Article

Moving LASIK From Good to Great

Enhance the patient experience while optimizing outcomes

Moving LASIK From Good to Great

Enhance the patient experience while optimizing outcomes.

BY KAY COULSON

Very few of us are new to the world of LASIK. Ophthalmologists who were just dabbling in the procedure exited the arena 5 years ago. The majority of LASIK today is performed by independent surgeons, specialists and large corporate entities. Yet many surgeons and administrators remain hopeful that the next big idea, the next captivating slogan or the next new piece of technology will unlock the doors to LASIK success.

Each of us believes that we have a good team, that our patients love us and that we deliver great results. If so, where is everybody? Nationally, the LASIK market is flatter than Kansas. At 1.4 million annual procedures, we have not grown at all since 2000. We have not broken the $2,000 per eye glass ceiling. And yet we have invested heavily in technology, staff and advertising specifically to grow LASIK.

To remain viable as a LASIK practice you must first perform the basics well. These can be captured in two broad categories — be positive and make it easy.

Be Positive

LASIK will grow if we focus on the benefits of the procedure, rather than comparative claims between technologies or surgeons. In the advertising that we develop for clients, we focus on three primary topic areas:

You want this. Capture the joy, the emotion and the hope that each customer feels about the possibility of LASIK. Focus on the whole person to effectively capture this emotion. I believe "body part" advertising epidemic in LASIK doesn't capture the full excitement of the LASIK decision and can actually be off-putting to the customer. They have a fear of their eyes being touched, so why do we zoom in on eyes or show lasers striking eyes in our ads?

LASIK is a great procedure. We should do more to emphasize how good LASIK is. The irrational fear people have is that they will go blind. A LASIK guarantee message is not so much about guaranteeing a medical procedure as it is about alleviating this irrational fear: "We're so confident in our results, we'll back it up."

We feel your (financial) pain. We should strive to make LASIK as affordable and achievable as possible. Utilizing themed programs for financing, flex spending and corporate discounts can help potential patients feel like the procedure is an employee benefit, with an insurance premium or even good credit helping them save.

Focus on the Patient Experience

LASIK practices should feel like vision spas. Nobody likes going to the doctor but everyone loves visiting the spa. How does your office compare?.

We Are Here to Serve You

Ensure that every member of the LASIK teams keeps a customer-centric focus. Patients should be greeted immediately upon check-in. Intake paperwork should be eliminated or modified so that it is approachable and brief. Technicians should approach and greet the patient before taking them back — never should they stand in a doorway and call out the patient name. Patients should be moved from the reception lounge to the work-up room to the consult lounge to scheduling. They should be seen within 5 minutes of their scheduled appointment time and never kept more than 5 minutes past their stated release time. Examine everything about your process. If it feels, sounds, smells and looks like a doctor's office, you do not have a great LASIK practice.

Are You a Vision Spa?Are You a Doctor's Office?
  • Reception lounge with attractive, modern furnishings grouped in seating pods.
  • Waiting room chairs lined up in rows.
  • Interesting books and magazines.
  • Time, National Geographic and Sports Illustrated.
  • Staff clothed in black, brown or navy suits
  • Staff clothed in scrubs, often mismatched.
  • Discovery Channel, IMAX or concert videos playing in the reception lounge. Procedure videos eliminated or presented privately to the patient after work-up.
  • CNN, soap operas on TV. Procedure videos on endless loop with the perception that this cuts down on surgeon lane time.
  • Lamp lighting.
  • Fluorescent lighting.
  • Uncluttered wood, granite or glass check-in counter. Attractive flat-panel computer monitors.
  • Formica counter with a sign-in sheet and lots of "Don't Do" and "Must Do" signs.
  • Make It Easy

    Answer the phone. It is amazing that this is continually mentioned in every article about developing a LASIK practice. Answer the phone. Within two rings. Personalize the discussion and effectively convert the lead into a consultation with a staff member who can listen and uncover the fears of the caller. This actually becomes a competitive point-of-difference because so few practices do it well.

    Offer convenient appointments. We are a service industry. Offer consultations over the lunch hour, first thing in the morning and at the end of the day or into evening hours. The same with surgery appointments. Every LASIK patient wants a Friday surgery date, but only some practices offer it. You do not want Saturday postops, but many patients cannot or do not want to take more than 1 day off work. Adjust your schedule to fit patient preferences.

    Provide simple payment options. Most practices take cash and credit cards. Only some accept personal checks. If you require advance payment or cashier's checks, re-examine your policy. This sends a message that you do not trust your patients and may be a policy held over from your comprehensive practice or a reaction to one or two bad apples.

    Maintain an uncomplicated fee structure. I'm a huge fan of either/or in offering elective vision procedures. Traditional or custom? Bladed or blade-free? LASIK or lens? I have not found it to be an advantage to offer a single fee. The one-price model emerged because staff prefers it. It does not attract more patients. It does not improve conversions. It does not showcase the technology advancements that are best for some, but not critical for others. It limits your ability to price and upsell effectively. You need a sub-$2,000 price point to convert effectively on the phone. The majority of patients will chose custom LASIK and/or a bladeless procedure once they attend the consultation.

    Recommend a procedure. Recommend what the patient should do. If a refractive counselor cannot commit to a patient that they are a candidate without having the surgeon review the chart, you have not set LASIK criteria appropriately for your staff. If you present patients with a full-distance vision vs. monovision LASIK option and send them home to think about it, you have lost the patient. The same for advanced surface ablation vs. phakic. Reason through the options silently while examining the patient and reviewing test results, but make sure that patient is very clear about what you recommend and aim to schedule the surgery at the time of consultation.

    The Real Key to LASIK Success

    Usually, after the above-mentioned practice improvement options are discussed, LASIK practice management articles stop. We look at our appearance, our employees and our advertising as the problems that need fixing. Many of you will say, "I do these things and we're still not growing." That brings us to the final, and in my view most critical aspect of LASIK success. We need to improve our results. We need to look at surgeon delivery of excellent outcomes. This is why LASIK is not growing.

    People do not know how good LASIK is. We do a terrible job as an industry in using our outcomes in advertising, patient communication and consultations to show each interested candidate just how great LASIK can be. What we sell is vision — specifically, glasses-free vision. The measure of success is 20/20 or better vision. Yet we promote the surgeon or the technology or the procedure fee or financing. Our med-legal paranoia has caused us to neglect the real benefit to the majority of our patients because we are worried someone will hold us to an outcomes standard.

    Many prospective patients think LASIK is not safe, or does not work. That is the flip-side of LASIK results. There are 38 million potential LASIK patients in the United States today. They wear glasses or contacts and are within the age range that we can effectively treat. Just over 6 million have had the procedure. So where are the other 32 million?

    LASIK practices live off word-of-mouth referrals. But have we considered that word-of-mouth might be hindering us just as much as it is helping us? Marketing consultant Shareef Mahdavi published an article in 2005 that demonstrated the power of referrals in the LASIK marketplace (The Whoops! Factor, www.sm2consulting.com). He cites consumer behavior studies that estimate a happy customer tells three people, while an unhappy consumer tells 10.

    This uncertainty is compounded by an industry that has priced itself from $299 to $5,000 per eye, the huge glut of physicians who claim they were first or best in some aspect of LASIK, and the technology face-off of small spot vs. iris registration vs. custom vs. bladeless. Is it any wonder the customer is confused? Is it any wonder we have paralyzed their willingness to act?

    How to Grow Your LASIK Practice

    We don't deliver great LASIK today. We deliver good LASIK. And good will not help us grow. To quote Jim Collins in the bestseller Good to Great. "Good is the enemy of great." Outcomes are the unspoken problem in more than 80% of practices today, because we do not track results. We do not report them. And we certainly do not live with them in real time to construct an accurate nomogram for surgery planning.

    Great LASIK happens when we provide thorough preoperative screening and surgical planning. If we thoroughly test, interpret topography correctly and ensure the eye is healthy, we are 80% successful. We achieve 100% when we construct each patient's surgical plan using a real-time accurate nomogram considering what your laser, with your flap-cutting technology, in your laser suite, with your hands, will deliver to this patient with this prescription today. Yet very few surgeons perform surgical planning using a personalize nomogram.

    The two best-known outcomes and nomogram programs available for the independent LASIK practice are DataGraph Med (www.datagraph-med.com) and Refractive Surgery Consultant (www.refractiveconsultant.com. The best estimate is that approximately 400 of the 2,000 LASIK surgeons in this country use these sophisticated and highly reliable programs. That is only 20%, and many of these systems are not in regular use in the practice because of poor data input or complicated planning output.

    When I begin work with a new LASIK practice, one of the first areas I examine is outcomes. Most surgeons think their results are great. Most who have personalized nomograms think they are used consistently in surgery planning. And in virtually all cases, this is false. In fact, one of the most difficult parts of the initial engagement is reporting to surgeons exactly what their outcomes are. Typically, they are good but not great.

    In my experience, great LASIK practices that incorporate all other aspects of an exceptional elective vision experience deliver 20/20 or better vision to 75% to 80% of their patients. I am often met with shock at this statement. Most surgeons believe they deliver 90%+ at 20/20. A lot of functional LASIK in the United States today is 20/30 or 20/25. Just a line or two off perfect. Not enough to enhance, but certainly enough to ruminate about with friends and family. "It's good. I wish it were a little better. I have a little trouble at night."

    In addition, much of the LASIK we deliver is 20/20 at distance for the 45-year-old who didn't hear it when you said they would need readers afterwards, and convey to their friends, "It's good, but I lost my close vision." And about 20% to 25% of the LASIK we deliver is monovision, which is good for many people, but not great. If the distance eye is not 20/20, monovision is not something that will generate substantial positive referrals. These acuity shortfalls are subtle. We may provide enthusiasm and coaxing in the lane to help the patient feel successful. But we need to be realistic about what they see every day, in every lighting situation.

    From "Good" to "Great"

    So how do we move LASIK from good to great? How do we move LASIK from no growth to growth? The changes we must make involve locking down that last +/-0.50 D of variability. Surgeons must move off laser-recommended nomograms into personalized nomograms. Surgeons must move off gut-feel, day-of-surgery planning and develop an objective, complete, accurate database of results so that the regression formulas used for surgery planning are perfectly aligned to their personal technique.

    If we could deliver +/-0.25 D accuracy, we could move LASIK satisfaction from 80% to 90%+. This increase in happy folks will shift the scales to a more positive customer buzz about LASIK, rather than the flatline we see now. If we then use outcomes meaningfully in advertising and consultations so that people factually see how great LASIK can be, we will grow.

    Surgeons, the driver for LASIK growth is in your hands. You need an attractive office, a customer-oriented staff and a level of direct advertising just to exist in elective medicine. But if you must choose only one investment in your LASIK practice in the coming year, invest in outcomes and nomogram development software. This $2,000 to $8,000 expenditure will yield the greatest return to your practice and our industry. Patients will tolerate old furniture, bad magazines and late appointments. They will not tolerate marginal results. OM

    Kay Coulson is president of Elective Medical Marketing and assists surgeons in the growth of their elective vision practices. She has no financial interest in any of the companies mentioned here. She can be reached at kay@electivemed.com.