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Cover Focus | Jul/Aug '16

Ethical Upselling

An Actionable Approach to Premium Lens and Laser Upgrades

I’m a sucker for an upsell. Optional technology system on a new car? Throw it in; how else will I fully enjoy my new ride? Taking that extra value meal from a medium to a large for only $1? How can I say no to those empty calories? Finer dining? The chef is recommending the fresh catch? As I often say, “I didn’t come all this way to do it wrong…”

Maybe it’s the salesperson deep down inside of me that wants to capitalize on others’ attempts to help me see the benefit of the upgraded option, or my bias as a medical practice coach and consultant, but I appreciate the art of creating additional desire for a product or service a consumer didn’t initially set out to purchase but sorely needs. Sales is something we do for people, not to people when we truly believe in what we’re selling.

Of course, helping a patient upgrade to the femtosecond laser and a premium IOL holds much more weight than upsizing to a large fry and requires a deliberate process with a level of sophistication and nuance. Assuming a patient is an excellent candidate for a premium lens or laser-assisted procedure (suitably low risk, significant potential for improvement, realistic expectations), the process of helping him or her realize, then take advantage of, the benefits of such upgrades actually begins well before his or her scheduled consultation.


If a doctor is just entering practice fresh from fellowship, it is understandable that he or she would have a lean staff. It might be just the doctor and the Jack- or Jill-of-all-trades (receptionist/nurse/biller/patient coordinator/marketing manager/sanitation engineer). Once the doctor has a practice of a certain size, however, the next most important position becomes the patient coordinator—the concierge in charge of maximizing every patient’s experience; the chief patient educator; the liaison; the protector of the doctor’s efficiency; and, indeed, the salesperson.

Any patient who calls the office and is interested in or in need of an appointment to consider a procedure that might involve an elective component—in this case, a cataract procedure—should be transferred to the most competent communicator, the patient coordinator. The patient coordinator should be equipped with skills and training allowing him or her to:

1. Efficiently build a solid level of rapport with the patient;

2. Gather the patient’s goals and details about his or her medical history that illuminate candidacy for the appropriate potential treatment or upgrade;

3. Communicate the accolades of the doctor and practice that set it apart from others;

4. Provide the chronological details of the cataract procedure, including preparation, anesthesia, recovery, follow-up, and results;

5. Outline the features and benefits of each level of the procedure, including a price range, such as: (1) traditional, (2) laser-assisted, (3) laser-assisted with upgraded lens;

6. Ask the patient which level of improvement he or she may be leaning toward;

7. Ask the patient about his or her timeframe for the procedure, should he or she be a suitable candidate, based on when he or she can take time to recover and afford the desired upgrade comfortably; and

8. Review what would be required to schedule a consultation and reserve a date for a procedure.

This eight-step process helps the patient feel heard and tied in to the practice’s goal of helping achieve his or her goals, become educated on the benefits of choosing this practice over another, and set recovery expectations during and after the procedure, increasing his or her comfort level. In short, the patient has now psychologically loosely committed to a course of action, pending the doctor’s recommendation.


Once in the office, the patient coordinator should greet the patient in the exam room prior to the doctor’s examination to reiterate all eight steps: continuing to build rapport, reconfirming the patient’s desires, re-educating the patient on the practice and procedure, and regaining commitment to a course of action, pending the doctor’s directives.

Armed with this information, the coordinator can prep the doctor on what was covered, allowing the doctor to greet, confidently examine, and then provide the patient with a recommendation that is neither passive (“You could have the LenSx and Crystalens, but it’s up to you.”) nor aggressive (“You definitely have to upgrade.”), but directive (“You’re a great candidate for a laser-assisted procedure with a premium lens, and, if you were my mom, that’s what I’d recommend.”).

The patient, by this point, has been given his or her options and indicated interest not only once over the phone but again, in person, to the coordinator. The doctor has confirmed the plan of action in a directive manner. Now, for the grand finale: the “close,” to use sales-speak, which, if the aforementioned is executed flawlessly, is only as “hard” as upgrading to a large fry. All the coordinator has to do is ask, “So, did you have any other questions before we go ahead and get you on the schedule?”


The answer isn’t always an easy “yes,” but as patient coordinators practice and improve, they will realize large increases in upgraded procedures. This is a win not only for the practice but also for the patient who achieves improved vision after being educated and well prepared by a competent staff. The satisfaction of happy patients and happy bosses is ultimately much more satisfying than those empty calories.

Ed Syring
Ed Syring