Discussing DED treatment cost can help build trust, lead to more same-day procedures
Click Here to Manage Email Alerts
In-office procedures are an integral part of modern dry eye disease management for general practices and specialty clinics alike.
My optometric colleagues ask me about my personal experience performing in-office treatments, such as intense pulsed light, thermal expression procedures and microblepharoexfoliation. Although they’re excited by the idea of implementing these treatments to help their patients with dry eye disease (DED), many of them are apprehensive about talking to patients about the associated costs of these out-of-pocket procedures.
Recommending cash-based procedures is a new conversation for many in our profession. Some doctors choose to hand off the cost discussion to their staff, but I prefer to address the subject myself because it strongly aligns with my desire to build trust and transparency. Once you’ve stepped outside your comfort zone and had this discussion a few times, you realize it’s really straightforward, and patients respond incredibly well to this approach.
Why I discuss costs
A lot of my eye care colleagues warily tell me, “I don’t like ‘selling.’” Neither do I! But after I’ve spent an hour doing a new patient’s initial dry eye evaluation, I want to continue building trust by sharing all the facts, not by having my staff spring the cost on them after the fact. To me, that approach feels like a car dealership “bringing in a closer,” a sales strategy I prefer to avoid in my practice.
By giving patients the complete picture, including clinical benefits, alternatives and costs that may factor into their decision-making, I’m preparing them to work through their decision with me. It’s an educational process, not “selling” a treatment. And because I personally make sure patients are comfortable with the cost, I never worry that they’re not 100% on board with treatment.
There’s a clinical advantage to this discussion as well. When I recommend a procedure and discuss the costs, patients are often quite willing to have an in-office procedure performed the same day. This would be difficult or impossible if I handed off the patient to a staff member. And by making treatment inroads right at the initial evaluation, we can streamline care for patients who have been suffering from DED.
How to have this simple conversation
While having a financial conversation up front may seem intimidating, it is truly not that difficult. You just need to get used to it.
In my practice, it all starts with a medical exam for a new DED evaluation, which typically runs about 45 to 60 minutes. Patients start with extensive objective testing. Next, we have a 10 to 15-minute discussion about their medical and dry eye history, followed by a thorough slit lamp exam.
Treatment recommendations are all about education, so my next step is to broadly explain DED, and then I review the patients’ objective testing — meibography, noninvasive tear breakup time, lipid layer interferometry and blink analysis — and explain what each test tells us about their condition. Finally, we’re ready to discuss treatment:
- Explaining treatments: First, I go through a base DED treatment protocol — omega-3 nutritional supplementation, lid hygiene, blink exercises, warm compresses and artificial tears — for everyone in my care and describe why we use each part of this treatment regimen. Then I explain that our dry eye clinic offers advanced in-office treatments that have been clinically shown to produce more significant results than most home therapies alone, and I may recommend one or more of those treatments based on their individual condition.
For example, I might say, “Based on your findings and testing, which show you have meibomian gland dysfunction, I think OptiLight (Lumenis) would be an excellent treatment choice for you.” I would follow this up by explaining how OptiLight works to specifically address MGD. - Introducing costs: Continuing with the OptiLight example, once I’ve explained why I think it’s the right choice, I add, “This treatment is FDA-approved for your specific condition. Based on your findings, I think it will be very beneficial. The only downside is that it’s not covered by insurance. It takes four treatments to achieve the desired effect, so we bundle all four together at this cost.” The approach is simple, conversational and honest, and the patient response is overwhelmingly positive.
- Reaching a decision: Finally, I present patients with their choices. “At this point, we have two options: You can start the base protocol treatments for a few months, and then we’ll see you back to reevaluate how you’re doing and decide if we want to pursue more advanced treatment. Or, if you want to be a bit more aggressive, we can start in-office treatment today in addition to these base treatments. But ultimately, the choice is yours.” After educating my patients about DED and their treatment options, they almost always choose to have the recommended in-office procedure, often on the same day.
Visible value: Do the procedures yourself
Another question peers often ask is whether I perform in-office procedures myself or delegate them to a technician. Some doctors choose to delegate these treatments to technicians — a safe and viable alternative that offers revenue advantages for the practice. However, although my technicians are more than capable of performing nearly all of our in-office procedures, I choose to do the majority of them myself.
This ties back into the cost conversation because patients psychologically feel a procedure has more value when it’s performed by a doctor rather than a technician. It does require more of my time, about 10 minutes per treatment with techs doing pretreatment prep, but after telling patients that I think an in-office treatment is their best option, I want to back up this value, trust and confidence — all essential characteristics of a successful relationship for long-term management of DED — by performing the treatment myself.
For more information:
Cory J. Lappin, OD, MS, FAAO, practices at Phoenix Eye Care and the Dry Eye Center of Arizona.
Collapse
Read more about
Click Here to Manage Email Alerts