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Cover Focus | June '13

What’s Your Practice Style?

Managing Premium IOL Selection for Patients in Private Practice

Nine years ago, I sat in a conference at the Grand Hyatt of Dallas/Fort Worth’s airport excited and attentively taking in the brilliant strategy offered by the talented Kay Coulson, MBA, on how to position these new lenses called premium IOLs. She, along with Kerry Solomon, MD, and Eric Donnenfeld, MD, offered new ways to counsel cataract patients on selecting these elective lenses. For the first time, cataract patients were going to have the opportunity to choose to invest their own money in a medical procedure traditionally covered by insurance to create a value-added outcome.

Most of the expert suggestions were useful, but some seemed a bit unattainable. The presentation was fabulous, and it got the attendees to dream big, but not every tip would work for every eye surgeon who wanted to start using these new IOLs. I knew that our office wouldn’t be able to completely redesign our interior, and it also would not be practical for our office to create a “silo day” where we could devote an entire business day to strictly counseling patients on potential premium IOL procedures.


In the multispecialty private practice I had joined, I quickly learned that the bottom line is always something to consider. I knew that we were going to have to pick and choose the best strategies to fit our needs. The one big takeaway I did get at the conference on premium IOLs was that my staff and I were going to have to slow down, go back to the basics, and invest the time needed with patients to make sure they understood their options and felt comfortable with the surgery.

Although I am not promoting any one recommendation over another, I thought it may be useful to see what patients’ experiences are like at our office. I wouldn’t imply that any of our surgeons or staff are gurus only after 9 years; however, I do believe we now have the familiarity and confidence to comfortably discuss the IOL choices, and we definitely deliver a better experience for our patients. Fortunately, as a surgical device goes, I believe that premium implants are no longer in the introductory phase but are in the growth phase. Like LASIK, some patients are now familiar with this technology and have family or friends who had the procedure themselves, and this makes the educational process a bit easier. On the other hand, femtosecond laser technology in cataract surgery is still very new, and educating patients is something that requires more chair time.


First impressions mean everything, but they also need to last. We expect our staff to have a clean, conservative appearance. We also train them to believe that the office exam room and hallways are like a stage: they must never break character, and their character is a smart helpful and professional eye technician. Each patient should be greeted brightly and with a smile, a smile that can even be seen over the phone if delivered well. Early education for patients is an important part of our customer service. If the patient is aware of his or her diagnosis or has been referred to us, we mail cataract pamphlets and e-mail informational videos via Eyemaginations Online. Early education informs patients and gets them excited about solving their visual problems.



Our back office technician collects an accurate medical history, starts the physical eye exam, and completes the primary testing to aid the surgeon in making the proper diagnosis. In the past, we used the vision preference checklist at this stage. We often found, however, that the sheet was filled out incorrectly. Prudent patient selection is important, but we found the checklist sometimes excluded patients who might otherwise be able to consider premium IOLs. We now offer the patient an IOL menu sheet that provides a full disclosure of all of the IOLs our office provides. Traditional phacoemulsification and femtosecond laser surgery are also presented.

The idea of a silo day is well intended. The aim is to ensure that potential premium IOL patients received a little more time with the staff and the surgeon for education. Our strategy is one that employs color-coded charts. Potential premium IOL patients have a red chart, so that there is an unspoken understanding that these patients should and will be given premier service. This sets the tone for the staff and alerts them that these patients will have a different flow through the office. We maintain the classic beige chart for all other medical patients.

All of our patients are encouraged to watch a 5-minute animated video (Eyemaginations). A picture is worth a thousand words, and for the last 6 years, we have found that the computer animation is a friendly and safe way to begin patients’ education of what to expect from the cataract surgery. The materials also provide a further discussion about the IOL choices. The option to explain the surgery in Spanish and other languages has also been huge for our office; there are newer versions of Eyemaginations for the iPad (Apple, Inc.).


The surgeons make the final diagnosis and recommends the appropriate surgery. I also feel we must review all of the IOL choices with patients and then discuss which implant best fits their needs. If there is family in the exam room, it’s important to loop them into the process as well. If the patient seems interested and motivated, I mark the IOL sheet and give it to him or her and say that this is my recommendation. I never promise that glasses won’t be needed, and I warn everyone about halos and glare and let them know that these side effects can occur more with multifocal IOLs. Next, the patient meets with the scheduler to discuss the timeline.



The scheduler is responsible for reviewing any last-minute details, finalizing the surgery date, obtaining informed consent and medical clearance, and reviewing fees. With many IOL choices, informed consent continues to remain crucial before surgery. Not only do we need to ensure that patients are told of the potential complications of cataract surgery, we need to be sure that patients know which IOL they selected and why. Our form is Ophthalmic Mutual Insurance Company or OMIC approved and similar to its consent form. On the last page, patients not only circle the IOL of their choice but then consciously cross out the remaining alternatives so they understand what they have consented to. As far as fees, any practices that do not offer some financing options like Care Credit or Reliance are potentially losing patients that could otherwise consider premium IOLs. If patients have any last-minute questions for the surgeon, the schedulers always know that I am available.


Our office has found the steps discussed herein helpful for teaching and encouraging more patients to consider premium IOLs. Professional service, a team approach, and proper education continue to be keys to providing premier service and outstanding patient care.

Damien F. Goldberg, MD

Damien F. Goldberg, MD is in private practice at Wolstan & Goldberg Eye Associates in Torrance, California. Dr.Goldberg may be reached at goldbed@hotmail.com.

June '13