A Private Practice Model for Laser Vision Correction

At Inland Eye Institute in California, our business model for laser vision correction (LVC) has always included a three-pronged marketing approach. Although this model has evolved over time in response to economic changes and new technologies, at its heart is still the recognition that we need word-of-mouth patient referrals, optometric referrals, and direct-to-consumer advertising to grow and thrive.

Historically, we have kept our LVC fees at the upper end of the spectrum. We offer tiered pricing based on the degree to which enhancements are covered. The three tiers are:

• Entry Level (Silver): This package covers all pre- and postoperative care for 1 year, including dry eye treatment as needed. However, enhancements are not included.
• Mid Level (Gold): As our most popular tier, in addition to all pre- and postoperative care, this package includes enhancements within the first 5 years.
• Premium (Platinum): Included in this package is a lifetime enhancement commitment.

I am a big believer in performing the best surgery possible. No matter which tier patients choose, they get the same advanced technology. I always make femtosecond laser flaps, and all ablations are wavefront-guided unless the patient is not a candidate for a custom procedure.

INSPIRE PATIENTS TO REFER

Patient referrals are the easiest and least expensive way to keep an LVC practice healthy, but patients do not automatically think to make referrals. At each follow-up visit, our staff actively asks patients to share their experience with friends, either in person or on social media. “If you are happy with the results of your surgery, a referral would be a great compliment,” I tell them.

A patient’s visual acuity result is the most important predictor of willingness to refer. Those with worse than 20/20 UCVA are not likely to be satisfied or to help spread the word—at least not positively. The LVC platform I use, the Star S4 IR excimer laser, iFS femtosecond laser, and Advanced CustomVue (all by Abbott Medical Optics), consistently delivers excellent outcomes that can be a foundation for referrals. On the first postoperative day, 90% of eyes are 20/20 or better, and 60% are 20/16 or better (Figure 1). By 3 months, approximately 90% are 20/16 or better.

We take advantage of those wow moments, when the patient is seeing better than 20/20, to remind him or her of how far he or she has come and to encourage referrals. The more time that passes after surgery, the more patients take their surgical results for granted. The anniversary of their surgery is another opportunity to send a message or thankyou gift to bring the surgery back to top of mind.

A BALANCING ACT

Every practice should engage in comanagement with optometrists and invest in direct-to-consumer marketing, but the balance between the two will vary from practice to practice. What works for marketing campaigns (lower prices) tends to have a chilling effect on comanagement efforts. How expensive one practice’s media market is can also make a big difference in which approach is more cost-effective.

Inland Eye Institute has always been weighted more toward comanagement. As a refractive surgeon, I acknowledge that the optometric office is where most LVC patients receive most of their eye care needs; it is where they get their contact lenses and glasses and where we can most easily find them when they are ready to get rid of contact lenses and glasses. Additionally, our 40-year-old comprehensive ophthalmology practice depends on community optometrists for referrals for many other services, including cataract, glaucoma, and retina surgery.

Comanagement is one of the reasons that we have kept our LVC fees on the high end. I am not comfortable exceeding the 20% comanagement fee that US Medicare has deemed reasonable for cataract surgery, so keeping total fees relatively high is a way to ensure that our comanagement payments are attractive.

The emphasis on comanagement means that we actively strive to be optometrist-friendly. For example, we consistently reach out to the optometric community through educational seminars and are accessible to them beyond LASIK referrals, such as consultations for corneal ulcers and other problems. We also have made a conscious decision not to compete with optometrists on optical sales. Any loss in revenue from not having an optical shop in our office is more than offset by the gain in optometric good will.

Because we are located in an expensive media market (metropolitan Los Angeles), we do not buy as much radio and TV advertising as practices in smaller cities might. We have found, however, that maintaining a baseline of direct-to-consumer marketing allows us to further our name recognition, if nothing else.

Direct-to-consumer marketing is an area where I believe most practices are best served by outside assistance. Enlisting the help of a marketing professional who is aware of current trends in advertising and social media is advantageous. We use an agency that specializes in elective surgery marketing. Our contract commits us to a monthly fee but also incentivizes the agency by providing higher fees for successful campaigns. Our oculoplastics and premium IOL businesses also benefit from these advertising efforts and can share the cost.

IMPACT OF NEW TECHNOLOGY

When CustomVue first came out, many surgeons viewed it as a golden opportunity to increase prices after years of cost cutting. The result was a shift back to where LASIK prices belonged. The introduction of femtosecond lasers was another opportunity to justly increase pricing, although our practice chose not to adjust pricing for laser-created flaps.

Major jumps in technology are few and far between, and one lesson from the experiences of the past decade is not to discount prices too much because it is difficult to bring them back up.

Two new LVC techniques, ReLEx smile and presbyopic LASIK, are not available in the United States and therefore have not affected our LVC business.

The addition of premium IOLs, cosmetic surgery, and dermatology treatments has given the practice a wider range of elective procedures and an increased opportunity to market to similar demographics; for example, those seeking Botox (onabotulinumtoxinA injection; Allergan) may also be good LASIK candidates. Lens-based refractive surgery has not significantly affected LVC volume because corneal procedures remain my preferred option for presbyopes without significant lens changes.

We will likely see a major impact on the LVC market when the US Food and Drug Administration (FDA) approves corneal inlays for presbyopia. Not only will many inlay patients require LASIK to get to the sweet spot for that procedure, but also the buzz about a treatment for presbyopia will generate interest in all types of refractive surgery.

PATIENT BARRIERS TO LVC

There are two major patient barriers to LVC: fear and cost of the procedure.

Fear. A referral from someone the patient trusts can help overcome the fear he or she may have concerning undergoing LVC.

Cost. We have taken two approaches to overcome LVC procedural costs. The first is to offer financing options that make the procedure more affordable, and the second is to establish a low entry price.

Tiered pricing, however one structures it, gives the practice a lower starting price to quote over the phone. We are confident that we can convince patients that Inland Eye is the best option for them once they see our advanced equipment, meet the doctors and staff, and hear about our results, but a lower starting point helps to get initial price-shoppers in the door. The starting point in pricing has to be real, so that patients do not feel they were victims of a bait-and-switch tactic.

Additionally, scripted conversations help the receptionist and call center staff understand how to effectively talk about price.

CONCLUSION

There is no doubt that the LASIK market is down from where it has been in years past, making an LVC-only model challenging. Fortunately, most ophthalmologists have other sources of practice revenue and have been able to expand those while maintaining successful LVC practices.

As the economy continues to recover from recession, and particularly as we reach a point at which younger demographic groups have greater job security and less debt, we should see a resurgence in LVC volume.

Christopher L. Blanton, MD, is President and CEO of Inland Eye Institute in Colton, California. Dr. Blanton states that he is a consultant to Abbott Medical Optics and Allergan and a medical monitor for Abbott Medical Optics. He may be reached at tel: +1 909 825 3425; e-mail: blanton007@aol.com.