Ophthalmology Business

MAR 2014

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.

Issue link: http://digital.ophthalmologybusiness.org/i/273499

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Page 12 of 27

go radial. If this occurs, the cataract may drop to the back of the eye, or it can result in vitreous prolapsing into the anterior chamber. If these complications occur with a patient that has selected a premium lens, the surgeon must abort and insert a different kind of intraocular lens. A third benefit of laser cataract surgery occurs during the hydrodis- s ection stage. Performed by hand, this step is conducted with fluid while you try to cleave the cataract away from the capsule so that it will spin easily. If a lens will not spin, problems such as zonular stress and dehiscence around the capsular bag may occur if you try to force the lens to rotate. The laser makes gas pock- ets within the capsular bag that help dissect the lens away from the corti- cal layer. This "pneumodissection" is gladly welcomed each time and helps reduce the importance of cortical cleaving hydrodissection. I have had several cases where I have bypassed hydrodissection and the cataract has been extremely mobile. Fourth, the laser fragments the lens, obviously significantly reducing the use of phaco, or ultrasound ener- gy. Less energy is safer on the corneal endothelium and on the iris. In addition, the laser makes a perfect crack down the middle of the lens, thus simplifying the step of manual cracking and fragmenting. The sur- geon can also customize the laser grid pattern to take into account the density of the lens, further eliminat- ing ultrasonic energy delivered inside the eye. Patient education Patients entering our office often do so with trepidation, expressing fear that their surgery will not be success- ful due to variable factors such as movement or difficulty holding the eye open. To educate our patients on their options and to help build their confidence in us, we have imple- mented a simple patient education program. When potential cataract surgery patients book an appointment with us, we mail them a brief cover letter and brochure about our laser and lens options. Our cover letter wel- comes them to our practice and informs the patients about the only two decisions that they will need to make. The first decision is about how to remove the cataract, either m anually or with the laser, and the second is about what type of lens will replace the cataract. When patients arrive at the office for the initial consult, we show a five-minute video on an iPad while their eyes dilate. Afterward, I meet with the patients and discuss their options. I have found that the majority of my patients are already sold on the laser after reviewing the brochure we sent previously and viewing the video. They want the peace of mind the technology offers them, regardless of the additional expense. We then discuss the addi- tional cost that is not paid by insur- ance and explain that as a bonus, this price includes correction of astigmatism. We also discuss lens selection, which includes a lifestyle assessment. From there, the patients work with our surgery coordinator. Economics When considering the purchase of a laser cataract machine, due diligence is a key factor to confidently select- ing the right machine for your prac- tice. Of great importance is the eco- nomic impact this investment will yield. There are several factors to consider including fixed costs, per case costs, amortization, and variable costs. In addition, we wanted a qual- ity laser that we could rely on and know that it truly was improving patient outcomes without increasing complications. In our particular case, we calculated that we would need to perform 16 laser cataract procedures per month in order to achieve a sat- isfactory return on investment. We projected a 30% to 40% conversion rate to meet this quota. However, we have far exceeded our expectations with a 75% conversion rate less than two months after installation of the laser. As a result, we will reduce amortization costs due to early repayment. Marketing Our practice is part of a university hospital located in a rural area of North Carolina. With the nearest metropolitan area over an hour away, our demographic is by no means wealthy. Still, we have not found it necessary to invest in televi- sion, print, or radio ads. Marketing has occurred primarily through word of mouth by our satisfied patients. I also attribute our high level of con- version to our excitement as sur- geons about the laser. Once we began doing cases and seeing posi- tive outcomes, it became quite easy to promote the laser to potential cataract surgery patients. Conclusion The addition of the laser cataract machine to our practice has been a positive and natural transition process. We credit our high conver- sion rate to several key factors, including the safety benefits offered to the patient, successful outcomes generating positive word of mouth marketing, and our own enthusiasm for the machine that has made the cataract surgical procedure simpler and safer. OB March 2014 • Ophthalmology Business 13 Dr. Walter is associate professor of surgical sciences, Wake Forest University Eye Center, Winston-Salem, N.C. He has financial interests with Abbott Medical Optics (Santa Ana, Calif.). Dr. Walter can be contacted at kwalter@wakehealth.edu. 02-19_OB March 2104_Layout 1 2/19/14 11:07 AM Page 13

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