This article is more than 5 years old. Information may no longer be current.
Evaluate a center's philosophy before venturing into laser vision correction industry
Click Here to Manage Email Alerts
In the 26 months since photorefractive keratectomy (PRK) received Food and Drug Administration approval, optometry is still learning its way around the bustling, evolving laser vision correction industry. As gatekeepers to most of the myopes in the United States, optometrists find themselves in a unique position - laser vision centers want access to their patient base, but many optometrists are not sure what to make of this attention or the various incentives that come with laser center affiliation.
The issues surrounding an optometrist's decision to enter into a comanagement agreement with a laser vision center are, according to Jerome Legerton, OD, MBA, "About creating a mechanism that's respectful of optometric involvement, which is to say priming the pump, because more than two-thirds of patients who are having surgery have their files in our offices. We are active in getting the first wave of people into surgical centers and helping those centers become successful."
Dr. Legerton, section editor of the Primary Care Optometry News Practice Management section, said optometric networks are only one conduit from the general public to the laser surgery center, and while some laser centers develop this relationship, others do not.
"Many surgery centers have a real worry that the optometrist is the bottleneck and a filter," said Dr. Legerton. "The laser centers believe that optometrists have bias and are afraid to lose the sale of glasses or contact lenses and, therefore, don't move the patient quickly through this conduit."
He said the bottom line is: "not every surgery center wants the patient to come through that optometric filter." The challenge for optometrists who want to venture into the laser vision correction industry is to find a center that wants a relationship with optometry.
"Visiting a prospective laser center is a lot like interviewing a prospective employee," Dr. Legerton said. "All too often, the practitioners I've worked with did all the talking and didn't get the other person talking, or their focal point was on the money. If I were interviewing a center, I would get past how I would be compensated for my preop and postop care - which is often non-negotiable - and get into the long-term goals and philosophy."
Initial resistance
In talking with optometrists who are not involved in laser vision correction nor enthusiastic about referring patients for the procedure, Dr. Legerton has found two core issues of resistance.
"First, when patients are happy and have good results with laser surgery, they do not always refer their friends and family back to the optometrist who made the original referral," he said. "A new patient who contacts a center does so as a free agent, yet the original feeder was an optometrist. That is a serious pitfall."
While optometrists are not guaranteed a system that will control this issue they can, Dr. Legerton said, choose not to work with a center that takes all newcomers without requiring patients to come through the optometric network. "This is one of the few safeguards an optometrist has, but the problem there is that you are telling patients what to do and possibly causing them to go somewhere else in some instances."
The second problem is subtle, Dr. Legerton said, and also involves patients who are happy with their laser vision surgery results but do not return to the optometrist for regular vision care.
"Practitioners are not seeing these patients return for care, and they may be lost to care to an ophthalmic provider for a while," he said, "but this falls into the realm of patient education. Practitioners who educate their patients the best get patients to return the most."
Emphasize vision care
Dr. Legerton describes the latter scenario as an inherent problem when optometrists receive an initial fee for laser vision correction pre- and postop, but do not see the patient after the final postop visit.
"The reason for this is that patients are undergoing a procedure, which they're often paying for with their own money, to have hassle-free vision," he said. "One of the hassles they want to be free of is vision care, not just the appliance."
But if the practitioner and laser vision center, as a team, can educate patients and tell them that just because they have sight without contact lenses or eyeglasses does not mean they have sight without vision care, this may help right the wrong, Dr. Legerton said.
"I hear both of these pitfalls from optometrists who were initially enthusiastic about laser vision correction but have lost their shine for the procedure," he said. "What amazes me are those optometrists who have conducted numerous follow-up visits yet have not successfully reinforced to the patient how happy they are to get referrals, or they fail to impress upon patients that they are the doctor who should be looking at their eyes on a regular basis."
Communication equals success
Jack W. Melton, OD, echoes the idea that optometrists who take an active role in the care of the laser vision correction patients are the most successful participants in the industry. Dr. Melton is president of the LExES Panel of Doctors in Edmond, Okla., which includes almost 1,000 optometrists and ophthalmologists nationwide.
"Optometry has 70% to 80% of patients who are potential candidates for laser refractive surgery, so all you have to do is communicate that you're involved in laser vision correction and can provide services through your office," Dr. Melton said. "Optometrists who have been most successful are those who communicate best with their patients."
Optometry's role should not be a passive one, said Dr. Melton. "As an optometrist, I need to make patients feel that I am their doctor, and I am not turning them over to someone else. It seems like a simple principle, but it can be easy to lose sight of."
Dr. Melton said he views the laser center as a place for optometrists to take their patients. "An analogy is found in taking a patient to the hospital," he said. "That is still your patient, but you are part of that experience and your role is to help them through the procedure."
Focus on aftercare
Dr. Legerton said optometrists can ensure they retain laser vision correction patients, even after successful surgery, by offering a laser vision correction aftercare agreement.
"This agreement includes postsurgical evaluation that is not covered by a patient's third-party or vision care plan, for example, corneal topography," he said. Part of such an agreement should also include an optometric referral back to the laser center if the patient needs an enhancement to correct a regression or residual error.
Optometrists should also remember to educate these patients about the need for eye wear following surgery.
"We know that most patients who have laser vision correction still need eye wear, so part of an aftercare agreement would be to offer them a fee reduction on supplemental eye wear," Dr. Legerton said.
This type of aftercare should work both ways, Dr. Legerton said, and means that a laser center needs to take a proactive role in getting the patient back to the referring optometrist and emphasizing the importance of aftercare. "The bottom line is to ask the centers what they are going to do to help get your patient back and to be sure that new patients referred by your patients come through you."
Successfully involved
John Herman, OD, in private practice in Pittsfield, Mass., has been sending patients out for laser vision correction for 2 years through his affiliation with the LExES network. Less than 1% of his practice is made up of laser vision correction patients, he said, "and we have thousands of contact lens patients here, so we're only scratching the surface."
Dr. Herman became involved in laser vision correction after patients came to his office and asked about refractive surgery, which meant radial keratotomy at the time. "But then PRK came along, and I began telling patients it appears that laser vision correction is going to be different," he said. "So I armed myself with more information and began discussing it further."
He said that both parties - the laser center and the referring optometrist - need to be comfortable with one another before any patients get involved. "The advice I would give to anyone getting started is not to be afraid of it," Dr. Herman said. "Also, there are no guarantees, so you can't tell a patient everything is going to be perfect. Choose your cases carefully and don't make outlandish guarantees to patients."
Part of choosing laser vision correction patients carefully, he said, is to go beyond the eye examination and interview prospective candidates to learn about their visual environment and what is important to them in daily activities.
Dr. Melton added that optometrists need to find out if working with a particular center will be a team effort for the care of the patient. "Philosophically, is there a team approach, and does the center welcome active participation from the primary care doctor?" he said.
Does center meet standards?
Optometrists who approach a laser center need to learn if the center really represents them and their practice philosophy, Dr. Legerton said. "Ask yourself if the center is orderly and professional. What is a good standard for clean, orderly and organized? Does the center and its staff meet it?"
A good measuring stick, he said, is for optometrists to ask if they would hire the same staff they find in the laser center. "Has the center selected staff members who meet your own criteria for good employees?"
Getting to know the business philosophy of the laser center is crucial to developing a good relationship, Dr. Legerton said, and should involve asking several direct questions designed to find out if this will be a win-win situation.
"The primary need of optometric practices are to have repeat and return business and to have referrals," he said. "So you ask the surgery center: How are you going to help me get the patient who is erroneously referred to the center and not to me? How are you going to help me get the patient back on an annual basis for postsurgical and annual aftercare?"
If a laser center indicates it has little interest in helping an optometrist with these issues, he said, ODs are usually not looking at a win-win situation. Other questions should include asking about the computer system and database at the laser center, and how easy it is for the center to monitor who the initial referring doctor is for new patients who are referred by former patients.
"How the receptionist is trained is an important issue, because 99.9% of patients present themselves on the telephone," said Dr. Legerton. "One of the first questions should be: `How did you hear about the center?' This is the information age, and anyone who can't go to a database and access the name of a referring practitioner is not being smart or organized."
Optometrists who ask these types of questions can learn quickly whether or not a center will send new patients through the optometric network for pre- and postoperative care and if that center is suited for them.
"The issue is validated trust," Dr. Legerton said. "How do you, the optometrist, trust the way the center sorts this out? If I were in a network and the center says it screens every caller for the original referring doctor, then I'd be a frequent mystery caller. Check it out. As a practitioner associated with a center you should not assume anything."
Protect patient secur
Another practical issue for optometrists to consider is the security need of the patient who is considering laser vision correction. "The number-one reason patients wouldn't get contact lenses is the fear of putting something in their eyes," Dr. Legerton said. "With surgery, it's fear of the actual surgery, so you have to ask the patients what they need to feel secure about the procedure - What would the environment be like? The staff?"
That kind of information can help ODs further gauge a laser center in terms of how it meets their patients' needs. Dr. Legerton said ODs should even consider their own needs, for example, "Does the center look like a place a person would have their eyes operated on? Ask yourself if you'd feel secure and comfortable having surgery there."
Finally, Dr. Legerton said, optometrists should ask for full disclosure of laser surgery outcomes before agreeing to any affiliation. "We tend to believe practitioners when they say they have good results, but I would like to get a true disclosure of positive outcome statistics and of any adverse outcomes, what they were and how they were resolved."
While laser surgery is not a flawless procedure, he said, the center should be forthcoming with surgical results, and optometrists should look at this information objectively because "the real issue is: How did they handle a problem and how is the patient feeling about it now?"
Tips for Evaluating a Laser Center |
| The center should:
|
For Your Information:
- John Herman, OD, may be contacted at 217 South Street, Pittsfield, MA 01211; (413) 499-3797; fax: (413) 499-3834. Dr. Herman is Eastern Regional Director for LExES.
- Jerome Legerton, OD, MBA, may be contacted at 105 Sierra Morena Court, Los Gatos, CA 95032; fax: (408) 356-6320; e-mail: jlegerton@aol.com. Dr. Legerton has no direct financial interest in any product mentioned in this article, nor is he a paid consultant for any company mentioned.
- Jack W. Melton, OD, FAAO, may be contacted at 1800 Canyon Park Circle, Suite 303, Edmond, OK 73013; (800) 809-3489; e-mail: laseramer@aol.com. Dr. Melton has a financial interest in LExES Panel of Doctors, LLC, as president and a principle stockholder.