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Customer service, patient education important to emerging RLE market
Educating patients about refractive lens exchange today is similar to explaining radial keratotomy in the early 1980s.
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Vision is the art of seeing what is invisible to others. – Jonathan Swift
If you are paying close attention to what is only now becoming visible to some, the opportunity you are about to have as a vanguard cataract surgeon today should feel a bit like the opportunity your older colleagues enjoyed in the early 1980s with the budding of keratorefractive surgery in America. Understanding the relative nascence of refractive lens exchange is critical to knowing how important it is to start with the fundamentals of customer care and patient education.
Radial keratotomy (RK) was aimed at 20-something-year-old baby boomers. I should know — I was one of them. I had worked in ophthalmology only a few years before lying on the table for my own procedure. (A shout-out here to Dr. Michael Gordon and his colleagues in La Jolla, Calif., who still practice at the leading edge.)
Thirty-five years on, this same patient cohort is now in their 50s and early 60s, and they are ready for the next big thing. Are you? The next-best boomer-driven practice opportunity could be refractive lens exchange (RLE), which is interchangeable with presbyopic lens exchange.
What do the numbers say?
In general cataract economics, we can look at the incidence or utilization rate of lens implant surgery and count it as the number of cataract cases per 1,000 65-year-old+ seniors per year. In recent years, that figure has been about 80 cataract eyes operated per 1,000 seniors per year, up from 50 eyes a generation ago; market penetration rates rose with increased safety, better outcomes and patient acceptance.
This is based on about 3.2 million cataract lens implants per year and about 40 million seniors. Because most cataract surgery is eventually bilateral, we could say that roughly one out of every 25 seniors in a given year goes forward with cataract surgery.
So much for senile cataracts. What do the numbers look like for RLE, a kind of “pre-need” cataract surgery for patients who are typically between the ages of 50 and 64 years old?
While the figures are not precise, according to industry sources, about 90,000 RLE cases are performed in the United States per year, or just under 3% of the total cataract cases performed annually in the country. This gives us a sense of how much further this practice segment could potentially grow.
One has to realize, of course, that every purely elective RLE case performed today is one less senile cataract surgery to be performed in the future by doctors-to-be who are probably graduating high school around now. I doubt there will be any grumbles from them, however, based on the rising tide of elderly patients and the falling tide of eye surgeons. The grumbles will be focused on the $250 allowable cataract surgery fees, based on the present course.
Let’s look at the comparable RLE utilization rate within its respective, younger pre-senior citizen cohort. How many RLE cases are performed per 1,000 U.S. citizens aged 50 to 64 years old, the usual bandwidth for RLE surgery? There are about 60 million Americans in this cohort. So that makes for less than two RLE eyes per 1,000 prospective patients in this age range. Like the bilateral calculus above, that would make for only one out of every 1,333 presbyopic 50-plus boomers having RLE surgery per year.
The bottom line is this: Senile cataract surgery for 65-year-old+ seniors is today more than 50 times more popular than RLE is for 50- to 64-year-old pre-seniors. And RLE is much less popular than keratorefractive surgery was in its heyday. Focused education and promotion could change that, and it is worth trying because of the huge scale of the market.
But to be successful in this emerging segment, you have to realize that your patient’s likely understanding of RLE is probably about as developed as the public’s understanding of RK around 1982.
What turns patients on and off
In all elective medical settings, the same patient education and customer care issues arise — issues that are not as critical as in other bread-and-butter domains of ophthalmology.
Out-of-pocket costs loom as the largest issue, but this issue is generally less important for the 50- to 64-year-old patient than for still-struggling LASIK patients in their 20s and 30s or, for that matter, for patients in their 70s who are living on a fixed income. Many of your patients in this late-midlife cohort are at the peak of their earnings capacity. So if you have a LASIK or elective plastics practice with patients who skew a bit younger than patients for RLE, you may be surprised to find that your new patients in the presbyopia correction space are less price sensitive.
The importance of discussing RLE affordability is just below that of discussing the clinical risks and benefits of the procedure. Cost concerns can be offset in several ways as they surface:
- You can apply flexible pricing, granting courtesy to selected patients, particularly when you are just launching your elective RLE cataract surgery practice. This should be handled by the surgical counselor sitting down with a patient who is declining surgery because of cost concerns. “I do understand that the cost of RLE is holding you back. But Dr. Smith wants to make sure that no patient misses out on needed care because of cost concerns. What could we do with financing or a courtesy fee reduction to help make this procedure more affordable for you?”
- You can offer in-house financing, which for this largely settled and stable age cohort is less risky than chasing down 20- and 30-somethings for missing payments.
- Third-party financing from CareCredit and others can facilitate the patient’s decision making.
There are higher standards for delighting patients in any elective, quasi-cosmetic setting. We have to go beyond mere “satisfaction.” This does not mean that you have to deliver five-star, spa-level attention, but four-star service in an electively oriented practice is a critical baseline standard and you should consistently strive for higher. What does five-star service and education look like in an elective RLE practice?
Unlike routine cataract or LASIK surgery, your patients probably do not have a friend or family member who has had this less-common procedure. You have to spend more chair time personally as the surgeon, developing rapport and trust and explaining the risks and benefits.
Keep in mind that while you may have given your “cataract speech” a thousand times, you may only be on your hundredth rendition of your “RLE speech.” Slow down. Remember your script. Explain with a high level of confidence in your voice the risks and benefits. Address each question in turn like you have all the time in the world. RLE is probably fairly new to you, and that will “read” as surgeon hesitancy by patients.
Most patient education in an elective practice should be delivered by the surgeon, not the lay counselor, because it boosts surgical conversion rates and allows you to personally ascertain the patient’s medical candidacy as well as their malpractice risk for unreasonable expectations.
To improve your performance as a patient educator, put an audio recorder in your lab coat pocket. After a series of patient encounters, play back the recording, ideally with your administrator, surgical counselor and lead tech present. If you allow yourself to be open to coaching, this will allow your staff to help you improve while at the same time exposing them to your verbiage. This pearl applies to all aspects of your practice, not just presbyopia treatment.
Staff attire, grooming and friendliness are critical. As the old hotel management saying goes, “We can teach anybody how to do any job here, from maid to general manager. But we can’t teach a person how to be nice. So we hire nice people and teach them everything they need to know on the job.” Your practice is also in the hospitality business. Customer expectations are rising. And your colleague-competitors are working to set the bar ever higher.
Tidiness counts. Look around your current office facilities with fresh eyes; it can be hard to do this because you have learned to overlook the dust bunnies and scuff marks. Is there a musty smell? Is the décor dated? Are equipment wires all over the place or neatly bundled? Are toilets and hallways messy by the middle of the morning and left that way?
Work to anticipate and ask about a patient’s needs before they ask you for something:
- “Here’s a fact sheet describing what the doctor just told you. Refractive lens exchange can be a little complex the first time you hear about it.”
- “I’m sorry for the wait; can we call your ride for you?”
- “It will only be a few minutes more. Can I get you a bottle of water?”
- “It looks like you’re a little puzzled. If you have any last questions, please ask me, and if I don’t know the answer, I can get the doctor back for you.”
- “Can I help you out to your car? The parking lot is a little slippery this morning.”
In the average geriatric/general ophthalmology practice, we want a patient’s daughter to say, “Wow, it really looks like we’ve taken mom to the right doctor.”
The RLE practice, like the elective plastics and LASIK practice, and the practice with a high-end optical, has to take things up a notch higher. We want the 50-something patient’s spouse to say, “Wow, I’ve never been in a doctor’s office this attractive with staff members who are so friendly.”
Patient education
Adjuncts to the patient’s experience and their education in your office are as creative as your imagination and the imagination of the many vendors who provide printed materials, graphics and Web content.
Patient Education Concepts (www.patientedconcepts.com) is an old-line firm in this arena, with more than a generation of experience preparing and updating information as newer procedures such as RLE emerge and mature.
Given how fresh this topic is in the public mind, it is time to roll out the same tactics we used in the early 1980s when RK was launched. Public education seminars. Face-to-face and doctor-to-doctor outreach to referral sources. And scrupulous attention to educating practice staff so everyone in the “cast” is reading from the same lines.
As we learned from the earliest days of refractive surgery in America, adding RLE is not just tossing a new surgical modality into the toolkit. It is creating an entirely new division to your company. Proceed with that level of seriousness and you will thrive. The patient demographics are on your side.