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Premium IOLs are the buzz in journals, guest lectures and at many of the ophthalmic meetings. As residents and fellows, the patient population we treated often did not have the resources for a premium IOL, causing most of us to ignore the topic until sometime after training. However, with the over-65 patient population doubling by 2020 and Medicare facing continual budget pressure, reimbursement for cataract surgery is on track to pay only $150 for the implantation of a standard lens.
For those of us just starting out, the premium IOL market will likely be what supports us and our families in the future. Here are some clinical pearls I have learned while implementing premium IOLs during my first two years of practice.
- Educate yourself. You must know the indications, benefits and possible complications of every premium IOL. Know the history of the IOL, what the FDA clinical trials have shown and the success it has had since being approved by the FDA. Talk to your mentors and find out their experience with premium IOLs and why they favor one over another. Once you choose the premium IOL(s) you will use, make sure you have access to the technology to get accurate IOL calculations and corneal topography for astigmatism correction. Finally, learn the nuances required for implanting premium IOLs.
- Choose the technology you believe in. To truly help your patients, you must believe in the superiority of the technology and in your ability to deliver it. Whatever lens or lenses you choose, you MUST believe in them or your patients won’t.
- Educate your staff. Have the surgical reps for the IOLs you choose educate your staff. If your staff doesn’t believe in these IOLs, or worse, doesn’t know anything about them, your patients will think the IOL is obscure and experimental, adding to their fear of the unknown.
- Do the paperwork. Once you’ve decided to offer premium IOLs, get the proper paperwork in place. This includes a consent form that properly educates your patients on the benefits and potential complications of premium IOLs and compares and contrasts them to a monofocal IOL. This can be used to educate potential candidates as well. You also need to draft an Advanced Beneficiary Notice (ABN) that Medicare patients must sign, acknowledging that they are responsible for the extra cost of the lens and surgeon fee. Include how much you will be charging them and what they are likely to be billed by the surgery center or hospital, so that patients fully understand their out-of-pocket costs in advance.
- Coordinate with your hospital/surgery center team. Discuss with their billing department what they will be charging the patient for the lens. Try to negotiate on your patients behalf so that their mark-up will be minimal in order to control the overall cost. Your OR team must also be aware of the special differences that a premium IOL case will entail, plus they must also believe in the lens. These people are part of your marketing team!
- Begin internal marketing. Talk with your surgical reps about the IOLs. Many times they have educational videos that you can personalize for your patients. They may also have educational brochures and other visual aids for your waiting room. Consider offering educational seminars on cataract surgery and rehabilitation options at least once every quarter. I invite my patients to bring their friends and family for a 20-minute PowerPoint presentation with light refreshments, and then answer questions. I also invite a former premium IOL patient to give his or her testimony. The response to these seminars has been so great that I often have a waiting list of patients wanting to attend. Editor’s note: For a list of the Academy’s IOL patient education resources, see below.
- Make it a family affair. During the consultation, the patient may be overwhelmed by the thought of needing surgery and may be too distracted to listen to all the IOL options. Having a concerned spouse or child in the room can help bring focus to the discussion.
- Keep it simple. Explain the three functional ranges of vision. A standard IOL will allow patients to see one out of the three ranges, but a premium IOL may allow them to have all three.
- Make an assessment and then a recommendation. Conclude the exam with your experienced opinion and recommendation. Your patients depend on your expertise to help them make the best choice for their eyes. If they are a good candidate for a premium IOL, tell them that it is the lens you would select for them.
- Exceed their expectations. Be wary of patients with unrealistic expectations. As Uday Devgan, MD, says, “You will see better, but not like you did when you were 21.” Have the patient circle and initial the last line they can read on a near-vision card prior to the surgery, and then again after the surgery. It is very effective in showing them how much their vision has improved. Finally, stress to them that their vision will improve with time. Setting realistic expectations is always a reliable strategy.
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About the author: Natasha L. Herz, MD, is a member of the YO Info editorial board. She is a cornea specialist practicing in the Washington, D.C., metro area.