Over the past 5 years, many of us in the developed world have moaned about the economic downturn and its impact on our practices, specifically difficulties in getting patients through the door and in generating adequate returns on investments. Yes, in Europe and the United States things have not been easy, and some of our fellow EU countries, particularly Greece, Spain, and Italy, have been hit hard. The United Kingdom has not been spared either, and, speaking for myself, we expanded during a downturn but thankfully managed to get through and are now thriving.
This issue of CRST Europe may be unexpected by our readers, as it concentrates not on surgical technique but rather a variety of practice models that have been of benefit to the contributing authors. Whereas some common themes are present, there are also many unique strategies, each of which has a specific fit for the individual practice described.
Some strategies, such as providing phenomenal customer service as advocated by Tom S. Tooma, MD, are fairly universal. Providing good service does not require a huge capital investment in terms of technology, but it does require good discipline and understanding by the whole team, from call center staff and reception to the clinical team and back office.
We are all aware of the risks of adopting new technologies in an economic downturn, as spending valuable cash when money is tight is risky. But from reading the rationales for doing so of a few risk-takers (Luca Gualdi, MD; Federica Gualdi, MD; Veronica Cappello, MD; and Massimo Gualdi, MD, in Italy, and Joaquín Fernandez, MD, in Spain), one can see how they have clearly derived benefit from adopting new technologies. Several of their suggestions can be beneficial to us all: (1) developing a rationale to increase fees, which in turn increases revenue, (2) introducing a new offering and product line, such as laser-assisted cataract surgery (LACS) or a laser procedure for presbyopia correction (eg, Supracor, as discussed by Jean Jacques Chaubard, MD; and Olivier Chauveau), and (3) marketing these technologies as differentiators from other practices, thus providing a means for increasing market share, as discussed by Dr. Tooma.
It is encouraging to see several successful models of provision of LACS. For those who charge an additional fee specifically for this procedure, it is interesting to see that patient acceptance is increasing. As Pavel Stodulka, MD, points out, we are probably going through a similar phenomenon as we did when femtosecond LASIK first became available. A large number of nay-sayers believed that femtosecond laser technology for refractive surgery was expensive and unnecessary and that blade microkeratomes were perfectly satisfactory. Ten to 12 years later, femtosecond technology has become the standard of care, with satisfactory economic models and more competitors than one can count in the refractive surgery space. Will the same be true of LACS? Many believe so.
Finally, it is reassuring to read the Turkish experience illustrated by Haluk Talu, MD, in which adoption of LACS has led to an increase in patient volume and a decrease in pricing—an altogether better option for patients. This model is one that might have application in the public health setting, such as in the UK National Health Service. (Our US counterparts across the pond will surely cringe!) It is wonderful to see a variety of approaches to economic models of laser surgery, and I am sure you will find some useful take-home messages throughout this issue.
Sheraz M. Daya, MD, FACP,
FACS, FRCS(Ed), FRCOphth
Chief Medical Editor
