is much easier for surgeons who are already transiting 20+ cataract cases per month. And 40+ is better.

3. You must believe in the technology broadly, conceptually, empirically and sincerely — and possess the confidence that you are providing your patients with the best available product option. Don’t try to fake sincerity. Not there yet? Keep up your exposure to advanced lenses through professional meetings and site visits to colleagues you admire until you are confident the technology is ready for prime time in your own hands.

4. Remember that the core “product” of your practice is you, the surgeon. The product your practice sells is not really the lens, any more than it is your office suite or your front desk receptionist. Patients choose a premium lens based largely on their confidence in you and your judgment.

5. Surgeon affect, attitude and communication style are all critical. Your own style ideally lives halfway between two inappropriate extremes: the premium IOL cheerleader, who creates unbalanced, impossibly rosy expectations, and the premium IOL apologist, who barely mentions advanced technology lenses for fear of pushing a patient over the edge to another surgeon’s clinic.

6. To build much above a 10% to 15% premium IOL implant rate, you need to possess an innate surgical assertiveness. Where you stand in this department is highly predictable today by examining your best corrected visual acuity profile, which I have described in prior OSN columns. For example, if you examine the last 50 cataract cases of the typical surgeon today, about half of these cases will present with 20/40 or better preop/pre-Brightness Acuity Test (BAT) BCVA. Surgeons who only have about one-third or fewer of their patients in this lower range (ie, who are more conservative in their case selection criteria) typically have very low premium IOL implant rates — and vice versa. More assertive surgeons, in whose hands more than 60% of patients have preop/pre-BAT BCVA of 20/40 or better, have a much higher premium IOL rate.

7. There is no other way to say it. With apologies for being crass, “What you say is what you sell.” Small nuances can make a large difference. “We can offer you the standard lens or the more costly premium lens” does not work as well as “We can offer you the basic lens or our preferred high-definition lens.”

8. A surgeon’s personal career history is highly predictive of advanced technology success. A history of having performed 200+ cases in residency training and early adoption since then in all practice technology segments is seen in surgeons with faster, deeper adoption of premium IOLs. You probably already know if you are an innately hard-charging individual. If you are not sure, then you are not. You may have to live with more modest premium IOL rates.

9. You ideally possess a passion to deliver superior, contemporary surgical care combined closely with a high-quality patient experience. Both sides count. “Quality” in the premium space obliges especially exacting objective standards along with doing all you can to boost the patient’s subjective impressions. Few patients are in a position to judge your training or how perfectly you have nailed their postoperative result. But every patient is a perfect judge of your office staff efficiency, your friendliness and the cleanliness of your facilities.

10. As all premium surgeons and staff are aware, the early postoperative course with some premium IOLs can be frustrating for patients and providers alike. A critical success factor is your ability to pre-empt, through the management of expectations, and when necessary shake off, the criticism of unreasonably picky patients. Fluent service recovery with unhappy patients includes listening to and agreeing with their concerns, apologizing for any undue worries, assuring them when their anxieties are very real but probably unwarranted, promising to continue to attend to their needs as the postoperative period unfolds and following up promptly all along the way to exceed even their unreasonably elevated expectations.

11. Educated, well-supervised, motivated support staff are important, but this trails well behind all elements that are provider-mediated. Not delegating the premium IOL conversion process to support staff is actually a prominent success factor in practices with higher implant rates. In almost all cases, the patient and surgeon should have agreed on lens choice before the patient sits down with a lay counselor/scheduler.

12. There should be no financial pre-screening or presumptions. The patient who presents in a manner of dress or level of education suggesting their inability to afford a lens upgrade may be frugal in their attire but lavish in their medical outlays. Engage with each patient as though they have the means to readily afford this technology.

13. You need to have at your command practiced, effective answers for the most common points of patient resistance:

• Cost, affordability, value
• Results (“Yes, but will this work for me, doctor?”)
• The hazard of being subjected to “unproven” new technology

14. Try your best to not interweave the “motivational” stage of patient education with the “informed consent” stage. You should first advocate for a premium IOL when clinically appropriate, and only then provide a thorough informed consent.

15. Finally, present each patient with an overall service and value proposition from your practice that exceeds expectations. Work with an administrator who is a real pro. Hire friendly, well-groomed, polished staff. Make sure that everyone is presenting the same message to each patient. Be timely. Maintain clean office facilities, ideally embedded within an A-class building. Take extra steps to give more than expected: premium refreshments, coffee table books instead of year-old magazines and your personal cell phone number for after-hours questions.

• John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management con-sulting firm established in 1979. He is the author of John Pinto’s Little Green Book of Ophthalmology; Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement; Cash Flow: The Practical Art of Earning More From Your Ophthalmology Practice; The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees; The Women of Ophthalmology; Legal Issues in Ophthalmology: A Review for Surgeons and Administrators; and his new book, Leadership: A Practical Guide for Physicians, Administrators and Teams. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.