1. TODAY’S PRACTICE
The Brave New World of
Refractive Cataract
A message to cataract surgeons who are going refractive.
BY SHAREEF MAHDAVI
The most important governmental
approval in ophthalmic medicine in recent A free market for IOLs increases
times did not come from the FDA but
from the Centers for Medicare and
the incentive for manufacturers and
Medicaid Services (CMS) when it voted to providers to develop new ways
dismantle a law that prevented consumers to improve vision.
from making their own decisions about
their eye care. Specifically, the CMS changed its rules to
allow ophthalmologists to bill separately from cataract sur- Several years ago, offering tiered pricing for different tech-
gery for the implantation of presbyopia-correcting IOLs. nologies seemed like a good idea for stimulating demand
Although a small army of dedicated individuals has worked because it allowed the consumer choices. In some cate-
for years to bring about such a change, few believed that gories, it works. I do enjoy choosing among the 17 different
the CMS would ever accept it. mustards available at the grocery store. But in other mar-
In this column, I want to share some thoughts with those kets, tiered pricing backfires. Imagine your auto mechanic
ophthalmologists who never embraced LASIK but now asking you which brand of carburetor you prefer. You
want to enter the world of “medical retail” by offering wouldn’t have a clue, and neither do most of your patients
refractive implants. Culled from a dozen years of working who seek eye surgery. They come to you for your expertise,
on the laser side of refractive surgery are four areas for you and they expect you to understand their needs and help
to consider before taking the plunge. sort through all the choices for them rather than throw
that responsibility in their laps. LASIK surgeons are learning
EFFORT: IT WILL TAKE TIME this lesson, as many have used the introduction of new
Ask any colleague who opened a laser center in 1995 or technology as an opportunity to consolidate their LASIK
1996, and he will tell you how difficult those early days pricing into a single fee.
were. There were a lot of lasers and too few patients willing Likewise, because numerous technologies will be avail-
to undergo treatment. Building procedural volume took able for presbyopia, you need to think carefully about how
increasing the availability of lasers across the country, train- you want to promote, educate, counsel, and manage
ing surgeons, broadening the available surgical options (eg, patients with respect to all the choices out there.
treatment for astigmatism and wavefront technology), and
spreading the word about patients who had had successful PRICE: THINK LIKE A BANK
outcomes. By mid-1998, the hard work of early-adopter Price is one area where the discussion should be weight-
surgeons to develop the market began to pay off in grow- ed much more toward the medical and less toward the
ing procedural volumes. retail side of the equation. A sizable portion of LASIK sur-
geons were led to believe that, if LASIK were a good thing,
CHOICE: A DOUBLE-EDGED SWORD less expensive LASIK would be even better. In the year 2000,
That the government has now given consumers a choice one in five LASIK providers charged an average fee of less
is good news for surgeons. If patients want to pay more for than $1,000 per eye. Advertising for discount LASIK spread
a lens with more capabilities, they can. But, cataract sur- across all media. But, the market didn’t grow. It shrank. The
geons need to take a lesson from LASIK surgeons, who lesson: when it comes to their eyes, people want safety and
learned the hard way that having too many surgical choices quality, not a low price.
confuses patients and their decision-making process. The way to solve the pricing conundrum is by focusing
JULY 2005 I CATARACT & REFRACTIVE SURGERY TODAY I 51

2. TODAY’S PRACTICE
on affordability. This is true in any market that has an aver- acceptance for these new procedures. Hopefully, we can
age purchase price of over $500. The solution is financing, build on what we have learned over the past decade and
which allows a consumer to borrow money and repay it in create a bigger and brighter future for all of refractive sur-
the future in exchange for making the purchasing decision gery and the millions of patients out there who need it. ■
today. With retail prices for a pair of refractive IOLs in the
$8,000-to-$10,000 range (approximately double that of Shareef Mahdavi draws on 20 years of medical device mar-
LASIK), patient financing becomes critical. Don’t finance keting experience to help companies and providers become
this cost yourself (note: you are a doctor, not a bank). There more effective and creative in their marketing and sales
are several national vendors as well as local banks that spe- efforts. Mr. Mahdavi welcomes comments at (925) 425-9963
cialize in this type of financing. Look for a vendor that will or shareef@sm2consulting.com. Archives of his monthly col-
consistently finance the entire amount, do it with minimal umn may be found at www.crstoday.com.
hassle, approve a high percentage of applica-
tions, and charge a reasonable interest rate to
the patient as well as a discounted rate to the ALCON CLOSURE
SYSTEM
practice. Expect to pay 4% to 5% to the vendor
to handle the loan, which should have an inter-
est rate of less than 10% based on current con-
sumer loan rates. You will pay more if you want
to offer a 0% interest rate (which has worked
well in LASIK). In return, you should see at least
70% of your patients’ applications approved
with minimal headache and hassle.
EXPECTATIONS: MANAGE THEM CAREFULLY
With these high price tags, patients seeking
IOL-based refractive surgery will have sky-high
expectations. Managing expectations becomes Specifically designed to meet
a critical skill for you as a surgeon, especially the needs of ophthalmic sur-
now that the transaction is direct between geons.
payor and provider. Resist the temptation to
promise more than you or the technology can
deliver, especially when we are knocking on the
- Stays sharp, pass after pass
door of future presbyopic solutions. Over-
- Choice of several materials, including
promising and underdelivering will disappoint BioSorb® absorbable sutures
your patients, even if their clinical results are
- Choice of needle point configurations
excellent, and can kill customer satisfaction and EXCALIBUR®
‘S’ SERIES
all the future business those referrals would have - Needles sharpened to the widest
point
generated. Instead, set the bar a bit lower for
your patients and let them be thrilled with their - Over 25 years of ophthalmic suture
excellence
new vision. Warning: set it too low, and no one
will sign up. Thus, properly managing expecta-
tions is a delicate balancing act.
®
A.C.S.
APOGEE®
IN CLOSING ‘N’ SERIES
Many years from now, I think we will look
back and see that spring 2005 was a major turn- Needles and Sutures
ing point in ophthalmology. A free market for CASE CLOSED.
IOLs increases the incentive for manufacturers
and providers to develop new ways to improve
vision. Keep in mind that the free market is far
from being without cost. It will take tremendous Alcon Laboratories, Inc.
6201 South Freeway
effort at the provider level to create consumer ‘A’ SERIES
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