Work smarter, not harder, when bringing presbyopic IOLs into practice

This report from the OSN New York Symposium presents various perspectives on how surgeons can get in on the presbyopic lens market.

NEW YORK — Surgeons should take a business-minded approach when they begin to incorporate presbyopic IOLs into their practice, according to surgeons and others who spoke here during the OSN New York Symposium.

“If we are going to commit to having presbyopic IOLs as part of our practice, we have to look not only on the clinical side, but perhaps consider re-evaluating the way we see things from a business standpoint,” Kerry D. Solomon, MD, said in a presentation.

Dr. Solomon’s was among a variety of clinical, marketing, legal and administrative perspectives offered during a session titled “Incorporating Presbyopia IOLs into Your Practice”.

According to Dr. Solomon, the timing is right for presbyopic IOLs because the increasing population of baby boomers represents a growing number of patients who are developing presbyopia and cataracts. These patients also have disposable income to spend on these lens technologies, he said.

Kerry D. Solomon

“In general, cataract surgery is going to be more prevalent by 2010. We will all see an increased demand for our services,” he said. But there are a few realities to consider, Dr. Solomon added.

The cost of doing business will increase, he noted. The need to adopt electronic medical records and the government’s pay-for-performance policies will all increase overhead costs.

“There is no question that incorporating all of this is only going to increase our practice overhead, and the reality of the situation is our reimbursements are going to continue to decline over the next 5 to 10 years,” he said.

Dr. Solomon said there is some risk in not getting involved in the presbyopic IOL market.

“Patients these days are becoming more and more knowledgeable. They know and will continue to ask about these sorts of options. If we do not offer it here, people may at least go for evaluations to those of us who do offer it,” he said. “If we are not comfortable doing these procedures ourselves, perhaps consider within our own practices having an individual who could manage this for us.”

Work smarter, not harder

There are two ways for cataract and refractive surgeons to increase premium lens-related revenues today, Dr. Solomon said. Surgeons can either choose to work harder or smarter.

“We want to put our clinical hat on and provide the best care we can with the patient’s interest always, yet put our business hat on and start working smarter rather than harder,” he said.

Surgeons can try to increase revenue by increasing the number of patients they see annually by 10% to 15%, Dr. Solomon said.

For example, an average cataract surgeon, who might do 350 cases per year, could try to increase revenue by seeing about 50 more patients a year, by expanding hours or working faster during the day.

This might increase revenue by 14%, he said.

“The downside is not great for your quality of life or overall health, and it compromises customer service to the patient,” Dr. Solomon said.

To avoid having to work harder, Dr. Solomon recommends working smarter instead.

“If you keep the same volume of flow (350 patients) and simply increase your percentage of presbyopic lenses, you could significantly increase your bottom line,” he said. “This is the whole concept of working smarter rather than harder.”

Lessons from LASIK

Dr. Solomon urged surgeons to put on their business hats and take a “LASIK approach” to their presbyopia-IOL practice.

“We have to re-evaluate the way we conduct our day-to-day business. We have to get out of our insurance mode of seeing so many patients in a day, and get into the premium provider LASIK-style of practice,” he said.

Surgeons who adopt a “smarter approach” will likely see fewer patients, but they will spend more quality time with those patients. Dr. Solomon recommended considering a half-day for lens-related surgeries only.

“We are charging a premium for these technologies. In addition to the tests and other things we are doing, it is also costing us something else, which is time,” Dr. Solomon said. “It is actually a breath of fresh air to take a little bit more time to spend time with patients and discuss these options.”

He recommends training schedulers to fill out templates with the right kinds of patients on days reserved for lens-related surgeries and having financial counselors available to speak to patients about their financing options.

“They have lots of ample opportunity to ask all their questions, so by the time the patient gets to me, I am in the role of an educator rather than a salesman,” Dr. Solomon said.

Perfect storm brewing

The premium lens market is growing so rapidly that surgeons are making substantial commitments to establish themselves in the market, according to Michael W. Malley, president and founder of CRM Group, a cataract and refractive marketing consulting business.

“I received a call from a client who said to take half of his LASIK budget of $400,000 and put it into marketing for presbyopic lenses,” Mr. Malley said. “That is the kind of commitment we are already seeing from our clients moving into these lenses.”

At the OSN New York Symposium, Mr. Malley presented ways to plan, prepare for and profit from the burgeoning presbyopic market.

“What is brewing is advancing lens technology and a rapidly growing presbyopic generation who control 70% of today’s wealth. For the first time in 10 years, cataract surgeons have something to be excited about other than a reduction in Medicare coverage,” he said. “In 2006, the first baby boomers started to turn 60, and they now represent the largest segment of the population.”

Initially, there was hesitation about premium lenses because surgeons felt their patients would not be able to afford the additional costs, he said.

“[Surgeons] cannot be myopic about the size of this growing market and the lure of a what a fuller range of vision represents for today’s new generation of cataract patients. They have to plan and prepare,” Mr. Malley said. “Fortunately, surgeons are now able to charge custom cataract patients a premium fee for the additional services they are providing. Thanks to the [Centers for Medicare and Medicaid Services] ruling, Medicare cannot dictate what surgeons may charge for these new presbyopia-correcting lenses.”

A steadfast system

Mr. Malley said the process of incorporating premium IOLs requires a streamlined system that begins with internal and external advertising and ends with patient-informed consent and counseling.

“To get started internally, practices need to do little more than put up signage throughout the office promoting ‘Great news for cataract patients’ or ‘Medicare patients, now you have a choice,’” he said.

Until now, cataract patients have not heard much great news about cataract surgery for the past 10 years, Mr. Malley said.

Educated technicians also help raise the perceived value of this process, Mr. Malley said. “Because of the amount of time technicians spend with patients, they have the perfect opportunity to introduce the new technology lenses to patients. By increasing the amount of information and education delivered by the techs, you can decrease the amount of time needed by the surgeons explaining the benefits of the lenses.”

Mr. Malley, echoing Dr. Solomon’s advice to mirror a LASIK-style business, recommends every cataract practice have a counselor.

“In every successful LASIK practice, there is a counselor who answers questions, presents options and addresses financial issues,” he said. “It is the same process, but even more critically important now with our presbyopic IOL patients.”

For more information:

• Kerry D. Solomon, MD, can be reached at the Medical University of South Carolina, Storm Eye Institute, 167 Ashley Ave., Room 221, P.O. Box 250676, Charleston, SC 29425; 843-792-8854; fax: 843-792-6347; e-mail: solomonk@musc.edu.
• Michael Malley, president and founder of the CRM Group, can be reached at 14614 Falling Creek, Suite 208, Houston, TX 77068; 713-839-0202; fax: 713-524-9466; e-mail: mike@refractivemarketing.com; Web site: www.refractivemarketing.com.

• Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology, focusing on optics, refraction and contact lenses.

Harnessing the growth opportunity By Daniele Cruz Presbyopia correction is a service with huge potential for increasing a practice’s surgical revenue, according to Candace S. Simerson, CMPE, COE. Candace S. Simerson Ms. Simerson is president and chief operating officer of Minnesota Eye Consultants. “What I find most exciting is a real opportunity for revenue enhancement,” she told attendees at the OSN New York Symposium. She explained, for example, that if 200 of a surgeon’s patients each year opt to receive a deluxe, presbyopia-correcting IOL, and the total charge for that procedure is $2,000, that could increase the practice’s revenue by $400,000. In a telephone interview with Ocular Surgery News, Ms. Simerson and Denise Hohrman, patient care manager at Minnesota Eye Consultants, shared ways that practices can begin to implement or reinforce patient education in premium IOLs. Surgeons who want to be brought up to speed on presbyopic lens options might consider contacting the individual lens vendors for educational and marketing materials, they suggested. “I think that is a good place to start. Gather all that information from the various vendors,” Ms. Simerson said. “One of the things we did here was create a generic brochure to educate patients overall that the lenses are out there, but then they need to talk to their surgeon to determine what the appropriate lens would be for them.” Whether or not surgeons choose to use presbyopic IOLs, they have to let patients know the option is available, Ms. Simerson said. “From my perspective, I had to make sure all the education took place, and we made sure all of our staff were aware that this is an option for patients and help facilitate the educational process,” she said. At Minnesota Eye Consultants, cataract patients who call the office to request more information or schedule appointments receive a brochure in the mail along with an informational DVD to begin educating them on their options. “One important thing would be to make sure there is a consistent message from start to finish and that all of the staff is well-versed in what the patient can expect afterward, so that there aren’t any surprises,” Ms. Hohrman said. When patients arrive for their appointments, technicians should ask them about their individual expectations for their vision after surgery, including their hobbies and daily lifestyle, she said. “After they are visited by the technician, the patients can watch an informational DVD with headphones while they are waiting for the surgeon,” Ms. Hohrman said. “That way, we are certain that they are aware of their options, so by the time they see the surgeon, the questions can get a bit more specific.” The surgeon, equipped with the information gathered by the technician, can then meet with the patient to answer more in-depth questions about the procedure before meeting with a scheduler or patient care coordinator to discuss the cost of the procedure. “We do not let the surgeons talk about the finances at all,” Ms. Simerson said. “First of all, it’s not an effective use of their time, and second of all, they are not comfortable doing it, so we definitely have the financial counseling done at the surgery scheduler or patient care coordinator level.” The biggest question patient care coordinators often hear is, “Why won’t my insurance cover this?” Ms. Hohrman said. To help patients understand the higher cost for premium IOLs, patient care coordinators at their practice may use examples such as manual wheel chairs vs. electric chairs or bifocals vs. progressive lenses. She tells patients that insurance companies will often cover the cost of a basic device, but not something more advanced because it is considered an upgrade. “If you can get by with something that is very simple that meets your needs, insurance is not going to pay for all the bells and whistles,” Ms. Hohrman said. “Multifocal IOLs are an upgraded IOL. They are fancier than what insurance prefers to pay for because it is not a necessity to them.” For more information: Candace S. Simerson, CMPE, COE, president and chief operating officer at Minnesota Eye Consultants, can be reached at Park Avenue Medical Building, Suite 106, 710 E. 24th St., Minneapolis, MN 55404; 612-813-3619; fax: 612-813-3663; e-mail: cssimerson@mneye.com. Denise Hohrman, patient care manager at Minnesota Eye Consultants, can be reached at 612-813-3624; email:dfhohrman@mneye.com.