Eyeworld

32 | EYEWORLD | NOVEMBER 2019 R EFRACTIVE Dr. Chang: When it comes to the global period, I don't differentiate between astigma- tism and presbyopia correction. My global period is roughly 1 year. "One year" because that's plenty of time for refractive change, any enhancements, and neuroadaptation to stabilize. "Roughly 1 year" because if the process is tak- ing longer—for example if the patient is travel- ing or busy with life for a few months—I want them to go use their vision instead of worrying about the timing of any additional care or pro- cedures they might need. Perhaps they miss an appointment or two, need a YAG laser capsulo- tomy, then an excimer laser enhancement, and it runs into the second year. It rarely does but my general attitude is: they've paid me, I'll do what I need to do to make them happy. Dr. Thompson: We're the same way, we have a global fee. It's the same period of time as yours. Early on, I didn't have a global fee. I charged for the enhancement, and I had more patients frustrated. They thought at 20/25 they didn't want to pay the extra for the enhancement, so they thought 'I'll just live with this,' but they never experienced the joy of getting to 20/20. Now that we've incorporated the enhancement into the global fee, they take advantage of it when we show them. I think having a global fee leads to higher patient satisfaction. Dr. Vukich: Does the global fee include a YAG capsulotomy and at what point does that expire? If a patient comes back after premium surgery at 3 years and requires a capsulotomy, how do you handle that? Dr. Thompson: We have a refractive cap- sulotomy and a therapeutic capsulotomy. A therapeutic capsulotomy has to meet the visual criteria, but a refractive capsulotomy, when "Patient Out-of-Pocket Expenses for Today's Best Practices and Lessons Learned" About the doctors Daniel Chang, MD Empire Eye and Laser Center Bakersfield, California Eric Donnenfeld, MD Ophthalmic Consultants of Long Island Rockville Centre, New York Robert Maloney, MD Maloney-Shamie Vision Institute Los Angeles Kerry Solomon, MD Carolina EyeCare Physicians Mount Pleasant, South Carolina Vance Thompson, MD Vance Thompson Vision Sioux Falls, South Dakota John Vukich, MD SSM Dean Clinic Madison, Wisconsin George Waring IV, MD Waring Vision Institute Charleston, South Carolina William Wiley, MD Cleveland Eye Clinic Brecksville, Ohio At the 2019 ASCRS ASOA Annual Meeting in San Diego, the Refractive Surgery Clinical Committee hosted a roundtable. The roundtable was chaired by John Vukich, MD, and Vance Thompson, MD. They were joined by Daniel Chang, MD, Eric Donnenfeld, MD, Kerry Solomon, MD, Robert Maloney, MD, George Waring IV, MD, and William Wiley, MD. What follows are highlights from a transcript, edited for length, from the second part of the discussion. The final part of the discussion will be shared in the next issue of EyeWorld. Dr. Vukich: What might a refractive cataract practice anticipate as an enhancement rate? Dr. Solomon: I think the enhancement rates are probably under estimated. We'll show patients who are 20/25 and 20/30, we show them the 20/20s, because the truth is patients might tell you and the staff that they're happy and then they leave and tell everyone else, "You know what, this really kind of sucks. I paid all this money and I'm not really getting what I want." So, we'll show them what's possible and some patients may say, "It's not that big enough of a difference, I'm fine"—that's great. Others might say, "You know, I love that, let's do that." People are concerned their enhancement rates would go up with that and it really hasn't, at least in our practice. I would say our enhance- ment rates are easily 10% and may be as high as 15%. Dr. Donnenfeld: The misconception is that happy patients build busy practices. It's actually patients whose expectation has been exceeded. A happy patient is the bare minimum of what you need to be in practice. I'm very aggressive about offering patients enhancements even when they're happy, because if they're happy with 20/25 vision, think how happy they'll be with 20/15 vision. Those are the patients that appreciate the extra effort you're willing to put in to achieve those results to become an excep- tional refractive cataract practice. Dr. Vukich: Most of us have a global fee for our patients. How long is that global fee effec- tive? Is there any end point at which you no longer would do an enhancement?

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