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The three Ps to facilitate the premium channel conversion
Focusing on people, process and product, along with performance, may improve the conversion rate for premium surgeons.
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The three Ps, no matter the industry or business discussed, always come down to the three same principles: people, process, product. There are many variations of the three Ps, and occasionally there is a fourth P known as performance. The core ideas are always the same nonetheless no matter how they are applied. As a premium surgeon, the procedure for converting patients to advanced technology always implements the three P/four P principles. Below I discuss my personal strategies step by step, invoking all four Ps in the conversion process as a premium surgeon.
People
I look at this principle as my staff from front desk to technician to scribe to surgery coordinator. The process of advanced technology conversion, be it femtosecond laser to astigmatism management to presbyopia IOL, starts the moment the patient encounters the practice. It may even start before the staff with word of mouth, optometric referral and/or social media/website presence. No matter the encounter, the office staff from the beginning to the end has an integral part in the conversion process. The surgeon ultimately closes the conversion, but the entire practice personnel must believe and follow the surgeon’s recommendation to make the closure possible. Almost every patient asks my scribe/technician once I leave the room the simple question, “What would you do?” My scribe/technician always answers, “I would follow the surgeon’s recommendation,” with appropriate due diligence of the information packet given to the patient to review before the next scheduling visit. The next step in my opinion is the most critical and falls on the shoulders of the surgeon.
Process
In my practice, the process begins on the day of the full cataract evaluation. All preoperative diagnostic testing is performed on this visit so the surgeon can make an initial recommendation for the advanced technology upgrade appropriate for that patient if he/she qualifies in the first place. Some patients just do not qualify for advanced IOL technology but may qualify for femtosecond laser technology with the good side effect of astigmatism correction. The process involves exhaustive diagnostic testing, which in my practice includes tear osmolarity (TearLab) for baseline ocular surface assessment along with dynamic meibomian imaging with LipiView (TearScience), Pentacam HR total corneal imaging (Oculus), Cassini total corneal imaging (i-Optics), OPD-Scan III (Marco) imaging to separate corneal vs. lenticular astigmatism, alpha angle/kappa readings, IOLMaster 700 (Carl Zeiss Meditec) for biometry with current-generation IOL calculation formulae (Barrett, Haigis, etc), OCT of the macula to rule out any macular pathology, flicker ERG (Diopsys) to rule out macular function in dense, no-view-of-retina type cataracts, objective scatter index grading (Visiometrics) with the HD Analyzer to show the patient his/her true visual function, and any other appropriate testing deemed necessary, such as visual field if the patient has had a prior stroke, for example. This process is where the surgeon will create two options at most to present to the patient before entering the exam lane. Occasionally, the referring OD will provide intel on what option is best suited for the patient, but a lifestyle questionnaire is always utilized preoperatively to assess the patient’s lifestyle needs both occupationally and recreationally, and the patient has to self-mark if he/she is easygoing on a grid all the way to perfectionist.
Product
Every premium practice needs to establish the various categories for advanced technology, as this is the product to be “sold.” Our practice utilizes various internal/external categories, with the external mentioned to patients and internal for our surgical coordinators to give the appropriate packet of information to review at home. Externally, we have the basic option in which patients will get phacoemulsification with a monofocal IOL with the expectation of full-time glasses for all levels of vision. We also have our mid-tier level “legal to drive” (LTD) option created by Jim Loden, MD, in which patients will get internally either a LTD limbal relaxing incision/arcuate incision or LTD/toric IOL packet and pricing based on their preoperative testing. Lastly, we have our “forever young” option, which most practices refer to as their presbyopia IOL option. I try to avoid medical jargon and terminology in the exam lane as most patients do not know what astigmatism, presbyopia or femtosecond laser even mean, and that is an extra 20+ minutes of wasted time trying to explain the concepts to them. I have chosen the lifestyle approach with my product for patients as that is what matters in the end. And by the way, the time saved in the exam lane is highly statistically significant when 86% of my patients convert at the minimum to femtosecond laser and up to 40% convert to advanced IOL technology.
Performance
Yes, there is actually a fourth P that has relevance to the premium surgeon both preoperatively and intraoperatively and even postoperatively. No matter the patient, patient expectations must be seriously set no matter the advanced technology proposed. And as premium surgeons already know, most patients have amnesia preoperatively when their expectations are not met postoperatively. Performance requires the use of the most advanced femtosecond laser platforms, the most advanced ophthalmic viscosurgical devices, the most advanced IOL calculation formulae, the most advanced phacoemulsification settings and the most advanced IOLs customized specifically for the patient’s overall lifestyle needs. I utilize technology from all the various companies and never become hostage to just one technology across the board. For example, I may use Streamline technology from Lensar to help align an extended depth of focus Symfony clear toric IOL (Johnson & Johnson), ORA (Alcon) to confirm aphakic power and pseudophakic axis, Stellaris microburst phacoemulsification (Bausch + Lomb) and Omidria (phenylephrine 1% and ketorolac 0.3% injection, Omeros) to maintain pupil dilation all in the same case to get me the best possible outcome for that specific patient. The next patient may get all different technologies based on his/her needs.
In the end, the three Ps, or really four Ps that most of the working world follows, even apply to us premium surgeons. I am fortunate to have great people, a great process with great diagnostic technology, and a great product to deliver the performance I promise to my patients as a premium surgeon. Keep up the great work to all my colleagues, and try to follow the three P/four P strategy.
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
Disclosure: Jackson reports he is a consultant for Lensar, Bausch + Lomb, Johnson & Johnson, Alcon, Diopsys, Marco, TearLab, Oculus, i-Optics, Visiometrics, Omeros, Carl Zeiss Meditec and TearScience.