Transcript of "The whoops factor why refractive surgeons need to take a much closer look at their enhancement rates"
TODAY’S PRACTICE The Whoops! Factor Why refractive surgeons need to take a much closer look at their enhancement rates. BY SHAREEF MAHDAVI Consumers who undergo the process of be guaranteed. The frustration your customer experiences deciding to have refractive surgery over- is the same as what you experience when a purchase come a great deal of innate fear before doesn’t go as planned. It is no different from what you choosing in favor of it. Having weighed the would feel if that expensive European car you bought last potential benefits and risks, they go for- year had to go back to the dealership to correct manufac- ward with the hope and expectation of turing defects. Actually, your patient’s disappointment is experiencing daily life without glasses. For worse, because he can’t trade in his eyes the way you ulti-nine of every 10 patients, the procedure goes as planned, mately can trade in the car.the outcome is great, and everybody’s happy. The Wow! fac-tor is alive and well. But what about the other 10%? I’m talk- THE COST OF RETREATMENTS TO YOUing about those patients who experience delayed visual Lost Time and Revenuerecovery and need a retreatment, which the profession has You probably know that retreatments can be expensiveneatly termed an enhancement. to your practice. I want to break them down into two areas of cost. The first is internal to your practice and is a meas-THE TOLL RETREATMENTS ure of the surgeon’s and staff’sTAKE ON PATIENTS time, laser usage and fees, and Those of us who work in the any disposables required torealm of refractive surgery perform a secondary treat-know that, over time, virtually ment. Daniel Durrie, MD, ofall complications disappear and Overland Park, Kansas , andthe patient will likely see very Richard Lindstrom, MD, ofwell. From the customer’s per- Minneapolis, have each calcu-spective, however, the product lated and published that ahas failed to meet his expecta- retreatment costs betweentions. Once he overcomes his $800 and $1,000 to perform.concerns (rational or irrational) Expensive indeed, when youabout long-term problems, his also consider the cost of thereaction is one of disappoint- lost time that you and yourment. This scenario reminds staff could have spent treatingme of how Phillip Crosby, the new patients.quality guru, describes poorquality: “They didn’t get it right Reduced Referralsthe first time.” A colleague of There’s another cost of re-mine noted that his LASIK treatments that might even bepatients who need retreat- more expensive. It is external toments give him a look that your practice and impossiblesays, “You must have pushed to control. I’m referring to thethe wrong button on the laser.” rate of referrals from patients, These sentiments are real, also known as word-of-mouthand I cannot stress enough Figure 1. On average, nine of every 10 patients is marketing. Traditionally, cus-how important it is to face happy with their refractive outcome, and each tells tomers who are happy withthem rather than ignore them. three people. The word-of-mouth impact of one their experience tell at leastNo surgical outcome can ever unhappy patient, however, is much greater. three people. Studies have also JUNE 2005 I CATARACT & REFRACTIVE SURGERY TODAY I 83
TODAY’S PRACTICE shown that upset customers tell an average of 10 people DO RETREATMENTS HURT FUTURE about their negative experiences.1 BUSINESS REVENUE? Applying these averages to refractive surgery, nine of every 10 of your patients will be happy with their experience SM2 Consulting is seeking a number of refractive prac- and tell three people, while one of every 10 will be unhappy tices to participate in a survey that measures the impact and tell 10 people. The quick math would show that happy of retreatments on referral rates. This will be a retrospec- patients have told 27 people, whereas the single unhappy tive analysis that looks at the actual number of referrals patient has told 10. But don’t breathe a sigh of relief just yet. generated from patients who have been re-treated and The emotional charge of the experience has a long tail. If compares this to the number of referrals generated from those 27 people each tell three more, then 81 people have patients who have had only a single treatment. To partici- been positively influenced by the experience of those nine pate, you will need the following: happy patients. Similarly, though, the 10 people who heard • computerized records for both practice management about the bad experience also tell 10 more people about it, and outcomes; and now you have 100 people who have been negatively • data entry that has accurately captured the name of influenced about undergoing refractive surgery at your the former patient that has referred the new one; and practice (Figure 1). • the ability to link outcomes (eg, retreatment required The “influence score” is now 81 positive and 100 nega- for patient X) to practice management (eg, the new tive—all from that one unhappy patient (out of 10) who patients referred by patient X). needed to be re-treated. This effect is a form of homeostasis The results from this analysis will be a major benefit to in the marketplace, where the negative word-of-mouth out- you and your refractive colleagues. With these data, we weighs the positive. The net result is that referrals from will be able to quantify the financial impact of retreat- patients decline, your practice’s growth is stunted (which, ments on referrals for the refractive practice. consequently, puts pressure on the practice to spend more If you are able to help, please contact SM2 Consulting money to attract patients), and the industry as a whole at (925) 425-9963 or firstname.lastname@example.org. doesn’t grow as fast. centric solution, when what is needed is a customer-centric REDUCING RETREATMENT R ATES alternative. Why are we further punishing the patient by The math exercise above is meant to illustrate that cur- making him pay additional money when the product failed rent retreatment rates in refractive surgery are likely having a to meet his expectations? You would not tolerate such more negative impact on industry growth than any of us treatment at that luxury auto dealership, but you expect as realize. The 10% (and that’s only an average) of patients who much from your customers. This doesn’t make sense in a don’t achieve quality results (as defined by Crosby) equates customer-centered practice. For example, one surgeon I to at least 70,000 people last year alone who don’t rate their know refuses to charge his patients for enhancements, using experience high enough to enthusiastically recommend the event as an opportunity to strengthen the doctor-pa- refractive surgery to their friends. That is, negative experi- tient relationship and fulfill one of his practice’s core values. ences by even a small percentage of patients are significantly Always remember that what truly makes your practice hurting growth in consumer demand for LASIK. grow is happy patients. Yes, it’s become increasingly harder Solving this problem requires a multipronged approach. to please them, as their expectations continue to rise along The first step is to improve your clinical outcomes by active- with improved results. But at the end of the day, you are in ly measuring them and refining your surgical techniques. business to serve your customers, and you should strive to The second is to invest in technology that helps reduce your serve them well. A focused effort on reducing retreatments rate of retreatments. For a practice treating 100 eyes per will have a positive effect on your practice as well as on the month, a 10% retreatment rate costs $8,000 to $10,000 entire industry. ■ every month. Reducing that rate by even a few points will easily justify any monetary investment in outcomes analysis Shareef Mahdavi draws on 20 years of medical device mar- and/or technology. keting experience to help companies and providers become The secondary effect of retreatments is more difficult to more effective and creative in their marketing and sales efforts. correct but, as stated earlier, even more critical. You should Mr. Mahdavi welcomes comments at (925) 425-9963 or handle every retreatment patient with extra special care in email@example.com. Archives of his monthly column order to minimize the negative impact of their failed first may be found at www.crstoday.com. experiences. Currently, most practices penalize the patient 1. Denton KR, Boyd C. Did You Know? Fascinating Facts and Fallacies About Business. for retreatments by charging extra fees. This is a surgeon- Englewood Cliffs, New Jersey; Prentice-Hall: 1994.84 I CATARACT & REFRACTIVE SURGERY TODAY I JUNE 2005