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    Why surgeons should not undersell their femtosecond laser

    Keith A. Walter, MDWhen it comes to their eyes, patients want the safest treatments, and they know the best technology available is a laser. The cataract patient demographic is changing, and patients today have active lifestyles that demand functional vision.

    They are traveling, use smartphones, and many continue to work. They have lived through decades of rapid technological innovation and understand that the best tools make great surgeons even better. 

    Purchasing a femtosecond laser is a significant investment, and surgeons should maximize the benefits the laser offers to themselves and patients. Converting patients from phacoemulsification to femtosecond laser-assisted surgery (FLACS) is easy when physicians take the opportunity to educate patients on the benefits. Patients can feel assured knowing their surgeon is delivering the best care with the best equipment available.

    At my office, we follow a simple education plan, which has produced a consistent 70% conversion rate for the past several years (despite a moderate-income patient demographic and a location in rural North Carolina).

    It starts with education

    The office mails every patient who makes an appointment an informational packet. This includes a welcome letter informing patients that they have two decisions to make: manual cataract surgery or femtosecond laser surgery and a standard or premium intraocular lens (IOL) implant.

    Although the literature does not discuss pricing, the letter says most insurance plans cover standard options. However, the premium options require an out-of-pocket payment.

    The office also include brochures about the non-covered insurance options, including the femtosecond laser and toric and multifocal lenses, so patients become familiar with the benefits associated with these alternatives. When patients arrive at the office for the initial consult, they already have been thinking about these decisions and are not blindsided by a sales pitch. They come prepared to have this discussion.

    The majority of my patients already are sold on the laser before they arrive for the consultation. It makes sense to them that a precision laser is safer than a hand-held blade.

    I take this opportunity to explain that although the femtosecond laser provides additional safety and produces better outcomes, the Centers for Medicare & Medicaid Services (CMS) categorize the femtosecond laser as a non-covered service because it corrects and manages astigmatism. CMS regulations do not permit billing for “better and safer,” we can only charge for the “non-essential” cylinder correction.

    I tell patients considering the laser that I will remove existing astigmatism greater than 0.25 D and we will prevent any blade-induced astigmatism. Besides better vision and outcomes, opting for the laser procedure eliminates the human factor of variability and the potential complications associated with using a blade.

    I express my enthusiasm about the laser, and my patients feel my genuine confidence in the laser. I always will recommend FLACS if they can afford it.

    FLACS: Making good surgeons even better

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