My Way - Coleman Vision

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PREMIUM PRACTICE
March 2012
TODAY
Volume 3, No. 3
MY WAY
The secret to my success.
BY ROCHELLE NATALONI, CONTRIBUTING EDITOR
Section Editor:
Shareef Mahdavi
Pleasanton, California
Editorial Advisors:
Matt Jensen
Sioux Falls, South Dakota
For more online and interactive
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see
throughout the article.
James D. Dawes
Sarasota, Florida
Premium Practice Today is a monthly feature section in CRSToday providing articles and resources to assist surgeons
and their staff in the pursuit of premium practice development to facilitate exceptional experiences for patients and business success.
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My Way: Surgeon Profiles
The secret to my success.
BY ROCHELLE NATALONI, CONTRIBUTING EDITOR
Success in a medical practice, as in life, is the result of doing many things
well and learning from one’s mistakes. Premium Practice Today devotes this
month to the perspectives on success of six surgeons who represent a diversity
of focus and styles in their practices. What is common among them is that
they take patient-centricity to a new level that includes taking care of
customers’ needs in addition to patients’ needs. Listening skills, convenience for
customers, and teamwork are shared concepts in their advice and are
evidence of the need to “walk the talk” on a daily basis. Far from being
buzzwords, these ideas are the ingredients essential to the premium practice
going forward.
—Section Editor Shareef Mahdavi
L
ike a successful surgical plan, a winning strategy for practice
management depends on the special something supplied by
the lead surgeon. Call it the “surgeon factor” or the “X factor.”
Either way, it is the element that makes one practice prosper while
another suffers from its lack.
In this month’s edition of Premium Practice Today, several surgeons
share the steps they took to bring their practices to the top of the heap.
Their discourse includes comments on diversification strategies,
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conversion rates, and patients’
demographics, but it is clear that
their down-to-earth, patientfocused, common sense tactics are
what make these practices tick.
STEPHEN COLEMAN, MD
COLEMAN VISION INSTITUTE
The secrets to success for
Stephen Coleman, MD, are
altitude and attitude.
Coleman Vision. “I moved
to New Mexico after completing
my training in New York City,
primarily due to a brief
conversation that I had with
Steven Trokel, MD, broadly
considered to be the inventor
of laser vision correction,”
explains Dr. Coleman. “He was
the chairman at Columbia, and
he encouraged me to move to a
location at high altitude, because
due to the relative hypoxia,
people would be less tolerant of
HOW TO SUCCEED 101
Cataract and refractive surgeons fresh out of training
are unencumbered by past-practice baggage. They have
the benefit of learning the latest techniques with the
newest technology and using them to create their own
success story one case at a time. Robert Melendez, MD,
MBA, chairman of the AAO’s Young Ophthalmologist
Committee AAO and partner at Eye Associates of New
Mexico in Albuquerque, offers the following suggestions
to newbie surgeons:
s )FYOUAREGOINGTOOFFERPREMIUMSERVICESOFFERPREmium surgery. These patients have extremely
high expectations.
s %XUDECONFIDENCE4HEPATIENTNEEDSTOSEEIT
s 4RAINYOURENTIRESTAFFFROMEVERYPOINTOFCONTACTTO
be prepared for premium patients.
s %NSURETHATEVERYPERSONWITHWHOMTHEPATIENT
comes into contact at your practice is knowledgeable
about what is available. This reinforces the patient’s
confidence. By the time the patient makes contact with
you, he or she will have few questions, and you can
focus on what is best for that patient.
s )NSTEADOFFOCUSINGONCONVERTINGPATIENTSTO
PREMIUM)/,SFOCUSONIDENTIFYINGTHEBESTOPTIONFOR
each individual.
s $ONOTGETTOOCOMFORTABLE,EAVEYOUREGOATTHE
door.
s 2EMEMBERTHATONTHEFIRSTDAYINTHE/2EVERYTHING
is a variable. Convert variables to constants.* This will
enable you to feel more comfortable while you are
honing your surgical technique.
*By converting many of your variables into constants,
you can add new variables into your surgical repertoire
with minimal disruption. This confidence in your surgical
technique will translate to the clinic and enhance patients’
perceptions of you. Variables include a new surgery center,
new hospital, new phaco machine, new instruments, visitors in the OR, new staff, vitreous loss, new IOLs, and new
surgical techniques.
Robert Melendez, MD, MBA, may be reached at (505)
892-3434; [email protected].
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contact lenses and likely become early adopters of laser technology
as an alternative. He was right. My clinic is at 5,000 feet, and right off
the bat, I had a rapt audience.”
Dr. Coleman’s attitude is equally impressive. “I see our role at
Coleman Vision primarily as educators, just informing patients what
the best options are for their particular situation,” he says. “If the
best option doesn’t include us, that’s fine. We keep the patients’ best
interest at the center of the conversation.”
Dr. Coleman’s practice development strategy is based on the
antithesis of diversification. He says he does one thing and does it
very well: “I only offer laser vision correction. I don’t have an
eyeglass dispensary, I don’t fit contact lenses, and as of today, I have
not incorporated IOL procedures into my practice. I do, however,
think the impact of this particular avenue of vision correction is, and
will continue to be, enormous. Referring a patient out for a lensbased procedure is actually very gratifying, because it typically comes
as such a surprise to prospective patients. They genuinely
appreciate the honesty. I never developed a general practice and
therefore never truly did cataract surgery. I fell in love with lasers and
never looked back. I really think that this technology, even in its early
stages, was remarkable—both precise and accurate—and it was the
single thing that kept me in ophthalmology.”
Dr. Coleman points out that he has never had a partner, “just a fleet of
amazing technicians and a referral network of optometrists with whom
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I would trust my family.” Because New Mexico is so large and rural,
comanaging patients is critical, he says. It is not uncommon for people
to drive great distances to see a particular doctor.
He is bullish on the future. “The baby boomers drove the initial
spike in LASIK volumes, with a roughly 78 million-person
demographic,” he notes. “We are currently muddling through
Generation X, which totals only 46 million people. Those of us
dedicated exclusively to laser vision correction are about to be
confronted by Generation Y—individuals roughly 21 years of age
and older—which numbers 76 million, similar to the boomers.
Despite the current economic climate, the sheer size of this
demographic is daunting. When you combine the enormous
advances in technology with the inherent familiarity with technology
that this group of patients has, the future of LASIK is very bright.”
Dr. Coleman’s advice to young ophthalmologists is go to meetings.
“Despite the time and expense, there is no substitute for actually sitting in
a room listening to smart people,” he says. “Get board certified and
maintain it. Don’t be afraid to be patient and concentrate on a specific
area and become a specialist or subspecialist. There is a tremendous push
currently towards generalists, but be mindful of the approaching
demographics [of patients] and their needs.” His advice to all
ophthalmologists is as follows: “Listen way more than you talk and do your
very best to leave every person knowing at least a little bit more about
their eyes than when they walked into your office.”
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A. JAMES KHODABAKHSH, MD
BEVERLY HILLS VISION INSTITUTE
For James Khodabakhsh, MD, technology and time compose
a two-pronged approach to building and maintaining a
successful practice,
Beverly Hills Vision. He has an
unwavering commitment to investing in the newest technology and
a willingness to offer each and every patient the tender loving care
he or she deserves. “I think the most important strategy to keeping
a practice strong over the near and distant future is to keep up with
the latest technology,” he says. “Although this may seem expensive
and at times unnecessary, we must make the most advanced
modalities of surgery available to our patients. For example, our
practice recently invested in a femtosecond laser for cataract
surgery, and we were one of the first in the country to have it
delivered.” By the same token, Dr. Khodabakhsh says that, no matter
how advanced one’s surgical armamentarium, “If one is not willing to
be kind and listen to [his or her] patients’ needs, then one will not be
able to build a tremendous practice.”
Dr. Khodabakhsh has been in practice for a dozen years, with the past 7
in solo practice in Beverly Hills, California. “When I opened my practice in
Beverly Hills, there were 134 practicing ophthalmologists within a 10-mile
radius,” he comments. “This is one of the most saturated areas in the
country. I decided early on that I wanted to concentrate on the
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growing needs of the baby boomers. I knew that LASIK volumes were going
to decrease over the next few years, and I concentrated on getting as much
experience with [presbyopia-correcting] implants as possible. I took every
course and spoke to my peers about these lenses. I implanted every single one
of them in their early stages of development, with varying degrees of success.
I started with the Crystalens [Bausch + Lomb], then went to the ReZoom
[Abbott Medical Optics Inc.], then the AcrySof Restor SN6AD3 [Alcon
Laboratories, Inc.], back to the Crystalens, then to the AcrySof Restor SN6AD1,
and back to the Crystalens and the Tecnis Multifocal [Abbott Medical Optics
Inc.]. I became known for being the ‘lens guy’ in the area.”
Surgeons now routinely refer their difficult cases to him. “My practice is
moving increasingly away from general ophthalmology and concentrating on
the premium lens market,” he says. “I also network with many optometrists,
so I don’t dispense glasses or contacts.”
One thing that distinguishes Dr. Khodabakhsh’s practice from some others
is that he aims to spend as much time with his patients as possible. “This is the
best way to continue to build a practice and increase conversion rates,” he
explains. “It also allows me to teach my patients about emerging technology,
especially in the field of lens-based surgery. I get to show them my confidence
in the technology. It goes a long way in getting more referrals but also in
converting patients to premium lenses—if not now, then in the future.”
His advice for up-and-coming surgeons who want to build a solid practice
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and reputation: “Tweak your technique and get back into refractive
cataract surgery. It is the wave of the future and here to stay. If you don’t
want to do lens surgery, then hire someone in your practice with the
personality to do it. It will truly pay off in the long run.”
JACQUELINE D. GRIFFITHS, MD
NEWVIEW LASER EYE CENTER
Jacqueline Griffiths, MD, has the good fortune to own a practice
in one of the areas of highest per capita income in the country—
Reston, Virginia, outside Washington, DC
NewView Laser
Eye Center. Even situated as she is among the moneyed and sophisticated
Capitol Hill crowd, she has taken smart steps to remain a winner in a
highly competitive market.
Dr. Griffiths has relied on diversification and a pleasant demeanor to
distinguish herself and her practice. She says that patients appreciate that
they can get everything in one place. She practices with an optometrist
and an optician and offers oculoplastic and aesthetic procedures in
addition to refractive and cataract surgery. When her older cataract
patients comment that their eyelids are sagging, she mentions that she
offers blepharoplasty.
Dr. Griffiths adds that she can diminish their fine facial lines and wrinkles
with Botox (Allergan, Inc.) or fillers, and she says patients are comfortable
taking that leap, because they are being taken care of by a surgeon they
already know and trust.
“I made a creative, focused effort at the very beginning to provide
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full-service, personalized attention in a doctor-owned and run practice, as
opposed to some of the corporate-owned laser centers that put all their
eggs in one basket,” Dr. Griffith says. “Because I chose to diversify my
practice from the very beginning, I think that it has helped me to maintain
revenue and, in fact, increase my revenue over the years, even in the lean
times. When one aspect of my practice was down, another was up.”
In recent years, she added an optical dispensary when she noticed that
more people were opting to stay in their glasses because of economic
reasons. “That has been an excellent financial decision for us,” she says. The
optician now accepts vision plans, which allows those patients to stay
within her practice. “We were losing some of our optical patients because
they had vision plans, so they would get the prescription from us and go to
an outside optical. By accepting these vision plans, we maintain them for
the optical, and then, we also have the opportunity to later on convert a lot
of those patients to laser vision correction and other services that we offer.”
The economic driver here is revenue per patient or getting as much as
possible out of each patient by filling a wide range of his or her potential
needs. “The patients really appreciate the one-stop shopping that we provide in our practice and the personalized attention that we give,”
she comments.
Dr. Griffiths says her attitude, her personality, and even her gender have
played a role in growing and diversifying her practice. “Sometimes, men can
be a bit uncomfortable talking about Botox or fillers,” she explains. “As a
woman, I have no problem saying, ‘Hey, did you see that we do some of the
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fun stuff here with the Botox?’ I think … my easy demeanor and the rapport
that I build with [patients] … makes it easy to bring the subject up.”
LISA BROTHERS ARBISSER, MD,
AND AMIR ARBISSER, MD
EYE SURGEONS ASSOCIATES
The husband and wife team of Drs. Lisa Brothers and Amir
Arbisser has a burgeoning multispecialty ophthalmic practice
with several locations throughout Iowa and Illinois
Eye Surgeons PC. Lisa handles a cataract caseload of 50 per week, while
Amir provides postoperative care for up to 70 patients per day in addition to
being what his wife describes as “the brains behind the business.”
“My husband and I started Eye Surgeon Associates nearly 30 years ago,
and we’ve built a 20-doctor multisubspecialty group with five locations,”
Lisa says. “I think the fact that we aren’t entirely dependent on Medicare
and cataract surgery alone is huge. We began the group as a mom and pop
operation. Today, we offer everything—except for neuro-ophthalmology—
and I think that’s why we’re prospering.” She points out that the practice has
always been at the forefront from a managerial perspective, and it has worked
well for them. “We were the first people in our area to have a capitated
contract some years ago,” she notes. “We’ve definitely experimented in being
on the forward edge of various types of delivery.”
Amir says their practice model is one of economic efficiency. “This doesn’t
necessarily mean the doctors earn less money,” he says. “It means that their
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skills are more appropriately employed. [For instance,] years ago, there were
three of us in the group who did cataract surgery, and we would rotate the
cases. However, over a period of time, I noticed that our growth curve
flatlined. When I analyzed it, I found that one of the three [surgeons] was not
getting predictable outcomes. After I realized this, if someone requested that
doctor, he was assigned the case. Otherwise, it was decided that to continue
to give him cataract patients on a rotational basis was actually harming the
practice. So, we are thinking about the patient’s best interest, and we are
thinking about the practice as a practice, not as a bunch of individual
doctors’ individual practices.”
Amir continues, “The most important philosophical thing that we did
more than 20 years ago was that we developed a new compensation
structure within the group. The traditional way of compensating
professionals is what I call ‘jungle mentality,’ where you eat what you kill.
Typically, if a surgeon provides a service, then they see the revenue generated
from that as their money. However, if you’re in a group, when you behave
that way, it ultimately creates conflict within the group, because it basically
puts partners in competition economically. Surgeons tend to want to
perform the ‘big ticket’ procedures whether it’s their strong suit or not.” The
compensation structure that they implemented turned that behavior on its
head and allowed the practice to function as a group. “You can’t completely
take away economic incentive as a behavioral driver for people, but you can
reduce it to such a degree that people realize they can actually make more
money doing the right thing, taking care of patients with skills that they have
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that might be better than some of their colleagues’ and partners’,” he says.
This, he argues, drives patients to a surgeon who can do something the
most efficiently, in the most skilled manner, using the fewest resources,
achieving the fewest complications, and having the fewest reoperations,
which is a win-win for patients and doctors.
With all of the changes afoot for health care in general, Amir says he has
an advantage over many of his counterparts. “I have a more positive
attitude about the future than a lot of people,” he comments. “The
concept of change is not frightening, because it’s really all about the
perception of control or the fear of losing control, and from my
perspective, we have control.” Q
Stephen Coleman, MD, may be reached at
(505) 821-8880; [email protected].
A. James Khodabakhsh MD, may be reached at
(310) 550-7888; [email protected].
Jacqueline D. Griffiths, MD, may be reached at
(703) 834-9777; [email protected].
Lisa Brothers Arbisser, MD, and Amir Arbisser, MD, may be reached at
(563) 343-8896; [email protected].