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How to build a successful refractive surgery comanagement practice
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Establishing a busy comanaging laser vision correction (LVC) practice does not happen overnight. Follow these steps and your commitment to integrate LVC into your practice and to provide the best refractive care to your patients will gradually make refractive comanagement an important and successful part of your practice.
Get comfortable with LVC
Before you can successfully talk to patients and put them at ease with refractive surgery, you must be comfortable with the procedure yourself. This requires confidence that the procedure is safe and effective and gives excellent results. Believing comes only from seeing. You must follow several patients, see the results and learn that complications are rare and can be successfully managed before you will be able to successfully recommend LVC to your patients.
Affiliate with a surgeon
Find a recognized expert surgeon in your community who you can trust. Comanagement is a mutually beneficial relationship for the doctors and patient. The surgeon will be glad to hear from you and to talk with you about comanagement.
Most surgeons with significant refractive volume perform laser in situ keratomileusis (LASIK) rather than photorefractive keratectomy (PRK). The much-improved comfort, more rapid return of vision, fewer follow-up visits and decreased need for steroids have made LASIK the predominant refractive procedure. Your practice will grow faster if you comanage with a LASIK — rather than PRK — surgeon.
Join a network
If there is a successful ongoing LVC company in your area, check it out to see if you would be comfortable joining it. We are involved closely with TLC The Laser Center. Laser centers such as TLC not only provide teaching and seminars for doctors who are new to LVC, but also offer ongoing continuing education for experienced comanaging doctors.
A larger group can provide seminars for discussing preoperative evaluation and management of postoperative complications. The group gives doctors the opportunity to see additional cases and significantly increases comfort and reduces worries about refractive laser surgery. The network also can provide marketing materials, informed consent documents and preoperative evaluation and postoperative follow-up forms.
A good network also supports camaraderie among fellow ODs and MDs in a cooperative and mutually supportive environment. The structure and contacts of a network help establish a good working relationship and also educate the comanaging doctor on how LVC can impact practice revenues and bring new patients into their practice.
Take a course
Be sure to take courses on LVC at the American Academy of Ophthalmology meeting and other credentialing courses through your network. These courses also are routinely offered at most of the national and international optometric meetings. TLC’s CE Foundation also provides accredited courses in conjunction with numerous colleges and universities. Display your certificates and the new skills they represent.
Incorporate LVC into your practice
Once you’ve gained the basic credentials and skills required to comanage patients, you will need to slowly incorporate LVC into every aspect of your practice. Make patients aware that you are an expert in LVC comanagement. This may begin with a telephone on-hold message discussing LVC and your network. Your patient information check-in sheet should ask every patient if he or she is interested in LVC.
Include LVC (in addition to glasses or contact lenses) whenever you discuss with your patients how to correct their refractive errors. Make sure that LVC information is highly visible in your office. Keep brochures, articles and posters in prominent positions in your waiting room and examining rooms.
You may also want to show patient education videotapes in your waiting room or a patient education area. TLC, for example, provides a sophisticated and informative video to its network doctors. There are also many professional tapes available that can be customized to your practice.
Give patients red carpet treatment
Give the red carpet treatment to any patient interested in LVC. Any patient who inquires about LVC has already overcome many obstacles to even mention it in passing. He or she has thought about the expense of the procedure and the fear of pain or blindness. Additionally, he or she has perhaps dealt with approval or, more likely, disapproval from his or her friends or spouse.
We owe it to the patient to roll out the red carpet. Do not keep him or her waiting. Return phone calls promptly. Recognize that the patient feels he or she is spending a significant amount of money and expects to be accommodated or may go elsewhere.
Get the whole staff onboard
Be sure that your entire office staff develops a comfort and enthusiasm about LVC, or your LVC practice will never develop. Be sure the receptionist answering the telephone knows that you provide this service. Make it clear that the jobs of your technical staff are not threatened by LVC.
Many networks offer seminars for office staff so they can develop the knowledge necessary to help with developing your comanaging practice. Recommend refractive surgery for appropriate staff members. Most comanaging surgeons perform procedures for optometric staff at a considerable discount.
Appoint an LVC coordinator
Carefully select and designate someone in your office to be the LVC coordinator. This person needs to be competent and compulsive about follow-up of phone calls and other leads for potential patients. Ideally, this person should also have undergone LVC by your comanaging surgeon.
Get lasered
It is important, too, to put your eyes where your mouth is. If you are not a candidate for LVC, that is fine. However, if you are wearing glasses in the office, whatever you say about LVC to your patients will not be believed. Nothing is more reassuring to your patients than having LVC performed upon yourself. Consider it for appropriate family members. Actions speak much louder than words.
Call postoperative patients
After your patients have LVC, you should call them at home on the evening of the procedure. Ask how they are doing, answer their questions and reassure them about the normal postoperative blur or temporary discomfort. This will demonstrate how much you care about them and will help put their minds at ease. They will remember this show of concern as much as their visual results.
Display testimonials
As your patient population grows, ask your patients to write you letters about their experience with LVC. Ask permission to post these letters in a book or on a board in your waiting room. Many patients are euphoric soon after their laser surgery. Their letters may be more credible than the words of their doctor. This is especially true as prospective patients may perceive that other patients have no monetary incentive for their recommendation. These "brag books" or "brag boards" are very helpful.
Introduce postop patients
As your refractive practice grows, there will be times when your postoperative patients are in the office at the same time as your prospective or preoperative patients. Put them together in the same room. A happy postoperative patient in a one-to-one discussion with a person considering surgery can do much to convince that person that he or she is not crazy to want to be without glasses and that these results are usually excellent and are not just hype. The patient will feel better about trusting the doctor as well as the comanaging surgeon.
Refine your communication skills
Continually review your experience with LVC. Think about how your words and actions help your patients make decisions and feel good about their decisions and results. Become more sophisticated in both word and body language when talking to your patients about the procedure.
When discussing laser refractive surgery, use words such as "the laser gently reshapes the corneal lens-window of the eye using cool, invisible, computer-controlled energy that you cannot feel to restore the natural vision of your eye." If you discuss LASIK and the keratome, use words such as "lift the surface cells of the eye." Avoid words such as "cut" or "burn."
When discussing potential complications, use words such as "patients may over- or under-respond to the laser," rather than words such as "over- or undercorrection," which may be interpreted as a surgical mistake, and that an enhancement should bring them closer to their "target correction." Make good eye contact with the patient while discussing LVC.
Initiate efficient marketing practices
Send an announcement to potential patients that you are offering LVC. If you have a newsletter, you might want to show photographs of some of your happy patients or staff. You may even mention LVC on your appointment reminder cards, contact lens renewal cards and, if your computer billing allows, as a brief note on the bottom of your bills. Be sure LVC comanagement is present along with eye exams and contact lenses on your business card.
Use the web
Do not neglect the technological revolution and the World Wide Web. We invite our comanaging optometrists to have a page on our web site, www.washingtoneye.com. TLC The Laser Center provides a similar service to its doctors. Web sites provide an additional means for your patients to obtain information about LVC. They also give the message that you are on the cutting edge.
Feature your web site address on your business cards, stationery and brochures. Be careful, however, about providing your e-mail address to patients unless office staff continually monitors e-mail. It is possible to be considered medically negligent if a patient e-mails a medical problem to you and you do not respond in a timely fashion.
Give seminars
Announce a seminar for your patients, and show slides discussing LVC. You may do this in your office or at your laser center. Often, a network will co-sponsor such an event with you. Bring along a happy patient or two to provide testimonials. Even if only a few patients attend the seminar, the announcement will let people know you are involved in refractive surgery comanagement.
For Your Information:
- Neil F. Martin, MD, FACS, practices with Washington Eye Physicians and Surgeons, PA, in the Washington, D.C., area. He is a Cornea Service and Senior Attending Surgeon at Washington Hospital Center and a clinical assistant professor of ophthalmology at Georgetown University Medical Center. Dr. Martin holds 10 patents for innovations in drugs and medical devices. He is a paid consultant for TLC The Laser Center.
- Roy S. Rubinfeld, MD, practices with Washington Eye Physicians and Surgeons. He is a Cornea Service and Attending Surgeon for the Washington Hospital Center and a clinical associate professor of ophthalmology at Georgetown University Medical Center. Dr. Rubinfeld is director of Training and Education for TLC The Laser Center. Drs. Martin and Rubinfeld can be reached at Washington Eye Physicians and Surgeons, 5454 Wisconsin Ave., Ste. 950, Chevy Chase, MD 20815; (301) 654-5114; fax: (301) 654-9132; www.washingtoneye.com. Dr. Rubinfield is a stockholder in TLC The Laser Center and is a paid consultant for TLC.
- David C. Eldridge, OD, FAAO, is executive vice president of clinical affairs for TLC The Laser Center Inc. He supports and coordinates training of optometrists and ophthalmologists in TLC’s 48 centers in North America. Dr. Eldridge can be reached at TLC Tulsa, 1323 E. 71st St., Ste. 210, Tulsa, OK 74136; (918) 491-6009; fax: (918) 491-6168.