Eyeworld

Like Dr. MacRae, Dr. Hardten has experienced staff go over pric- ing. But while Dr. MacRae uses a senior technician, Dr. Hardten uses a patient care coordinator. "It's helpful for the schedulers to be able to spend more time with the patient, going over the exact charges, what's included, and what's not included," he said. "The best thing is to have the staff prepared for a wide variety of questions." John A. Vukich, M.D., surgical director, Davis Duehr Dean Center for Refractive Surgery, Madison, Wis., uses a similar system. He takes it a step further, though, by actively staying out of pricing and financial discussions, making only a clinical recommendation based on patients' needs and wants. For example, Dr. Vukich will ask patients if being free of glasses is im- portant to them. If they say "no," that ends the conversation about premium implants. "I try to soft sell unless the pa- tient says, 'This is really important, I want to be free of glasses,'" he said. "Then I'll tell him or her what my recommendation is to achieve that goal." From there, Dr. Vukich sends the patient to the in-house coun- selor to go over the specifics of pric- ing and financing and answer any remaining questions. "The consumption of time can be crushing otherwise," he said. "These are patients who tend to be internet savvy and will come in with a lot of questions, taking up as much time as you're willing to give them. Of course, that doesn't provide effi- cient patient flow." Not everyone works this way, however. Melissa Cable, M.D., F.A.C.S., Discover Vision Centers, Kansas City, Kan., actually speaks to her patients directly about pricing and insurance during the initial consultation. "Patients are always interested in the advanced technology and their question to me is, 'Will my in- surance cover it?' That's a natural lead-in to the cost conversation," she said. "Their reaction is all over the board. I have some patients with sticker shock. Then I have some pa- tients who planned on this. They have friends with these lenses, they know how much they cost, and they came in wanting them." Like her colleagues, Dr. Cable keeps her techs well versed on pre- mium IOLs so they can answer pa- tient questions before she gets into the room. "My techs know the lenses I pre- fer and if they hear something that makes them think this is a full-focus patient, the tech will start the process by having the patient watch a video or read a brochure," she ex- plained. All of the doctors use some sort of third-party financer for those needing a payment plan, although the companies differ. Dr. MacRae uses Capital One and Dr. Cable uses CareCredit. For many cataract pa- tients, though, financing isn't help- ful because they aren't actively working. Additional money isn't coming in and the patient is living off savings and retirement. Whether or not that deters fixed-income pa- tients from premium IOL purchases can't be anticipated, as it's extremely variable. "It's very hard to predict who will pay for it and who will not," said Dr. Vukich. "You can give all sorts of examples of elective things people will spend money on. It de- pends what their value system is." "Usually, if a patient is curious about premium IOLs but not sold on the idea, the patient perceives the cost as high," said Dr. Hardten. "For the most part, when patients find out what pricing is, they are pleas- antly surprised it's not $10,000 per eye." Whatever the decision, it's criti- cal they aren't swayed. Premium IOL patients tend to have elevated ex- pectations and are looking for value received for money spent. Patients who have been talked into these lenses are known to be most critical of the technology and the most dis- satisfied. "The lower the motivation to get premium IOLs, the higher the frustration with post-op vision," said Dr. Hardten. "Patients who aren't motivated to be free of glasses are the ones who complain more about glare and halo at night. They're a lit- tle bit harder to manage." There's no perfect answer or sys- tem when having pricing discus- sions with patients. But regardless of who in the office leads the conversa- tion, it's best to let the patient lead the premium IOL decision. EW Editors' note: None of the physicians interviewed have financial interests related to their statements. Contact information Cable: mcable@discovervision.com Hardten: drhardten@mneye.com MacRae: scott_macrae@urmc.rochester.edu Vukich: javukich@gmail.com Ethics of IOLs August 2011 Talking continued from page 45

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