Eyeworld

Methods for making laser-assisted cataract surgery fit in your practice 2 fee for astigmatic patients who receive a toric IOL as we do for those receiving arcuate keratoto- mies. Marketing the technology After we implemented our laser, we began talking with patients about it and featuring it on our website. Surgeons also use other types of marketing, such as brochures and television, print, and radio advertisements. In our practice, our website and referrals from patients and doctors are our best marketing tools. Conclusion Owning a femtosecond laser for cataract surgery has been very successful for us and has grown our practice. Although some surgeons worry that femtosecond procedures may take longer, the laser should not slow them down that much. When considering this pur- chase, I recommend examining your baseline and the costs and developing a pro forma. If you think it will work, I encourage you to consider it strongly. I think it will work at your current level and help you grow your practice in the future. References 1. Uy HS, et al. Femtosecond phacoemul- sification: the business and the medicine. Curr Opin Ophthalmol. 2012;23:33–39. 2. Donaldson KE, et al. Femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2013;39:1753–1763. 3. Hatch KM, et al. Laser-assisted cataract surgery: benefits and barriers. Curr Opin Ophthalmol. 2014;25:54–61. 4. Bartlett JD, et al. The economics of fem- tosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2016;27:76–81. Dr. Slade practices with Slade & Bak- er Vision Center, Houston. He can be contacted at sgs@visiontexas.com. By developing the pro forma, we knew what to expect as we proceeded. It is not a difficult exercise. There were no surpris- es, and the costs are relatively straightforward. Surgical fees When charging patients for pro- cedures, we simplify the process for them, offering three cataract packages, based on the surgeon's fees (Figure 2). These focus on patients' desired postoperative uncorrected vision. However, we do not overpromise that they will not need glasses. The distance vision package includes a monofocal IOL and monovision if patients prefer. This is what insurance usually will cover. However, it does not correct astigmatism. Patients with astigmatism will need to wear glasses after surgery. The middle package corrects astigmatism with either a toric IOL or arcuate keratotomy, pro- viding good uncorrected distance vision. However, patients will need glasses for near and interme- diate vision. The goal of the third package is to treat presbyopia so patients can read without glasses at near, intermediate, and far. We try to make the decision as easy as possible, without offer- ing too many financial choices. For example, we charge the same added personnel costs for operat- ing the laser and allotted a small amount of real estate in our prac- tice for the device. We compared these totals with our practice revenue and growth potential. Based on our volume of cataract cases, we thought the femtosecond laser would help us grow our practice. I think surgeons who are exploring the option of purchas- ing a femtosecond laser should take these steps. Bartlett et al. also discussed how to perform a cost analysis when determining whether to purchase a femtosec- ond laser. 4 Our patients are impressed with the technology and our experi- ence with it. They appreciate the precision and potential of the laser. We were impressed with our results with the technology. Costs of ownership Of course there are a number of considerations when weighing this investment. 1–3 To determine whether we should purchase the technology, we asked our ac- countant to develop a pro forma for acquiring the laser, which included the capitalization costs, per-click fees, and maintenance fees (Figure 1). Of course, we also Figure 1. Primary costs when purchasing a femtosecond laser continued from page 1 Primary costs when purchasing laser • Capitalization costs • Per-click fees • Maintenance fees Additional considerations • Personnel fees • Space requirements Figure 2. Sample cataract packages based on the surgeon's fees Package Patient goals What it includes Anticipated result Distance vision Distance vision after surgery Monofocal IOL, including monovision, if desired. No astigmatism correction Glasses needed for near and intermediate. If astigmatic, will need glasses at all distances Astigmatism correction Astigmatism correction for distance vision Astigmatism correction with toric IOL or arcuate keratotomy Good uncorrected distance vision. Glasses needed for near and intermediate Presbyopia correction Ability to read at near, intermediate, and distance without glasses Multifocal or accommodating IOL Reduced dependency on glasses

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