August 2011




Ethics of IOLs

Talking finances with premium IOL patients

by Faith A. Hayden EyeWorld Staff Writer


When and who should discuss pricing

"What's it going to cost me?"

Woman and doctor

Doctors should expect to answer that question from premium intraocular lens (IOL) candidates at some point during the cataract surgery consultation. Talking about money is rarely a comfortable conversation in any setting, especially in the healthcare industry. But cataract surgery patients need realistic numbers to work with, sooner rather than later. Opinions vary on how specific a doctor should be and who in the practice should discuss money matters, but ophthalmologists need to give some indication early on that premium IOLs come with premium pricing. There are a number of ways doctors can introduce this aspect of cataract surgery. Some prefer to be hands on, taking chair time to discuss insurance and cost with the patient directly. Others rely on staff to answer questions and review pricing details. Many practices have patients watch instructional videos or read information packets in advance to give an overview of the different IOL categories.

"The packet talks a little bit about the various IOL choices and [explains] that some of the services aren't covered, especially if the patient chooses a specialty IOL or wants to correct astigmatism," said David R. Hardten, M.D., F.A.C.S., director, clinical research department, Minnesota Eye Consultants, Minneapolis. "I think it's useful for the doctor to explain that there's an extra charge. That way the patient has time to think about that aspect."

Scott MacRae, M.D., director of refractive services, ophthalmology department, University of Rochester, N.Y., has a senior tech review the basic IOL alternatives and discuss pricing with the patients, even before he sees them. "The patients get reading material prior to me seeing them," he said. "I examine patients and review the options to reinforce the choices. I do not try to candy-coat the information, but try to make it clear what they can realistically expect."

Like Dr. MacRae, Dr. Hardten has experienced staff go over pricing. But while Dr. MacRae uses a senior technician, Dr. Hardten uses a patient care coordinator.

"It's helpful for the schedulers to be able to spend more time with the patient, going over the exact charges, what's included, and what's not included," he said. "The best thing is to have the staff prepared for a wide variety of questions." John A. Vukich, M.D., surgical director, Davis Duehr Dean Center for Refractive Surgery, Madison, Wis., uses a similar system. He takes it a step further, though, by actively staying out of pricing and financial discussions, making only a clinical recommendation based on patients' needs and wants. For example, Dr. Vukich will ask patients if being free of glasses is important to them. If they say "no," that ends the conversation about premium implants. "I try to soft sell unless the patient says, 'This is really important, I want to be free of glasses,'" he said. "Then I'll tell him or her what my recommendation is to achieve that goal."

From there, Dr. Vukich sends the patient to the in-house counselor to go over the specifics of pricing and financing and answer any remaining questions. "The consumption of time can be crushing otherwise," he said. "These are patients who tend to be internet savvy and will come in with a lot of questions, taking up as much time as you're willing to give them. Of course, that doesn't provide efficient patient flow." Not everyone works this way, however. Melissa Cable, M.D., F.A.C.S., Discover Vision Centers, Kansas City, Kan., actually speaks to her patients directly about pricing and insurance during the initial consultation. "Patients are always interested in the advanced technology and their question to me is, 'Will my insurance cover it?' That's a natural lead-in to the cost conversation," she said. "Their reaction is all over the board. I have some patients with sticker shock. Then I have some patients who planned on this. They have friends with these lenses, they know how much they cost, and they came in wanting them." Like her colleagues, Dr. Cable keeps her techs well versed on premium IOLs so they can answer patient questions before she gets into the room. "My techs know the lenses I prefer and if they hear something that makes them think this is a full-focus patient, the tech will start the process by having the patient watch a video or read a brochure," she explained. All of the doctors use some sort of third-party financer for those needing a payment plan, although the companies differ. Dr. MacRae uses Capital One and Dr. Cable uses CareCredit. For many cataract patients, though, financing isn't helpful because they aren't actively working. Additional money isn't coming in and the patient is living off savings and retirement. Whether or not that deters fixed-income patients from premium IOL purchases can't be anticipated, as it's extremely variable. "It's very hard to predict who will pay for it and who will not," said Dr. Vukich. "You can give all sorts of examples of elective things people will spend money on. It depends what their value system is."

"Usually, if a patient is curious about premium IOLs but not sold on the idea, the patient perceives the cost as high," said Dr. Hardten. "For the most part, when patients find out what pricing is, they are pleasantly surprised it's not $10,000 per eye."Talking finances article summary

Whatever the decision, it's critical they aren't swayed. Premium IOL patients tend to have elevated expectations and are looking for value received for money spent. Patients who have been talked into these lenses are known to be most critical of the technology and the most dissatisfied. "The lower the motivation to get premium IOLs, the higher the frustration with post-op vision," said Dr. Hardten. "Patients who aren't motivated to be free of glasses are the ones who complain more about glare and halo at night. They're a little bit harder to manage."

There's no perfect answer or system when having pricing discussions with patients. But regardless of who in the office leads the conversation, it's best to let the patient lead the premium IOL decision.

Editors' note: None of the physicians interviewed have financial interests related to their statements.

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Related articles:

Evaluating patients for premium IOLs by Enette Ngoei EyeWorld Contributing Editor

Blepharitis and premium IOL patients by Elizabeth A. Davis, M.D.

Premium intraocular lenses by Nick Mamalis, M.D.

Premium IOLs … the European perspective by Michelle Dalton EyeWorld Contributing Editor

Talking finances with premium Intraocular lens patients Talking finances with premium Intraocular lens patients
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