Marketing LASIK
Promoting LASIK the Right Way
How do you market LASIK effectively if you don't have an excimer laser in your office? The answer comes from within your practice.
BY BRIAN CHOU, O.D., F.A.A.O., San Diego, Calif.

I recently drove by a fellow optometrist's office, which was adorned with a large sign that simply read, "LASIK." What if a prospective patient called? The dialogue might go something like this:

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Caller: I saw your sign and I am interested in LASIK. Who's your surgeon?

Receptionist: Oh, we don't have a surgeon. We provide the care before and after surgery. We'll refer you outside for the procedure.

Caller: Umm, okay. Thanks. (Then hangs up.)

What happened? The sign led the prospective patient to think that LASIK was available on site. Then he learned that this wasn't so. He may have felt misled and concluded that the optometrist was an unnecessary "middle man." In the end, the patient probably went to a LASIK center for a consultation. The staff there may have congratulated him on avoiding "costly comanagement fees" by coming to their center.

Yet many optometrists market LASIK externally. In fact, my group practice used to do so in the yellow pages -- until I heard enough phone inquiries play out like the dialogue on page 80. Unless you have an excimer laser in your office, externally marketing LASIK probably doesn't help the image of your practice or profession. But O.D.s can successfully market LASIK. Here's how.

Marketing LASIK efficiently

In LASIK centers, the cost-per-lead for the externally generated patient is around $300. For optometric practices, the cost-per-lead for these same patients is even greater. That's because people who are interested in LASIK gravitate toward surgery centers -- not optometric offices. From an O.D.'s standpoint, externally marketing LASIK is inefficient.

A better way is to market to your existing patients. Ask yourself this: "Why do refractive surgeons solicit optometrists to co-manage?" The answer: They want access to your patients! Industry estimates are that three quarters of prospective LASIK patients are already under the care of optometrists but that optometry co-manages less than one third of LASIK patients.

So if you haven't maximized awareness of LASIK within your practice, it's premature to market externally. Start by bolstering your practice infrastructure to accommodate your existing, yet undiscovered, LASIK candidates.

Marketing internally

Internal marketing involves communicating your involvement with LASIK to your existing patients. In competitive markets, you must also convey why you're the provider of choice. To develop a plan of action, identify and modify all points of patient contact. Start with these areas.

Posters, countertop displays, videotapes and brochures. Ask your LASIK surgeon's office for in-office displays and promotional materials. (These items are also available from excimer laser manufacturers and companies that sell practice promotional materials, such as Patient Education Concepts).

Place these point-of-purchase displays in your office waiting room, contact lens training area and exam lanes. Whenever possible, these items should equally promote the qualifications of the surgeon and of yourself.

Staff interactions. When patients make appointments, have your staff ask, "Is this for glasses, contact lenses or laser vision correction?" Doing so proactively announces that you provide full-scope refractive care.

Train your staff to handle LASIK inquiries and consider designating a refractive surgery coordinator (preferably a staff member who's had LASIK). Ask your surgeon's office and the excimer laser manufacturer about available staff-training materials and workshops.

On-hold phone message. It's never ideal to put someone on hold, but it happens in busy practices. Take advantage of such time with an educational on-hold phone message that explains your LASIK services to your patients.

Web site. An increasing number of optometric practices have Web sites that allow patients to request appointments, download office forms, access office hours and driving directions and reorder contact lenses. This is another excellent venue to provide information about your LASIK services. Consider forming a mutual Web-link between your practice and your surgeon's office.

Testimonials. Written testimonials from your LASIK patients are powerful. With your patients' permission, display them in your office. Frame them on the wall or collect them in a binder for the waiting room. You can also share excerpts of testimonials in office newsletters or on your Web site.

Direct mailings. Most optometric practices send patients recall letters and newsletters (either in print or in electronic form). These are opportune vehicles for providing information about LASIK. Some patients can enroll in a flexible spending account (FSA) through their employers. A direct mailing reminding patients to enroll can serve as the "call to action" to have LASIK. These accounts allow patients to allocate pre-tax dollars to have the procedure. FSA enrollment periods vary according to employer, but they typically end in November or December.

"Meet the surgeon" seminars. Conduct LASIK seminars so your patients can informally meet your refractive surgeon. You can tie the seminar in with a trunk show for sunglasses or viewing a LASIK procedure.

Good reasons to co-manage

Comanagement is the mutual division of patient services related to surgery between two doctors. How does comanagement benefit patients undergoing refractive surgery? Simply, it provides checks and balances for optimizing their outcomes because they see two doctors instead of one. Conveying this point forms the keystone of a successful internal marketing plan.

You can't beat an existing relationship. Patients benefit when you evaluate their LASIK candidacy because you have a pre-existing patient-doctor relationship. No one else understands their visual demands, expectations, personality, ocular history and level of compliance quite like you. Consider the following scenarios:

• The engineer who claims to notice 0.125D steps and has a history of repeated prescription checks. This patient wouldn't be happy with any reasonable LASIK outcome. Without your coordination of care, the LASIK center might not know about this patient's unrealistic expectations until after surgery.
• The patient you once saw at 2:00 a.m. because of a severe corneal abrasion. You know she shouldn't have LASIK performed in that eye because of an increased risk of epithelial sloughing, ingrowth and diffuse lamellar keratitis. It's conceivable that a LASIK center wouldn't elicit this information until a repeat flap lift for removing interface epithelium.
• The 21-year-old waitress who thinks that her twin brother has "lazy eye." However, you know that she shouldn't have LASIK because you diagnosed her brother with keratoconus a year ago. The LASIK center may never know the significance of her mildly asymmetric pre-op topographies until she goes from ecstatic to ectatic 3 months post-op.

You offer everything. Optometrists benefit their patients by offering the full spectrum of refractive eye care -- glasses, contact lenses and refractive surgery. The optometrist is positioned as the expert in refractive triage. Patients walking into a laser center don't routinely receive glasses and contacts -- even when they leave learning that refractive surgery is a poor option for them.

Furthermore, patients going to non-co-managing LASIK centers may not learn about advanced alternatives such as continuous wear silicone hydrogel contact lenses and accelerated overnight orthokeratology.

Patients gain from our strength in analyzing refractive error. This fact is particularly important in refractive surgery for determining the attempted surgical correction and monitoring the outcome. With roots in ophthalmic optics, we analyze the refractive state not only through refraction, but also through evaluating patient history, visual acuity, binocular vision, corneal topography and keratometry, retinoscopy and ocular health.

We're committed to a lifetime of comprehensive care. Your commitment doesn't end once the surgeon completes the LASIK procedure and the patient pays his balance. You continue seeing the patient, so you have an incentive to maximize his satisfaction. This requires careful selection of LASIK candidates, referring them to a qualified surgeon and receiving continuing education in refractive surgery management. Laser centers don't have an incentive to see patients after the immediate post-op recovery.

Setting comanagement fees

Perhaps the most frequent criticism of refractive surgery comanagement is the allegation that the fees are a referral inducement. To be sure, patient care suffers whenever a physician's financial interests are placed ahead of a patient's well being.

The Centers for Medicare and Medicaid Services (CMS, formerly known as HCFA) set a precedent with the acceptance of the 54- and 55- modifiers to split the global fee of cataract surgery into 80% for the surgeon and 20% for the co-managing doctor.

Although Medicare doesn't directly regulate refractive surgery, a legitimate argument can be made for an 80/20 split of LASIK global fees. If the refractive surgeon also performs cataract surgery that's reimbursed by Medicare, then any refractive surgery comanagement fee above 20% (or the fair market value of pre- and post-op care) may violate the Stark II and Federal Anti-kickback statute.

In such a case, the Office of the Inspector General could allege that an exorbitant LASIK comanagement fee serves to induce future referrals for cataract surgery or other Medicare-covered services. To protect yourself, don't refer your patients to any refractive surgeon who baits you with excessive comanagement fees. In such instances, the amount of the comanagement fee above the fair market value is tantamount to a referral commission.

Instead, set your own fees for pre- and post-op refractive surgery care, either as a certain dollar figure or as a percentage of the surgeon's global fee. Collect your fees separately from the surgeon. Alternatively, authorize your surgeon's office to collect your fees for you. In this manner, it's clear to the patient that you are getting paid for rendering professional services.

Note that some third-party agreements such as VSP's Laser Vision Care have payment arrangements that override your standard fee collection policy. Proper disclosure of financial arrangements ensures that comanagement proceeds with the interests of patients foremost.

Don't deny your patients

The majority of lay people still don't understand the value and benefits of co-managing LASIK patients. In this void of understanding, certain M.D.s who have old political sentiments have combined with discount laser centers to define comanagement as "costly" and "unnecessary."

While this is unfortunate for our profession, it's most unfortunate for our patients. This is why properly executed internal marketing should educate patients on the benefits of LASIK comanagement. Comanagement is desirable to many patients, but they won't know why unless you tell them.

The end result

When you properly institute internal marketing, your patients will think of you each time they see another provider's external LASIK marketing. Unlike the discount laser center that spews coupon specials and late-night infomercials, you're a credible source of information.

Patients want to know whether LASIK can reasonably fulfill their needs. So don't just tell a patient that he's a candidate for LASIK -- any laser center can do that. Go one step further by telling him just how good of a candidate he is. While you should never over-promise the outcome, it's just as important that you don't encourage unrealistic fears. Doctors who overplay the inherent risks can end up denying their patient the joy that LASIK typically brings.

Rating your marketing savvy

How do you know if you've successfully implemented your internal marketing? One signal is receiving testimonials from your LASIK patients about why they chose you instead of a place that heavily advertises. Another is when your patients refer their loved ones to you for LASIK evaluations because they know you won't pitch surgery if it's inappropriate. When you get to that point and look back, I think you'll question why any optometrist would market LASIK externally.

Dr. Chou is in group practice at Carmel Mountain Vision Care in San Diego. A frequent writer on refractive surgery and contact lenses, he completed a fellowship in cornea and external disease at the Jules Stein Eye Institute.