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New technologies benefit business, patients
![Y. Ralph Chu, MD [photo]](OSN_M/0610b/chu.jpg "David R. Hardten, MD [photo]") Y. Ralph Chu |
With the recent ruling from the Centers for Medicare and Medicaid Services on presbyopic IOLs, traditional cataract surgeons are challenged to transition to refractive cataract surgery. In turn, traditional refractive surgeons will likely want to incorporate lens-based technology into practice. To develop a strong lens-based refractive business, surgeons must address patient needs.
Patient expectations for almost any type of eye surgery have been shaped by dramatic improvements in outcomes over the past decade. Patients seek improved quality of life, full range of vision and decreased dependence on glasses.
Implications of the aging population
The aging population in the United States will likely give rise to an increased demand for all eye care services. By 2010, cataract surgery procedures may increase by 25%.
During the same time, however, ophthalmology will see increased practice expenses because of inflation, business costs, pay for performance, conversion to electronic medical recordkeeping, and decreased reimbursement for services.
Developing strong clinical and business practices for the increasing demand for eye care services is important and must accommodate aging baby boomers who may have cataracts and want to reduce dependence on glasses.
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Increase revenue
While generating revenue is not the primary focus of an eye care practitioner, surgeons can strengthen their businesses by offering improved or new technologies. Patients with cataracts who elect to have a presbyopic IOL implanted can affect the revenue of a practice. The average cost of the additional testing and procedures necessary to optimize patient outcomes with these IOLs is approximately $1,500 per eye.
If we assume the average surgeon performs approximately 350 cataract procedures per year and that the average surgeon reimbursement between Medicare and private insurance companies is approximately $700 per eye, then the yearly revenue of a practice may increase by $154,000 if only 20% of patients elect to receive a presbyopic IOL such as the ReZoom multifocal IOL (Advanced Medical Optics). If 30% of patients elect to receive a presbyopic IOL, then yearly revenue may increase by $210,000.
Maximize conversion
The most important principle to remember while integrating presbyopic IOLs into a practice is to provide as much education as possible to patients so that they can make their own decisions about whether a presbyopic IOL is right for their lifestyle. Basic education should be presented before a patient sees the surgeon so that the surgeon can focus on the clinical examination. The clinic’s staff is critical in this educational process.
When a patient schedules an appointment for a cataract evaluation, a staff member can inform the patient of the new IOL options available to eliminate or reduce the need for reading glasses. Before the appointment, a staff member can mail the patient a brochure, which should review facts about cataracts and presbyopia, inform patients about available options, and guide patients through new technology IOLs. In addition, a practice Web site may be a useful educational tool for patients.
When the patient arrives for an examination, a technician presents the patient with a lifestyle questionnaire that will provide critical information for beginning the new technology IOL discussion. The technician should then review the lifestyle questionnaire responses and provide a brief introduction to cataract surgery, and presbyopia-correcting and wavefront-designed IOLs.
The surgeon interaction with the patient should be straightforward, focusing on educating the patient further about the advantages and disadvantages of presbyopia-correcting IOLs and how these relate directly to the patient’s specific lifestyle needs.
The surgeon should explain each step of the examination and let the patient know the findings. During the eye examination, the surgeon can continue to discuss the patient’s lifestyle needs, making the experience a dialogue. The surgeon can then make specific recommendations for treatment and ask if the patient is interested in more information.
A patient seeking more information can speak to a counselor who could also show a short video on the recommended IOL, explain expected outcomes including advantages and disadvantages, and answer any further questions for the patient. Thorough education and assistance help facilitate good patient decisions. If the patient would like to undergo the procedure, then Medicare and out-of-pocket expenses should be explained, payment questions answered, and financing options discussed, if needed. All patients should be given ample time to think through all of the information given to them so they feel comfortable with their decision regardless of the type of IOL chosen.
Avoid promoting as premium
As a final note, I recommend that surgeons avoid promoting presbyopic IOLs as the premium IOL. Instead, surgeons should inform patients that many options are available and that the potential benefits of each lens depend on each individual patient’s specific lifestyle needs and demands. Surgeons should educate patients so that the patients are able to choose the best IOL technology for their lifestyle.
Y. Ralph Chu, MD, is adjunct assistant professor of ophthalmology at the University of Minnesota in Minneapolis and founder and medical director of Chu Vision Institute in Edina, Minn.
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