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Presbyopic IOLs can have positive impact on practice profitability
Indirect reimbursement comes in the form of patient satisfaction and patient growth.
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SAN FRANCISCO — There is a large unmet need in ophthalmology practices with regard to treating presbyopia, with the potential for profitability outstripping that of more conventional lenses, according to a speaker here.
“Very little revenue comes into our practice now from presbyopia, and it should be a lot higher,” OSN Cornea/External Disease Board Member Eric D. Donnenfeld, MD, said at the Ophthalmology Innovation Summit.
At Ophthalmic Consultants of Long Island, which accommodates 180,000 patient visits per year, 10% of revenue is attributed to monofocal lenses and about 4% to presbyopic IOLs. That is a disproportionate relationship, according to Donnenfeld.
“In 2012, 9% of the 8,500 cataract surgeries in our practice chose a presbyopic IOL, while 84% chose a monofocal spherical lens,” Donnenfeld said. “Nine percent of our patients choosing presbyopic IOLs drive as much profit to our practice as the 84% of patients who choose conventional IOLs.”
Eric D. Donnenfeld
Presbyopia positioning
Over the past 5 years, the number of patients choosing presbyopic IOLs has remained flat at about 8% to 9%, Donnenfeld said. About half of patients aged older than 40 years choose monovision with LASIK.
“This does not drive economic results in our practice, but it does drive patient satisfaction,” Donnenfeld said.
With the profitability of presbyopic IOLs being higher than for other refractive options, Donnenfeld said his practice emphasizes presbyopic IOL positioning.
“What you see here is a tremendous opportunity for our patients and our practice,” he said.
Even though external marketing is minimized, internal marketing with websites, brochures, posters and social media drive the practice’s presbyopic market.
“We have a dedicated internal and external refractive coordinator,” Donnenfeld said. “We incentivize our staff in one of our offices for presbyopic IOL value, and that really drives volume significantly.”
Even so, whether a presbyopic IOL is implanted is not up to the office staff.
“The bottom line is, presbyopic IOL surgery in our practice is really surgeon-dependent,” Donnenfeld said.
Presbyopia economics
Donnenfeld’s practice encompasses 12 offices, two surgical centers, two laser centers and 31 eye care professionals, including four optometrists, two ophthalmic plastic surgeons, three retina specialists and two medical ophthalmologists. One-third of his partners or associates do not perform cataract surgery, he said.
Donnenfeld said his personal fee for a presbyopic IOL nets a profit of $1,600. Pairing that with femtosecond laser increases the profit to $1,850. Conventional IOL with monovision yields no incremental practice profit, he said.
“With LASIK, our fee is $5,300, and our additional fee for monovision is basically zero,” he said.
Expenses must be accounted for in order to determine IOL profitability; however, even though there is significant incremental work involved with a presbyopic IOL, there is little incremental expense involved.
“There are also intangibles like the benefit to patient satisfaction and practice growth, which I believe is very significant,” Donnenfeld said. “These are by far the happiest patients in our practice, but they can also be the highest maintenance patients in our practice, and I think this causes many of my partners to shy away from them.”
Donnenfeld said that new presbyopia-correcting technology is waiting for U.S. Food and Drug Administration approval, which would benefit and grow his presbyopic practice.
“We are looking very soon to see corneal inlay surgery having a significant impact on our practice, and we look forward to new multifocal and accommodating IOLs,” he said. – by Christi Fox and Patricia Nale, ELS