How We Added LASIK

The number of people getting refractive surgery is increasing all the time; by some estimates, one out of every 150 Americans will have "had their eyes done" by the end of 2000. Adding LASIK was a natural fit for our network, which is affiliated with the esteemed Wills Eye Hospital-our surgery centers are multi-specialty, but 80 percent of our procedures are ophthalmologic. As our patients became more interested in LASIK, they started asking our doctors for the procedure, and in turn, our surgeons asked us for it. About a year ago, we became convinced that we needed to add LASIK in order to remain competitive.

One of the things that helped most in developing our LASIK program was visiting other centers that offered the procedure; learning about other people's experiences helped immeasurably in tackling our own challenges. Perhaps our experience will be useful to you.

Tackling Equipment and Space Challenges
Our first challenge was figuring out how to equip every center with an excimer laser, plus the additional instruments and supplies needed for LASIK. We purchased a $500,000 excimer laser and a $60,000 microkeratome for our Philadelphia location, which had the population density to support a full-time laser. But we couldn't afford to purchase a laser for each of our nine suburban centers.

The answer came to us in the form of a mobile excimer laser. For a per-eye fee of around $900, we contracted with Laser Vision Centers, Inc. to bring the laser to our centers once or twice a month. The fee could be included in our global fee to the patient, which would also include our facility fee and the surgeon's fee.

Performing LASIK requires a corneal topographer and pachymeter, as well as a table-top sterilizer in the procedure room to keep an efficient pace from one case to the next. In total, these instruments represented an investment of about $25,000, and it didn't make sense to multiply this by nine for each of our other centers. We ended up buying one set of instruments and arranging with LVCI to build and install custom storage boxes to hold the instruments so they could be transported with the laser.

After we determined how to assemble and pay for the necessary equipment, we turned to the issue of housing the laser. Each of our centers had access ramps needed to bring in the laser and a procedure room that met the size requirements. We modified the rooms according to directions from our laser maker; for example, we added a special power outlet and emergency shutoff in each room.

Humidity has a major effect on corneal tissue, so it must be carefully controlled in the laser room. Therefore, we installed a special HVAC system for our fixed laser in Philadelphia and built these into our newer suburban centers. A staff person is always in charge of checking the humidity and preparing the room prior to the laser's arrival.

Staffing and Credentialing Issues
To provide the best service to surgeons, we needed to provide them with trained staff. We updated our staff's skills by setting up training sessions to teach them to perform topography and pachymetry.

We also needed to credential some of our surgeons on the use of the laser and microkeratome. We required surgeons to provide us with proof of training; we also required them to complete a wet lab on pigs' eyes before they started offering LASIK at our centers. Setting up wet labs in our facilities often required a four to five week lead time. It involved obtaining pigs' eyes for the surgeons to practice on and arranging for a microkeratome technician to be on hand during the sessions.

Other Issues
As part of our post-op care, we assembled kits to give to LASIK patients. The kit we developed included sunglasses, anti-inflammatory drops, antibiotic drops, and goggles or an eye shield.

We also shopped around to get the best prices on other disposables, including lint-free eye sponges, powder-free gloves and eye drains.

To record LASIK pre- and post-op care and standardize our record-keeping, we developed user-friendly surgical forms to enable the staff to quickly scan the records, spot any missing data, and make sure all pertinent information was filled in, no matter which surgeon was performing the procedure.

With the help of our legal department and resources at the American Academy of Ophthalmology, we also developed an informed-consent form. This nine-page document reflects our review of consent forms from other LASIK providers, as well as an interpretation of FDA guidelines for informed consent. Each surgeon reviews the consent form with the patient and sends it home with him or her to read (the patient also must write out some statements, which verify that he or she has read the form). The patient brings the form on the day of surgery and signs it in the presence of a witness.

Marketing
Because LASIK is elective, we had to invest more in marketing than for other procedures. Our affiliated surgeons market their own LASIK practices, and we support them with phone referrals, patient seminars, a web site, and ads promoting the Wills centers.

Telephone referrals direct prospective patients to our surgeons' practices. In order to capture as many prospects as possible, our operator connects callers with surgeons' offices based on their location, so they can make an appointment immediately. We strive to ensure that we have trained, knowledgeable people answering the phones, because patients are well educated about LASIK and ask detailed questions.

About once a month, we offer our surgeons the use of our centers for patient seminars, supplying them with A/V equipment and a comfortable location. We've found that live laser seminars are especially effective. After obtaining a patient's consent, we schedule a procedure at a convenient time. The patient meets with the attendees prior to surgery, and then chats with them again post-op. In most cases, the prospects can observe the actual procedure.

We've had a good response to print ads and radio advertising; whenever ads appear or radio spots air, we see an increase in calls and scheduled procedures.

Off to a good start
About a year after introducing LASIK, our program is going very well. We offer surgeons blocks of time in the afternoon, after our other surgeries have been completed. If those times are not filled, we offer them to other eye surgeons. LASIK patients are spending an average of 90 minutes at our centers; one center is performing about four to six procedures per hour.

Over the past year, we've seen a gradual building of patient volume. Our first center to offer LASIK started with just three patients who underwent bilateral LASIK. Now that center is doing 40 to 50 eyes per month, and the other centers are handling volumes of 10 to 20 eyes per month.

To keep the volume growing, we are increasing marketing and working to attract surgeons. We continue to emphasize to our surgeons the importance of doing marketing within their practices.

By adding LASIK, we've expanded our services to eye surgeons and their patients, filled in empty slots in our surgical schedules, and have been able to use our facility and staff for more hours each week. We continue to get compliments from surgeons and patients, and we're excited about developing our LASIK program to keep up with the demands of this market.