A Winning Formula for Improving Premium IOL Conversion Rates

Taking extra time can translate into extra income.

BY WILLIAM K. CHRISTIAN, MD

Despite phenomenal advancements in presbyopia-correcting IOLs, the average conversion rate to these lenses in the United States remains around 8% to 9%. A huge discrepancy in conversion rates also exists between different ophthalmologists across the country. The biggest difference between ophthalmologists with a 70% conversion rate and those with a 7% conversion rate is not that the former are much better surgeons; it’s that the high converters are better at educating and communicating with patients about presbyopia-correcting IOLs.

Educate the Patient

Communicating the benefits of presbyopia-correcting IOLs begins as early as the cataract consultation. The process begins with the scheduling receptionist. It is imperative the receptionist tells the patient to bring a spouse or significant other to the appointment. This serves a dual purpose. First, it provides an extra set of ears to ensure the patient clearly understands what each IOL option entails. Second, it’s important the patient has the ability to discuss the options with a spouse or family member immediately after the consultation, while the information is fresh in both their minds. Conversion rates to premium IOLs markedly decrease when the patient is left to remember the doctor’s words and translate to a spouse later.

It is also helpful for the receptionist to obtain an e-mail or a home address so educational material introducing presbyopia-correcting IOLs may be sent to the patient before the visit. This gets the patient intrigued, even excited, about premium IOLs before he or she even meets with the surgeon. This educational primer tends to facilitate the conversation between the patient and surgeon. It prepares the patient for the concept of having to choose a lens.

Attitude Counts

Once the patient arrives for the appointment, it’s vital he or she has a pleasant experience from start to finish. It is much easier for anyone to reflexively say “no” to something when irritated. The decision for a patient to spend money out-of-pocket on an IOL is no different.

A key component of the patient’s experience comes from the overall culture of the practice. The biggest pitfall in providing a good experience for patients is wait time. It becomes difficult to keep patients happy if their experience starts with an annoying wait. This puts the cataract consultation behind the eight ball from the start and creates an uphill battle for the conversion rate.

Another important aspect is how the patient work-up proceeds. We should treat all cataract consults as though they are being evaluated for a presbyopia-correcting IOL. This includes obtaining corneal topography before the surgeon enters the exam room. The surgeon needs to know the patient’s degree of astigmatism to best address the patient’s expectations of immediate postoperative visual acuity.

Dialogue between the patient and staff during the evaluation is equally important. This interaction sets the stage for the surgeon during consultation. If staff uses words such as “upgrade” or “premium,” it imparts the perception that these custom IOLs are not typical, or are somewhat of an elective luxury, like flying first class. Patients typically prefer to conform to what’s “normal,” especially when faced with something as foreign to them as eye surgery. So, it’s important to create a sense, both to the patient and to our staff, that the practice’s “norm” is a presbyopia-correcting IOL. Banning the use of words such as “upgrade” and “premium” and evaluating all cataract consults in the same manner will help achieve this environment.

Four Key Points to Discuss with Patients

In shaping patient expectations, keep in mind these four key talking points:

■ Inform the patient about nighttime vision. You must inform the patient about the real possibility of seeing haloes and glare around streetlights and headlights while driving at night. It is best to tell him or her to just expect these dysphotopsias and that it is fine if they occur because the brain learns to ignore them over the ensuing six to 12 months. If you do this before surgery, patients rarely will have a major issue with them postoperatively.

■ Stress that presbyopia-correcting IOLs are intended to maximize spectacle independence. This approach is different than promising the ability to eliminate spectacle wear completely. This is an important distinction to make and one that trips up many ophthalmologists on the path to becoming successful refractive cataract surgeons.

■ Inform the patient of any visually significant residual refractive error after the operation. This prepares the patient for any subsequent laser refractive procedure once their refraction has stabilized at three to four months postoperatively. It’s better to charge a little more out of pocket at the front end to all patients to offer this free laser enhancement to the few that need it. The patient who needs laser refractive enhancement after cataract surgery typically already feels disappointed and frustrated. The last thing we want to do is then have to ask him or her to pay out-of-pocket for this corrective procedure.

My approach is to suggest a specific presbyopia-correcting IOL rather than the full array of custom IOLs. Asking patients to choose only confuses them and they are seldom confident in their selections. It’s also imperative we don’t undervalue cataract surgery. By describing cataract surgery as quick, painless, bloodless, and “no stitches,” what we’re unconsciously doing is imparting the impression to our patient that cataract surgery is “easy.” Doing this just makes it harder for patients to understand the value of a procedure that costs several thousand dollars out-of-pocket per-eye, regardless of the IOL they select.

■ Discuss price with the patient without getting into specifics. Many times, patients will just passively sit there agreeing with everything the doctor recommends until the out-of-pocket price is brought up. Then, they tend to snap out of their fog, and an alert, engaged patient has some very important questions to ask. It’s always better for we surgeons to field these questions ourselves. This brings total clarity to the patient’s expectations. Problems tend to arise when these questions are left to the financially incentivized surgical coordinator to address.

A Perpetual Satisfaction Machine

Having success with refractive cataract surgery does not just come hand-in-hand with good surgical results. Success comes with happy postoperative patients and they translate into a happy surgeon, which then perpetuates into more happy postoperative patients. It can become a wonderful cycle that catapults the practice’s revenue while creating cheerleaders out of patients. Success in this arena is dependent on the surgeon investing the chair time with these patients preoperatively. OM