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6 Secrets to Success With Laser Cataract Surgery
Expert advice if you're thinking of adopting the femtosecond laser.
Scott LaBorwit
Publish Date: June 8, 2018   |  Tags:   Ophthalmology
Scott LaBorwit, MD
CONVERSION RATE Cataract surgeon Scott LaBorwit, MD, purchased his first femtosecond laser 6 years ago. More than two-thirds of his eligible patients choose laser cataracts.

When I decided to buy a femtosecond laser for cataract surgery 6 years ago, I wasn't certain I could make it work financially. At the time, no blueprint existed. I was the first cataract surgeon in the Baltimore area to purchase a femtosecond laser and only the 42nd in the country to obtain the brand I chose. Of this, however, I was sure: After seeing the accuracy and precision of the laser, integrated with imaging and, in my opinion, the new level of safety, I needed to make the option available to my patients.

Doing my usual spreadsheet analysis for adopting new technology, I determined I would need to perform 14 cases a month with the laser to cover my expenses for the next 5 years, and patients would need to spend more than $1,000 per eye out of pocket in addition to their insurance copays and deductibles. I filled in the rest of what would become my femtosecond laser-assisted cataract surgery business strategy based on the issues and challenges I was able to anticipate. Happily, the principles I initially set forth have worked very well. Two years after I purchased the laser, 68% of my eligible patients were choosing laser cataracts, and I purchased a second laser, this time with a partner in my surgical center. So today, both ASCs I'm affiliated with, one as the majority partner and one as a minority partner, own a femtosecond laser. A few secrets of my success:

"To maximize the benefits of laser cataracts, I've changed the non-laser parts of my surgery to reflect what the laser accomplishes."

1 Believe in the technology wholeheartedly. Without my core belief that laser cataracts is a better procedure for patients and a more predictable procedure for me, I wouldn't have been able to convey my enthusiasm to my staff members and referring doctors. I would have had nowhere to go from there given how they also need to be enthusiastic to make the technology a success for the practice and surgery centers. Explaining to staff and referring doctors why I want to use the laser was a crucial step. Early on, I closed the practice so staff and I could have a lunch-and-learn session. What sealed the deal for staff and referrers was seeing the laser in action. Everyone observed a procedure, including the billing department. Had I known the incredibly positive effect this would have, I would've made it happen even sooner.

DING DONG As the surgeon implants the IOL in the OR, the circulating nurse rings a wireless doorbell, which signals a technician to prepare and position the next patient in the femtosecond laser room.

2 Control information in a positive way. In order not to overwhelm patients by giving them too much information about laser cataracts, I keep it simple and provide it in stages. New patients receive a brochure about laser cataracts with their mailed intake forms. When they're in the office, we hand them a brief introduction to implants, which also points out that their surgery can be done with laser. Every staff member understands what laser cataracts is, but I am the first to discuss it. During dilation, we let patients relax and watch fun programming such as Johnny Carson and Candid Camera. I see them after dilation and testing. If I'm recommending cataract surgery and they indicate they'd like to schedule it, I explain the 2 ways it can be done: manually or with laser. I explain that I can use the laser to make incisions, open the capsule, break up the cataract and manage astigmatism. I don't tell patients that the laser procedure produces better outcomes or that they'll be glasses-free afterwards, but I do say I prefer to use the laser, and astigmatism management can help their post-op distance vision.

To preserve the integrity of the doctor-patient relationship, what I absolutely don't do in my conversations with patients is discuss price or ask them which procedure they'd like to choose. All of that is handled with 1 of 2 staff members whose duties include surgical counseling. The counselors answer questions and convey copay and deductible amounts. They walk through a menu indicating which procedures the patient is a candidate for: traditional, laser or laser with premium IOL. The menu includes the price for each as well as what the monthly payment would be with 2 years of interest-free financing for laser cataracts.

3 Think about your fees. While I can't tell anyone what fee to charge for laser cataracts, I can share what went into my decision. I wanted my laser cataracts fees to cover my costs and reflect the value of the procedure, but also to result in me using the laser for as many patients as possible. Even though I have the most laser cataracts experience in my area, my fee is just below the area's average. Also, for patients who choose laser cataracts and a premium IOL, I don't charge A (for laser) + B (for IOL). Instead, I charge a blended fee that's lower than A + B. I take a bit of a loss with that strategy, but I don't want to use a premium IOL without also using the laser, which in my opinion gives me the best predictability, effective lens position and astigmatism control. Interest-ingly, when I bought the second laser, I raised my laser cataracts fees to bring them closer to the average in the area, but the increase had no effect on my conversion rate.

DON'T OVERPROMISE Best not to tell patients they'll be glasses-free after laser cataract surgery.

4 Create efficiencies. We changed our clinic scheduling and our patient flow through the surgery centers to accommodate laser cataracts. In the clinic, every Monday and Thursday I do only cataract surgery evaluations. This lets me spend time with patients while educating them in a controlled and relaxed atmosphere. In post-op video testimonials that we record, most patients mention the amount of time I spend with them and the clarity of the explanations they receive. I see fewer patients on cataract evaluation days than the average seen by most ophthalmologists in a day, 22 vs. 35 to 50. However, I schedule 37 cases in 2 ORs each Tuesday and 25 cases in 1 OR each Wednesday —about two-thirds of which are laser cataracts.

In the surgery center, the laser is in a procedure room, not an OR. We schedule all of the laser cases before the manual cases. When I arrive in the morning, I perform the laser portion of 2 cases. That means there is always a patient waiting to be wheeled into the OR by the anesthesiologist while I do another laser. Patients remain on the same wheeled stretcher, which is a convertible chair/bed with remote-control memory settings. Each time I implant an IOL in the OR, the circulating nurse rings a wireless doorbell to signal the laser room that I'll be there in about 2 minutes. I speak to the completed patient's family while staff administer the topical anesthetic, place the lid speculum and position the next laser patient in the laser room. While I perform that laser, the OR is turned over and the next patient is wheeled in. With this system, I am at no time waiting for anyone.

"The best marketing strategy for me is to focus on keeping referring doctors informed and creating an experience for patients that keeps them coming back."

5 Change the entire surgical approach. To maximize the benefits of laser cataracts, I've changed the non-laser parts of my surgery to reflect what the laser accomplishes. In other words, I don't use the laser but then perform the same inside-the-eye procedure that I always had in the OR. For example, I no longer use traditional longitudinal phaco. Instead I use torsional phaco with linear control and different settings (more vacuum, less ultrasound). Patients recover quicker with more predictable refractive outcomes. They have fewer restrictions post-op, as they can bend and lift after 2 days rather than a week. They can have surgery on Wednesday and golf on Saturday instead of waiting 7 days. It's a better overall experience for patients, and referring doctors take note.

6 Market within your comfort zone. When I purchased my first laser, I also spent money on a radio ad and a local cable TV commercial. While they paid off somewhat, I chose not to repeat them. I didn't want to be "the guy on TV." I also worked with a local marketing professional to create laser cataracts handouts and to update the practice website with video and patient testimonials, both of which were beneficial (select-eyecare.com). However, ultimately I decided the best marketing strategy for me is to focus on keeping referring doctors informed and creating an experience for patients that keeps them coming back. A key aspect of the latter is providing patients with a video of the laser portion of their surgery. We watch it with them so they can see what was done and explain it to others. This helps them to become advocates for the technology. Many post the video on their social media.

How I define success

When people ask me about my return on investment with laser cataracts, my answer isn't financial. Sure, it turned out to be a practice-builder and an economic benefit, but I consider my greatest success to be that my adoption of the technology lets me offer my patients what I believe is a better way to do surgery and also lead the way for other surgeons to do the same. Today, 17 doctors in my area offer laser cataracts. The surgeons who use our 2 lasers perform more than 140 cases per month. And I've personally performed 6,000 laser-assisted surgeries to date. OSM