Eyeworld

December 2016 • Ophthalmology Business 15 "I analyzed in what percent of my cases I was using toric lenses, in what percent of my cases I was using LRIs, and then tried to find a price point that was in the middle of those two," he said. "If I put in a toric lens, maybe I lose a little bit, but I make up enough from my LRIs that I don't think about it," Dr. Bafna said. 3. Choose the right word Standard, routine, conventional vs. basic. Premium vs. advanced technology. Word choice can make all the difference, according to Dr. Tipperman. "The second you say standard, people assume that's the operation everyone will have because everyone wants what everyone else gets," he said. "But if it's a basic operation, they understand it a bit differently. … It's not pejorative; it describes to the patient what it is. You get what you pay for and not much more." Premium, on the other end of the spectrum, implies luxury, Dr. Tipperman said. "People are not willing to make a luxury purchase, but they are willing to make a purchase for technology that is better," he said. "That's why I think a lot of how you describe it to patients is helping them understand what is the value proposition of what they're getting out of surgery. Sometimes, if they miss the value proposition, they don't realize that it is something that is at least worth considering." Instead of premium, Dr. Tipperman prefers calling options that allow for refractive outcomes advanced technologies. As for de- scribing these specific technologies, Dr. Tipperman said he thinks patients understand astigmatism-correcting IOLs more than the term toric, for example. Instead of monofocal or multifocal IOLs, he uses the terms fixed-focus lens and lenses with more range of vision or focus, respectively. In a presentation at the 2016 Com- bined Ophthalmic Symposium in Instead of speaking with patients about every cataract surgery option under the sun, Dr. Bafna said his practice started to lump various tech- nologies together into broad catego- ries from which patients can choose. "From a consumer standpoint, I want to achieve a certain level of vision. When I choose a provider … I trust that provider to make the right choices and try to determine what I need in order to get that particular type of outcome," Dr. Bafna said. As such, he spends more time speaking with patients about their hobbies, their profession, and what they hope to achieve with their vi- sion after cataract surgery. 2. Consider a fixed price point In addition to bundling technolo- gies into broad categories based on desired outcomes, Dr. Bafna said he keeps those bundles at a fixed price point as well. This gives the physician more freedom to change technologies, if necessary, to achieve that outcome without an awkward financial discussion. "The perfect example is a patient with 1 D of astigmatism," Dr. Bafna said. "In the past, I used to be in a difficult situation where, for example, I told the patient [I would put in] a toric lens. If I ended up not using a toric lens, [I would have to] go back to the patient and refund money. "Or worse, let's say I'm in the OR and I thought I was going to do an LRI and I determine that the best thing is a toric lens. I'm thinking 'Do I put in a toric lens and after the fact say I need another $900 to cover a toric lens?' It's an awkward situation. "I've felt at the time of surgery that a toric IOL would be the right thing, but because the patient had chosen an LRI, I went with the LRI and felt like I compromised," he said, explaining that bundling technol- ogies in packages with fixed prices helps avoid those situations. Doing this, he said, has raised the cost of these refractive cataract surgery options by about $1,000. C ataract surgery has more options than ever: manual capsu- lorhexis vs. femto laser-created; manu- al chopping vs. femto fragmentation; limbal relaxing incisions vs. toric IOLs; monofocal IOLs vs. multifocal IOLs; intraoperative aberrometry, and more. When presented with all of these options, patients can get what Shamik Bafna, MD, Cleveland Eye Clinic, Cleveland, calls "analysis paralysis." "Initially, when we started this process, we tried to give too much information at the very beginning. Patients were overloaded and said, 'Let's just do what insurance covers —I don't want to deal with anything else,'" Dr. Bafna said. For patients who might have valued spectacle independence after cataract surgery, this is an opportu- nity lost, both for them and for the physician who could have performed a potentially more satisfying surgery. But counseling a patient on cataract surgery that could have a superior refractive outcome without feeling like you're a salesman can be nuanced. "Most people did not go into ophthalmology to be involved in retail-type sales, so this is something that makes doctors uncomfortable," said Richard Tipperman, MD, Wills Eye Hospital, Philadelphia. Both doctors offered pearls for counseling patients on cataract sur- gery options that help them make the best decision for their refractive goals, which might mean sticking with monovision and glasses, or it might mean femtosecond laser-assisted cata- ract surgery with a multifocal IOL. 1. Be outcome oriented Understanding a patient's visual goals from the start—a reasonable target outcome—can eliminate a lot of needless talk about technologies that might not be of interest or appli- cable to them. continued on page 16

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