Five Trends That Drive Ophthalmology Growth

There are three absolutes in the challenges physicians face in ophthalmology practice development over the next several years.

More people will need care. Population and incidence estimates indicate 60% more cataract sufferers by 2025 and almost 50% more glaucoma sufferers.

More people will expect care. 30M more people have access to insurance with the recently passed healthcare legislation. The general population believes this means they’ll have access to care. Yet there will be no net increase in ophthalmologists to treat them.

Your practice will earn less for each person you see. There is absolutely no possibility in either government-subsidized insurance of private insurance that reimbursement rates will rise. The only possibility we have to increase practice profitability is to see more people more efficiently (which has reached its practical limit) or offer services that are non-covered by insurance so that we are allowed to work directly with the patient for payment.

Overlaying these parameters are five trends that will influence your ability to successfully grow in the future: patient attitudes, vision expectations, fee collection, employee characteristics and staff compensation.

Active vs. Stoic Aging

We are transitioning from patients who have made up the majority of our practice visits—the World-War II Greatest Generation—to an increasing concentration from the Boomer Generation. These “Brokaw” vs. “Boomer” patients present different challenges. The Brokaw patient had a stoic approach to medical care. They deferred treatment. They insisted their vision wasn’t poor. They were reluctant to spend money on themselves, preferring to save it for their children or a rainy day. They respected your medical expertise and deferred to your recommendation.

Now the Boomer generation is increasingly sitting in your exam chair. They visit your office at a younger age, the minute they notice any vision compromise. They want a cure, not just stability. They are willing to spend money on themselves. They are interested in your recommendation, but bring with them a broader skepticism from internet research and higher education, weighing what you’ve said vs. crowdsourced wisdom.

The implications for your practice are two-fold. You must improve patient education; including printed materials, online education, video explanations and extended physician consultations. And you must shorten the treatment process. The number of visits must shrink, their convenience must improve, on-time visits are critical, and a clear discussion and recommendation of treatment will be required to satisfy patient expectations. The Boomer audience will not hesitate to pay for service, but they will chafe against delays, lateness, and lack of shared discussion with the physician.

Patient-Preferred vs. Plano Vision

The measure of vision correction success has historically been plano. Until a few years ago, we never had conversations with cataract patients about the vision they wanted post-surgery, other than occasional discussions of monovision. Increasingly though, vision solutions offered to an aging population we will be measured against a revised standard —glasses-free vision. We must be more thorough in understanding how a 70-year old uses their vision, requiring a level of conversation and exploration we’ve never done. Their hobbies, computer use, driving needs, close vs. distance work, and vanity will all dictate the type of vision they prefer. Our success will be measured by how much of the day a patient spends glasses-free, rather than Snellen acuity.

The implication for your practice is that you must implement screening tools that elicit post-surgery vision preferences and determines reasonableness of expectations. This process requires participation from your staff. Patients have never been asked what type of vision they want, so it takes effort to assist their thinking.

Private Pay vs. Insurance Reimbursement

In my observation, the healthcare debate has had an unexpected positive effect on elective vision. People now are more aware that their insurance won’t cover all the healthcare they want or need. As a result, our conversation with patients about covered vs. non-covered services just got easier. With certainty, insurance will cover less tomorrow than it does today. The only way to improve financial performance is to incorporate private pay services into your practice. While refractive surgery, presbyopia correction and astigmatism correction are non-covered now, more services will fall into this category soon. Learning how to talk with patients about fees, providing great results and delivering a personalized experience will be required for success. Otherwise, you will be left behind in the over-burdened, under-compensated reality of an insurance-only practice.

Service-Oriented vs. Process-Oriented Employees

For 20 years, we have adjusted hiring methods toward employees who work quicker, navigate crushing levels of paperwork better, and accept relatively low compensation. These employees by necessity are process-oriented. However, the Boomer population that will frequent our practices will demand better service. The discussion of fee collection will require finesse. We must shift our hiring from a process-oriented employee to a service-oriented employee. The frustration many of our current and potential patients feel is that we’ve made our process their problem. A positive service orientation in medical care will become a meaningful point of difference for tomorrow’s practice.

Performance vs. Attendance Compensation

The majority of ophthalmology employees are paid hourly, and compensation rates are low. Often focus is not on performance excellence, but simply getting through each day’s slate of patients on time. As we prioritize the types of patients we see, the conditions we choose to treat and the physician’s practice preferences, we need to update this compensation model. I advocate a pay-for-performance system, rather than an attendance-based system. Compensation that combines hourly rates with per-procedure or %-of-collections pay will provide increased motivation and adherence to best practices. There will be consequences reflected in compensation if goals aren’t met. Entrepreneurial employees will love this system. Those who expect to be paid simply to show up will choose to work elsewhere. Performance-based pay will be required to attract and keep the best and brightest in our clinics.

While we can’t change the difficult parameters we face with the population, health care demands and limited provider resources, we can actively address the trends that dictate success and satisfaction over the next twenty years. These trends are clear. The choices are well defined. It’s up to you to choose the type of patients you’ll see, the staff you’ll hire, and the vision results and financial performance you desire.

By Kay Coulson, MBA, founder of Elective Medical Marketing, a Denver, CO-based consultancy focused on helping physicians grow their elective service lines. Originally published in EyeWorld.  Updated May 2016.