Ophthalmology Business

APR 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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"It's not like buying a phaco machine because these devices may not last as long as our phaco devices do," Dr. Miller said. "With the service agreements currently out there, practices are going to have to do a significant amount of procedures just to pay the agreement fees." Dr. Miller said the number of patients that elect to have the laser aspect of cataract surgery is probably the most important financial consideration—if a practice has 250 patients/year who opt for the service, the practice will need to charge around $550 plus a $400 procedure fee in order to break even in five years (providing for a 7% financing over the life of the laser and a base price of $450,000), but those numbers drop to $93 plus the $400 procedure fee per patient if the practice is performing 1,500 a year. And, unfortunately, "most practices don't know what their volume is going to be until they actually sign on the dotted line and get their femtosecond laser and then start trying to sell it to patients," Dr. Miller said. Dr. Weinstock said he wanted to position his practice as an early adopter and decided to purchase a laser early on "and just jump in with both feet." When one laser didn't offer all the features he wanted, Dr. Weinstock waited and purchased a second system. In Utah, Dr. Rivera said many physicians are contracted to perform cataract surgery in the hospital because private pay patients "cannot have surgery in an ASC." And hospitals are notorious for having limited funds that need to be spread over disciplines that are deemed more profitable than ophthalmology. At Jules Stein, Dr. Miller said the financial model where the laser will bring in money above and beyond what insurance pays is "something hospitals don't know how to deal with very well." He's been negotiating for a femtosecond laser for more than two years and still has not been able to convince hospital management it's in the best interest of patients. "In an ASC setting, the few principals make the purchase decisions. So it's easier for them," Dr. Miller said. "Learn from your colleagues in the area who have already gone through this process, and don't be so quick to jump into it, and really get a sense of your volumes." If surgeons have not begun to offer premium IOLs, "the first thing they have to do is get used to charging for premium services: premium lenses, astigmatism management, whatever; get into that first before you buy a femto laser because you'll get killed financially otherwise." He also advises surgeons to get comfortable discussing the finances of femto for cataract and not delegate it to practice personnel. ASCs have plenty to evaluate as well, Dr. Weinstock said. "There are so many compliance issues and regulatory issues that go hand in hand," he said. Patient flow will slow as they undergo an additional step under a different machine. If a practice serves an area where patients simply do not have the means "to invest in their vision and their cataract surgery and their outcome financially," surgeons will have a difficult time upselling, he said. "That's a very important consideration in this equation," Dr. Weinstock said. "I really am afraid that those who don't pick up [how to use this technology] will be left behind," Dr. Rivera said. SightPath Medical (Bloomington, Minn.) recently announced its intention to offer a mobile femtosecond (MoFe) laser for cataract service. The MoFe service suite will include a femtosecond laser, an intraoperative wavefront aberrometer, and a certified laser engineer, offered on a stop fee and variable cost basis. A nationwide rollout is planned throughout 2013, the company said, which may be a way for some practices to gauge patient acceptance of the technology without outright purchasing it. Patient considerations Dr. Rivera's patients "are coming into the office and demanding femtophaco," he said. "They're telling me they've done the research and this is what they want." Dr. Soscia's group conducted several focus groups to gauge interest, to try and define patient financial thresholds, and to determine how to market the technology to their patient base. "That involved everything from our advertising to rewriting our brochures to revamping parts of the website," he said. OB Editors' note: Drs. Miller, Rivera, and Soscia have no financial interests related to this article. Dr. Weinstock has financial interests with Alcon (Fort Worth, Texas) and Bausch + Lomb (Rochester, N.Y.). Contact information Miller: 310-206-9951, kmiller@ucla.edu Rivera: 801-568-0200, rpriveramd@aol.com Soscia: 941-806-9784, sosh@tampabay.rr.com Weinstock: 727-244-1958, rjweinstock@yahoo.com April 2013 • Ophthalmology Business 15

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