How refocusing on our patient base has kept my practice strong in a slow market.

My partners, staff, and I made a decision 4 years ago to try to broaden our patient base. We did not want to be the kind of practice that continuously seeks new surgical patients and then sends them elsewhere to get follow-up care. I call that strategy the “catch-and-release” model, and it has helped many cataract and refractive surgeons succeed financially over the years. Nevertheless, we have made “vision for a lifetime” the theme of our office. The following describes the strategies we have employed to fulfill this goal.

A NEW MODEL
In response to the economic downturn that has affected elective surgery, we have refocused our attention on our existing patient base. We used to receive 60% of our surgical volume from referrals. We still support our referral doctors, but we found out that our patients would rather see us for long-term follow-up. Therefore, we have established a program to keep our patients for a lifetime by talking to them about the general health of their eyes and educating them about the services we offer to maximize their vision over the years. We treat everything from congenital ocular defects that require LASIK surgery to presbyopia and refractive lens exchanges. Many patients we treated 10 to 15 years ago have returned to us for additional treatments.

CHANGES IN SCHEDULING
We redistributed our staff's time so that they now spend more time on examinations and less time in surgery by one-third. We now place more emphasis on long-term follow-up care by calling patients who are due for follow-up to come back in. Many people do not schedule regular eye examinations as long as their vision remains stable for several years. Once they start experiencing symptoms of presbyopia and early cataracts, however, they are happy to return and learn about the latest treatments. We are enjoying steady growth in the lenticular part of our practice, for example, because a lot of our patients who have had refractive surgery are very interested in preventing presbyopia and early cataracts, and these individuals are good candidates for alternative refractive procedures such as refractive lens exchange. We also are conducting more nutritional evaluations and treating many more patients for dry eye. Again, we are increasing our focus on our existing patients rather than trying to continuously grow our practice, and the strategy is working. My staff is busy, we are setting records every month, our surgical days are full, and I am performing more examinations than ever.

SURGICAL CONVERSIONS
I think the most effective strategy for converting patient examinations into surgeries is to educate candidates. As part of our new business model, we purchased new diagnostic equipment to study the lens more carefully. We take a photograph at the slit-lamp of each person's dilated eye so we can show patients their lens and compare the image from their last visit. We also take Scheimpflug photography images of dilated eyes with the Pentacam (Oculus, Inc., Lynnwood, WA) in order to show patients the increased density of their lens. We recently added a machine called the OQAS (Visiometrics, Barcelona, Spain), which is a special aberrometer that can measure scatter in the lens. These tools have improved our diagnostic capabilities and allow us to inform patients about the life cycle of their lenses. These devices have already proven their value; for example, we found that early nuclear sclerosis was the cause of significantly decreased vision in some of our patients. Consequently, we have been performing more refractive lens exchanges, and patients have been commenting, “I wish I had done this 5 years ago. My vision has never been so sharp. I didn't know my colors were starting to fade.” As a result of these patients referring their relatives and friends, we are starting to see more patients whose cataract disease does not yet qualify for Medicare or other insurance coverage choosing to undergo refractive procedures at a younger age, when they are healthier and will get more benefits out of the procedure. I believe that this growth is a direct result of focusing on our patient base, who already know and trust us. In addition to referring friends and older family members, many of these patients are bringing in their kids for LASIK surgery. Thus, we have been spending less on external advertising and conducting more internal marketing.

FOCUSING ON THE EXPERIENCE
Our philosophy of the patient experience is to exceed their expectations during every minute and at every touch throughout the examination. My staff is really into friendly, quality service. We strive for a great experience in every area, from the phones, to the front desk, to the check-in, to the educational counseling, to their interactions with the doctor. We try to give patients an enjoyable experience that they will want to tell their friends about. Visitors never wait at our front desk or fill out a form on a clipboard; we take them back immediately. Our practice really is a positive environment, and I believe that patients talk about the quality of their visit as much as the quality of their vision. My staff loves this model, too. They appreciate the compliments from the patients, which in turn motivates them to continually strive to improve.

INVESTING IN THE STAFF
When my other partners and I decided to implement this business model, we invested in our staff. We conducted a lot of education about interacting with patients and using the new technologies we purchased. We provide the staff uniforms and we hold monthly team meetings. Our managers are very oriented toward making the employees happy to work with us. We want to be an employer of choice in our area and have people waiting in line to work here. We do not want our employees to feel like theirs is just a job.

IN CLOSING
I really believe that we surgeons have to get better if we want to survive a weak economy. The economy will improve eventually, but I do not think we have seen the worst of it yet. My staff and I decided not to wait for something we cannot control. We have tried to position ourselves so that we have a strong foothold in these uncertain times, and we will be ready to grow when the economy turns around.

My advice to other surgeons and clinical administrators would be to pay attention to your staff; they are your biggest asset. Your second-biggest asset is your existing patient base, so focus on what you can do for them. Consider that every patient you have treated with LASIK will need IOLs eventually. If you keep or reestablish contact with your patient base, they are more likely to refer new patients to you.

Daniel S. Durrie, MD, is Director of Durrie Vision in Overland Park, Kansas. Dr. Durrie may be reached at (913) 491-3330; ddurrie@durrievision.com.

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You can maintain a healthy surgical volume in a weak market if you know how to attract patients.

Many practitioners adopt a fatalistic outlook when the Consumer Confidence Index falls. They tell themselves, “Well, there's really nothing I can do. It's the economy.” If you have set your practice's achievement bar to average, then you're right. However, smart, innovative practitioners know that during tough times, they will shine the brightest. Discriminating consumers who demand more value for their dollars expose flaws in lesser practices' customer service, patient handling, and outcomes. Make no mistake; even in these uncertain economic times, there are plenty of people willing and able to pay for LASIK. They're deciding whether you're worth it.

THE ECONOMY IS NOT THE PROBLEM
Consider the statistics. In the US, 46 million adults between the ages of 20 and 54 wear glasses or contact lenses.¹ We know that 5 million of these folks have had LASIK, but 10 to 11 million more people want the procedure.² Over 2 million of these potential candidates will call your practices this year,³ yet only 650,000 will be treated! ⁴ Think about that for a minute. As a group, you refractive surgeons deliver services to only one-third of the people who contact you about LASIK every week, every month, and every year! You don't need a better economy; you need to do a better job of capturing the huge pool of customers who reach out to you.

Is it possible to find an extra 20, 30, or 50 eyes per month out of this huge pool of 10 million people? Yes — by changing your viewpoint. The following is a list of mistakes refractive practitioners are making and suggestions for how to solve them.

1. It's how you market. Many practices' marketing campaigns promote a message about “us”: our surgeon, our technology, our experience. You should be talking about “them,” as in, your target consumer. What vision you will give them, how LASIK will help them, etc. Also, your messages must alleviate the fear that LASIK is not safe. Calculate your practice's percentage of 20/20 and 20/Happy patients and make this total number the cornerstone of your message.

2. It's how you answer the phone. Does your phone staff know how to take control of a call? How to uncover the caller's fears? Do they know how to answer a question about price in a way that will book the consultation, or how to explain that LASIK is simply bringing the eye back into round? Do they know your (their surgeon's) outcomes and how to explain them in patient-friendly terms to callers?

3. It's how you and your staff behave when customers enter your office. This includes how the reception area looks, how the staff is dressed, and the appearance of the lanes and lounge areas. Have an objective party grade your practice on a scale between a doctor's office on one end and a spa on the other. The evaluation should include every detail, major and minor: greetings, staff's clothing, office furniture and magazines, chart jackets — even the number of tissue boxes displayed. Tissue boxes do not say 'vision spa!'

4. It's the hurdles you make them leap. In a patient-centric practice, why would any visitor need to be out of contact lenses before a consultation, or out of soft lenses more than 3 days before surgery? Why would you ever hesitate to do a monovision trial with proper fitting and astigmatic correction? Why wouldn't you always do surgery on Fridays, and include punctal plugs in the global fee? Why would you give someone an appointment time for surgery, and then tell him to arrive 30 minutes in advance of that time? Make your practice patient-centric, not surgeon-centric. A surgeon-centric mindset undermines superior customer service every day of the week, and it stalls LASIK volume.

ALWAYS LOOK FOR IMPROVEMENT
Instead of waiting for the economy to change, look for how you can create change for your practice. Diagnose problem areas. Develop an improvement plan. Follow through. Building a LASIK practice is predictable and expandable if you monitor and improve performance metrics. The two most critical metrics:

• Seventy-five percent of inquiring patients should attend a consultation. Every inquiry counts, and you must encourage, prod, and monitor your employees to make sure they take accurate counts of inquiries. You will be amazed at the leads you didn't even realize were coming through your office because they were mishandled, dropped, or transferred to voicemail and they never left a message.
• Seventy-five percent of consultative patients should attend surgery. I don't mean 75% of candidates, but 75% of all consults. Every consult counts. Re-examine your candidacy requirements if your surgeries have fallen below the benchmark. Is your ASA versus LASIK requirement too strict? Is your pachymetry threshold too tight? Are you a practice that looks for reasons to say “no,” rather than earnestly trying to say ”yes?” Fears of litigation are unfounded when laid against OMIC claims and settlements. Don't let fear cloud the criteria you use to screen LASIK candidates.

Every practice I have ever consulted with thought it was converting patients at 75% or better on both of these measures. Yet, if this were true, national LASIK volumes would be 2 million eyes this year, instead of the 1.2 million they actually will be.

IN CLOSING
Will LASIK look rosier when economic conditions in the US improve? Sure. But, is our success predicated on that improvement? Not at all. Look inward today to fine-tune your LASIK practice. You will find real practice growth and a more satisfied patient base.

Kay Coulson is the Founder of Elective Medical Marketing (www.electivemed.com), a consulting group based in Boulder, Colorado, that helps surgeons build their elective vision service lines. Ms. Coulson may be reached at kay@electivemed.com

1. US Census Bureau 2007 population estimates. Available at: http://factfinder.census.gov/servlet/DTTable?_bm=y&-geo_id=01000US&-ds_name=PEP_2007_EST&-
_lang=en&-mt_name=PEP_2007_EST_G2007_T006_2007&-format=&-CONTEXT=dt.
Accessed September 15, 2008.

2. Total adults, weighted by population (Doublebase study). New York, NY: Mediamark Research & Intelligence Inc; 1999.

3. Author's proprietary research, 2000.

4. Trends in refractive surgery (quarterly report). Fort Worth, TX: Alcon Laboratories, Inc. Available at: http://www.alconmeded.com/docs/Alcon_LVC_Report_2008.pdf. Accessed September 17, 2008.

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