Productivity

Investing in patient education is key to Adding new revenue streams to the practice

Knowing how to reach patients can accelerate ROI on laser cataract and premium IOL procedures.

Michael Lutz, COO, West Mifflin Pa.

The partners of our practice decided to make a concerted effort several years ago to drive more revenue from services not based on the Medicare fee schedule. With Medicare fees for many ophthalmic procedures being reduced, payment rules on diagnostic testing being implemented (resulting in decreased revenue) and sequestration, today’s ophthalmic practice faces many challenges to providing patients adequately advanced technology and treatments and, retaining qualified staff.

Offering services paid directly by patients at the time of service has been a successful way for our practice to meet these challenges.

Custom Cataract Counselor Angela Kuzma tests a patient.PHOTOGRAPHY BY KATHY WOLFE PHOTOGRAPHY

Introducing new technologies

Our practice, Associates in Ophthalmology in West Miffiln, Pa. (partners Miguel A. Busquets, MD, FACS, Lisa M. Cibik, MD, FACS, Brian H. Jewart, MD and John P. Nairn, MD), was one of the early adopters in the use of premium IOLs several years ago. Therefore, it was a natural transition for us to embrace the use of femtosecond laser cataract surgery. Our surgeons’ belief in this technology was the basis of our decision to become early adopters. But the technology also allowed us to add an additional revenue stream. When we decided to implement the femtosecond laser in conjunction with premium IOLs, we felt it was important to provide staff a general knowledge of services, the reasons for offering these services to the patient and the benefit to the practice.

As part of our afternoon semi-annual all-employee staff meetings, we presented materials available from the laser manufacturer, as well as videos from third-party vendors. We also had our lead cataract surgeon discuss the technology and its benefits to both patients and the practice.

From left, Clinical Director Victoria Caumo, RN, BSN; Chief Operating Officer Michael Lutz, COE, CMPE, MBA; Surgery Scheduling Manager and Custom Cataract Manager Melanie Nickel.

Branding and marketing

We discussed the phrasing we planned to use consistently throughout the practice when referring to femtosecond laser cataract surgery and premium IOLs, as well as the marketing campaigns and various advertisements they would soon be seeing in the media. We chose to refer to the femtosecond laser technology as simply “laser cataract surgery” to emphasize the word “laser.” With the advice of the vendor and other compliance experts, we trained our staff to boast the use of the laser as making cataract procedures more “gentle, accurate, and precise.”

From a branding and marketing aspect, we used the tagline “The revolution in laser cataract surgery begins here.” We revised the practice introduction to our automated attendant phone message to include the tagline. The staff greeted this involvement enthusiastically. It really made them feel a part of the plan and helped them understand our goals.

Positive reinforcement

We learned several lessons throughout our implementation process on the impact to the practice and the staff of implementing a new revenue stream to the practice. Staff must be encouraged by management to be open to new ideas and the process of change. Managers can accomplish this by providing positive reinforcement throughout the change process and remind staff to have patience while everyone learns from one another.

Our practice managers provided verbal positive reinforcement and encouragement during daily interactions with the staff and during the morning huddle meetings they conduct. Another easy, but effective, method of positive reinforcement we implemented was the use of personalized thank-you notes sent to an employee’s home whenever they went above and beyond their normal duties or provided excellent teamwork or customer service. We had our managers send an e-mail to the COO outlining an employee’s achievements and the COO then handwrites and signs a personal thank-you note.

The staff really appreciated receiving the card at home as an unexpected surprise they could share with their families.

Clinical Director Victoria Caumo, RN, BSN tests equipment.

Surgical testing

It is important to develop a testing protocol with your surgeons for cataract evaluations that makes sense for your office environment and scheduling templates. The surgeons’ need for additional testing for their premium IOL and laser cataract surgery patients impacts the work-up technicians the most. It is crucial to have the surgeon outline the specific testing required for the evaluations, and which tests must be completed prior to seeing the patient.

Surgical counseling

It is also important the surgeons inform the managers when they want to make a change to this protocol. While some practices separate the cataract evaluations into two separate visits, where testing and counseling may be done in a second visit, we elected to conduct all testing and counseling in one visit. Using our protocol, the counselors meet with the patient while they are dilating. Based on their experience in working with the surgeon and the results of testing already completed at that point, the counselors can customize their discussion to the type of lens or procedure they believe the surgeon is most likely to recommend. Likewise, the surgeon can discuss with the patient their surgical plan based on the testing results and the information gained during the counseling session regarding their lifestyle and daily activities.

We also found focusing the discussion on the specific activities and benefits to the patient during the process greatly increases their interest and willingness to pay out-of-pocket for the use of the femtosecond laser and premium IOLs.

Adjust your workflow

To provide a positive patient experience, the workflow must be as efficient as possible while allowing the patients to understand all their options. We listened to staff suggestions while changing the workflow for our cataract evaluations, which eventually led to a new cataract workflow checklist we implemented for each surgeon based on their desired testing (Click here to see an example of this checklist.)

Our technicians are required to sign their initials next to each step they complete in the process and to write the specific values as indicated on the checklist. This allows the physician’s scribe to easily identify if any step in the process was not completed prior to rooming the patient for the physician without having to login to the EHR and scroll through various screens.

If a step was missed, the appropriate technician is contacted to complete the testing in real time. The checklist also provides the physician with a one-page summary of everything she wants to know about the patient prior to entering the room. Upon completion of the visit, the checklist is scanned into the EHR as part of the permanent record. We’ve found this useful to address specific patient complaints or questions about procedures recommended.

Reading the patient

One vital component of successfully implementing any new revenue stream, but particularly premium IOLs and laser cataract surgery, is to ensure your staff keep an open mind and not judge a patient’s interest or willingness to pay thousands of dollars out-of-pocket for a service. Whether patients can afford this additional expense is up to them, not you. Have patients meet with a premium lens educator to gain a better understanding of their options.

Education methods

One of the most effective tools our educators use is an iPad video showing the difference between traditional and laser cataract surgery. Another tool educators use is a lifestyle questionnaire. Based on a patient’s responses, an educator can explain how a multifocal lens may help a patient see more clearly. The educator’s job is to paint a picture of life without glasses or contacts. We’re now seeing younger, more active cataract patients and, for them, quality-of-life is highly valued.

These discussions take time, however, which is why it is so important to develop a workflow and schedule template that makes sense for your individual surgeon and practice. We have an educator meet with every cataract patient prior to seeing the surgeon for evaluation. This allows the educator to provide the patient with information on pricing. We present our patients with a menu of options and make sure not to diminish the benefit of standard cataract surgery with a monofocal lens.

Surgery Scheduling Manager and Manager of Custom Cataract Melanie Nickel uses an iPad for patient education.

The right educators

In order to maximize the use of the new technology and make a return on your investment, it is vital to convert as many patients as possible to this new service. Based on our workflow and model, we hired additional premium lens educators. Now, we can have an educator meet with each patient on the same day of the cataract evaluation prior to the surgeon’s portion of the visit.

We searched for individuals who were the right type of person to educate patients about their lens options. An extrovert who enjoys getting to know people, finds it easy to start a conversation with anyone and is not afraid to discuss the price of the various options will be very successful in this role. This individual should be articulate, make a professional first impression and be perceived by the patient as having their best interests at heart. In our model, the premium lens educators become the patient’s concierge for their cataract surgery experience. He or she will contact patients by phone before and after surgery, greet them the day of surgery in the ASC, and handle the collection of their out-of-pocket fees in a professional manner. While adding staff was another expense to the practice, their success in converting patients to elect laser cataract surgery and premium IOLs has accelerated our return on the investment and more than paid for themselves.

An independent future

When looking to provide a new revenue stream, I would highly encourage a practice to evaluate what services align with your practice culture and current offerings, to engage staff from the beginning, provide them with the best educational tools available and hire new staff to make the venture successful.

This new revenue stream has allowed us to continue to acquire new technology, hire additional staff and consider future growth opportunities without being as dependent on future changes to Medicare reimbursement. OP

Michael Lutz is chief operating officer at Associates in Ophthalmology, Ltd., a multi-specialty ophthalmology practice with 7 office locations in Western Pa and Wheeling, W.V.