Strategic Update to an Economic Model for LACS

I am a senior cataract and refractive surgeon at the Atakoy branch of Dunya World Eye Hospital in Istanbul, Turkey. As the country’s most respected private eye hospital, our practice is known for using the latest technology and providing patients access to the latest techniques in each ophthalmologic subspecialty. For instance, our refractive surgery unit has long been equipped with many laser platforms in order to provide patients with a full range of laser vision correction options. We have also acquired a femtosecond laser platform for cataract surgery, so that now our cataract patients can enjoy the same level of customized care that we have offered for years with refractive surgery.

The femtosecond laser was first introduced to Turkey by our hospital in 2003. Over the years, we devised many marketing activities to promote femtosecond lasers in refractive surgery, and blade-free LASIK has gained wide popularity. In those 11 years, I have witnessed how femtosecond laser flap creation has increased the safety and success of refractive surgery, and I am now witnessing how the same is true of laser systems for cataract surgery.

Dunya World Eye Hospital was the first in Turkey to acquire a femtosecond laser unit for cataract surgery, purchasing one as soon as they became commercially available. We first purchased the LenSx (Alcon) and then the Lensar (Lensar). Seven hospitals belonging to the Dunya Eye Hospitals group now offer laser-assisted cataract surgery (LACS), and an eighth is close behind.

FRAMEWORK FOR LACS

Surgery. Our laser technicians are responsible for the daily operation and maintenance of all femtosecond laser units, and each trained cataract surgeon has access to the LACS system. The Atakoy branch has five surgical theaters, of which one is reserved for the femtosecond laser unit. The LACS procedure begins in this room, and, after the laser portion is performed, the patient is taken to one of the other rooms for the surgical part of the procedure.

Pricing structure. In Turkey, cataract operations are covered under social security, but hospitals have the right to charge a limited additional amount. Our patients must pay out-of-pocket for LACS. After they are informed about its advantages, many elect this procedure. Patients also pay a separate additional cost for a premium IOL.

We try to promote LACS with various marketing methods. At first, with no competitors in the market, we were free to price the procedure as we saw fit. We decided on a price that we thought was affordable for patients and that was calculated to cover our investment expenses. As other Dunya hospital branches purchased LACS units and more surgeons started to have access to the procedure, we updated our economic model to a more affordable one in order to increase our overall LACS volume in some of the other hospitals. At that time, we repriced the procedure, reducing patient costs to two-thirds the initial amount. The hospital management also assesses patient reactions to the price of the procedure regularly and uses other benchmarks to ensure that our facilities remain a competitive option for Turkish patients. Because our LACS numbers regularly increase, we believe we have set the right pricing level. No other services are included in the cost unless astigmatic keratotomy is planned; in that case, Pentacam (Oculus Optikgeräte) and topography exams are included.

THE IMPACT OF LACS

I was already a high-volume premium IOL cataract surgeon, but adopting LACS has slightly increased the volume of procedures I perform. The addition of this procedure has also provided a significant increase in the hospital’s overall volume, which has enabled our junior doctors to perform more surgeries. I have found that my LACS cases steadily increase in proportion to the confidence I have in the procedure. I tell patients that the laser is my high-tech assistant, helping me perform better and simpler surgeries.

My premium IOL volume may have also increased slightly because I now feel more confident with a perfectly centered and well-sized capsulorrhexis. Other surgeons in our hospital system who previously did not implant premium IOLs have started to implant them more frequently as they have adopted LACS. Consequently, the total number of premium IOLs implanted in the hospital system has increased significantly.

CONCLUSION

Our philosophy at Dunya World Eye Hospital is this: Lasers will surely pay for themselves as we use them. But even if they do not, providing the latest technology to our patients is a must for our hospital, and it further protects our excellent reputation.

Haluk Talu, MD, is a senior cataract and refractive surgeon at the Atakoy branch of Dunya World Eye Hospital, in Istanbul, Turkey. Dr. Talu states that he has no financial interest in the products or companies mentioned. He may be reached at e-mail: haluk.talu@dunyagoz.com.