Eyeworld

40 Dismantling barriers: Clinical pearls and practical guidance to implement laser-assisted cataract surgery by Gary Foster, MD Committing to laser-assisted cataract surgery W hen choosing to implement laser-as- sisted cataract surgery (LACS) in an ophthal- mology practice, sur- geons need to be sure they are ready to make the full commitment. Gathering the team To implement LACS successfully, surgeons need to be sure all team members are on the same page. If the surgeon and staff give different signals, patients will be confused. In my practice, we sat down with everyone on our team and reviewed findings of each of the scientific studies, which showed less tilt, less coma, better centration, better corrected distance vision, less corneal edema, and less macular edema. Our staff were impressed with these data and were all behind the technology. I did not need to drive the effort, and we were all on the same page. Establishing pricing In addition, clinicians need to establish a price that makes sense to them, their staff, and patients. There are two basic strategies. With a one-price bundling ap- proach, everyone who receives a to- ric lens or presbyopia-correcting lens also receives LACS. In this situation, we don't need to discuss the laser. The other is an a la carte approach, where patients can pay a higher price for laser and toric or they can pay a lesser price for the toric and manual surgery. The advantage of the bundling approach is that it is simple and makes it easier to speak with the patient. The benefit of the a la carte option is that it allows patients to price discriminate if they cannot afford the bundle price. Educating patients In implementing this technology, surgeons also need to develop an effective education plan, determin- ing in advance who will educate patients about their options, rec- ommend what is best for their eyes, and discuss financial aspects of the procedure (Figure 1). In our practice, we email patients a video link before their appointments. When they arrive for their visit, patients watch additional educational videos. Gary Foster, MD We also ask them to complete a questionnaire outlining their life- style desires and visual needs. It is important to recommend what we believe is the best option for them. I explain, "Based on what you have told me about what you want, I would recommend the fol- lowing lens." I'm very specific about the lens, and I'm very clear about why I recommend it, what I dislike, and what it will not do for them. The patient then moves on to the scheduler, who discusses insurance and financial factors. Planning flow The practice also needs to plan efficient flow. If the surgeon operates in one room and the laser is outside that room, it does not affect surgeon flow. The surgeon can perform the case and leave the room to perform a laser procedure while staff is turn- ing over the room. Conclusion Surgeons who choose LACS should make a definitive decision and move forward without vacillating, for the benefit of both patients and staff. Everyone on the team should be on the same page. Surgeons also should establish a price that makes sense, an effective education plan, and an efficient flow. Dr. Foster is a cataract and laser eye surgeon in Fort Collins, Colo. Figure 1. Patient education plan Effective education plan Options: Before arrival: Email video link During dilation: Video Recommendation: Administer questionnaire Use: "I recommend" • Presbyopic IOL • Toric IOL • Single-vision IOL Financial options: Counselor It is important to have a fi- nancial informed consent to help patients make this decision. In weighing whether to adopt LACS, surgeons also need to consid- er the economics of not offering it to their patients. There are ongo- ing pressures to improve financial performance in medical practices. In addition, the marketing transforma- tion, which touts bladeless surgery and other advances, is underway. If surgeons are not yet sold on the advantages of femtosecond laser technology and desire to answer the question themselves, they may opt for a transportable laser (Figure 1). With mobile lasers, there is no guar- anteed financial commitment. They do not have to train an operator or have a laser engineer because they come with the laser. In addition, they do not have to pay expensive maintenance costs. After performing approximate- ly 20 cases per month, however, it begins to make sense for surgeons to consider investing in their own laser. Conclusion The bottom line is that surgeons need to assess the economic impact if they decide against LACS. It is be- coming increasingly challenging to operate a financially healthy medical practice, and advanced technologies that bring patient benefit can signifi- cantly improve both the bottom line and the joy of practicing medicine. LACS is affordable and the benefits and risks can be calculated. We need to make the best decisions " If surgeons are not yet sold on the advantages of femtosecond laser technology and desire to answer the question themselves, they may opt for a transportable laser. " –Vance Thompson, MD continued from page 39 for our patients, but it is a nice side benefit when it makes our practices healthier. Dr. Thompson is director of refractive surgery, Vance Thompson Vision, Sioux Falls, S.D.

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