The Changing LASIK Patient
Attract late adopters by seeing refractive surgery through their eyes.
By Howard Gottlieb, O.D., President, Eyecare Consultants Ltd., Woodbridge, Conn.

There's no question that the market for LASIK (laser-assisted in situ keratomileusis) is a growth market. So far, only 3 to 4% of all the individuals eligible for LASIK have had the procedure. So it's no surprise that an increasing number of refractive surgeons have added LASIK to the list of services they offer.

However, many of those doctors have gotten more than they bargained for. An explosion in marketing and price advertising, extensive media coverage, a multitude of corporate surgery centers and advances in laser and diagnostic technology have all contributed to an incredibly rapid product and market evolution.

Now refractive surgeons are faced with yet another challenge: dealing with changes in the type of patient expressing an interest in LASIK. Here, I'd like to explain why LASIK patients are changing and offer some practical steps you can take to win over the current wave of new and different LASIK patients.

Why your practice needs to change (again)

Most ophthalmologists are primarily accustomed to treating older patients with health problems. Today, thanks to LASIK, many practices are dealing with young, healthy patients who pay out-of-pocket for an elective procedure. The changes wrought by this shift -- including a new emphasis on marketing and having to compete with bargain-priced competitors -- mean that many practices must alter the way they do business.

Now, just as surgeons have begun to adapt to these circumstances, a more subtle change has begun to occur: The nature of the typical LASIK patient has begun to change. This is mainly the result of three factors:

• As time passes, LASIK is attracting different patients with different motives. When a new procedure becomes available in the marketplace, it's not immediately accepted by everyone. In fact, different groups of individuals accept a procedure after different lengths of time, for different reasons.
  The first patients to request LASIK fell within the group called "early adopters." These original patients felt a very strong occupational or recreational need for this kind of surgery. They had very negative feelings about glasses and wanted to get rid of them at any cost. For the most part, they also had higher levels of refractive disorder. These patients were the innovators, the opinion leaders and the influencers, and they helped to generate public interest in LASIK.
  Over time, as a procedure builds a reputation, the type of patient interested in having the procedure begins to change. This is now happening with LASIK: It's beginning to attract patients who don't feel a compelling need to have the surgery. These patients think that life would be better without glasses, but they don't see the surgery as mandatory. They also tend to have less extreme refractive errors than earlier patients.
  Capturing these differently motivated patients will require a change in your approach to marketing, education and patient accommodation.
• Word-of-mouth referrals are now driving interest in and acceptance of LASIK. Why is this happening? In my experience -- and I've seen studies that support this -- almost 95% of patients are either satisfied or very satisfied with their LASIK result. Not having to wear glasses or contact lenses is liberating. They can't wait to go out and tell their story to their friends, their families and even strangers they meet on the street! This has a very positive effect on potential LASIK patients, because many of these later adopters rely on referrals and word-of-mouth experiences to mitigate their fears about the procedure.
• Because this new wave of patients has less motivation offsetting their fear, they're more price-resistant. Sure, even early adopters feel fear when they undertake a new procedure -- after all, they have far fewer people taking the plunge ahead of them, reassuring them that it was worth it. However, their motivation to take the risk is strong.
  The current wave of patients, by definition, consists of individuals who feel less urgency about having the procedure done, so their fear is more of an issue. If you want to win them over, you have to take steps to assuage those fears.
  This difference also affects the patient's response to price. If not wearing glasses is merely a convenience rather than a high-priority personal need, patients will be asking themselves whether having LASIK is really worth paying thousands of dollars. (However, lowering your prices isn't necessarily the right way to respond. See "Why You Shouldn't Lower Your Prices" )

The bottom line? The patient is changing, the market is changing, and like it or not, your practice needs to change.

Understanding later adopters

Later adopters represent about 65% of all refractive patients. They're typically between 30 and 50 years old. Surveys indicate that these patients tend to be well-educated; more than 22% have masters degrees or Ph.Ds., compared with only 7% nationally. About 60% of the LASIK patients in this group are women.

The fact that this is a better educated, more affluent group of patients means that you need to put many of them into the "value and premium service" category. Also, many of the patients in this category live, eat, and breathe the Internet. For that reason, you should provide a connection between the patient and your practice via the Internet. For example, you can use a regular series of e-mail messages to reach out to this new group of patients and help them overcome their fear and price objections. This can be a very effective way of marketing LASIK. (More about that in a minute.)

Later adopters and price

As you know, price competition has become a serious issue in the LASIK market. At least part of the reason for this is that later adopters are more sensitive to price than early adopters.

Basically, later adopters (like most patients in general) fall into three categories when it comes to price:

• Those who only want their fundamental needs met. These patients have a short list of concerns. They don't care which surgeon they see or what the center is like. Consequently, they have no reason to look for anything except a low price.
  These patients are the ones who respond to the price advertising in the newspaper. The good news is, these individuals only represent an estimated 20% of the later adopters.
• Those who want value. These patients want a combination of price, service, and convenience. They're looking for:
  • caring and individualized attention (they want to have a relationship with their doctor and they want to be catered to)
  • state-of-the-art equipment
  • brochures and videos that explain the procedure
  • faster service
  • convenience (Friday and weekend surgery, for example)
  • financing, to make the procedure more affordable.

This group comprises about 60% of the later adopters.

• Those who want a premium procedure. These patients, who make up about 20% of the later adopters, want to be pampered. They want all of the above, plus extensive personal attention, a deluxe setting and possibly transportation to and from the surgery. They're looking for a lifetime warranty (even though this may not be realistic). Practices servicing these patients can usually charge more for the procedure.
  If there's a moral to this story, it's this: Don't try to market yourself to the bottom 20% of this market. The value and premium service patients make up 80% of the market -- and these are the consumers who care about more than just price. (Besides, the competition is much more fierce on the low end; a large number of price competitors are already competing for the smallest segment of the market.)

Meeting the patient's emotional needs

The best way to bring later adopters into your practice and keep them there is to address their emotional needs. These usually fall into three categories:

• They want to feel comfortable about the procedure.
• They want to feel that paying for the procedure will be manageable.
• They want to be convinced that you have the expertise to give them the glasses-free eyesight they want.

If you successfully meet these needs, word of mouth should keep plenty of patients coming in your door. In the next few pages, I'd like to share some specific things you can do to meet these needs.

Make the patient feel comfortable

The best way to put your LASIK patients at ease and reduce their anxiety is to help them develop a relationship with you and your practice. To make this happen:

• Take every opportunity to inform and educate your patients. Make this the focus of the first conversations you and your staff have with the patient. Provide an information kit. Make information easily visible in your reception area.
• Create a dialogue concerning the patient's specific needs at the earliest opportunity. This makes it possible to reassure the patient that his or her specific needs will be addressed by the procedure (or to find out that they won't and advise the patient accordingly). It also makes patients feel that you're really interested in them as individuals.
• Provide a separate waiting area for refractive surgery patients. These patients don't have a health problem, and they want to feel special. Also, they'll have the opportunity to hear more success stories and share concerns with other patients.
• Review your practice environment for soothing "cues." Make your waiting area friendly and comfortable. Provide cookies, coffee, soda, warm lighting and comfortable chairs.
• Retrain your staff to think in terms of "connecting," not processing. Your staff's attitude will make all the difference in how your patients feel. For example, instead of just pointing out the coffee machine, a staff member should offer to get the coffee for the patient and use this as an opportunity to answer questions and put the patient at ease.
• Address the patient by name. This is a small detail, but it does a lot to personalize the experience for the patient.
• Create excitement about the procedure. Say things like "This must be very exciting for you," or "Do you have any plans for after the procedure?"
• Look at your practice from the perspective of these patients. Now that you know the fears and needs these patients have, walk through your practice and see it as they do. (This can be an eye-opening experience.)

Make it easy for patients to pay

Offering financing is one of the best ways to increase patient volume -- without lowering your fees. However, many surgeons still have misconceptions about pricing and patient financing. When I ask doctors why they don't offer financing, I hear comments like these:

• "No one wants financing -- credit is for deadbeats." That's patently wrong. Today, everyone uses credit. Besides, paying a little each month makes a large expense much more manageable, and that's an idea everybody can relate to.
• "No one ever asks us about financing." That's because patients don't want to bring it up. They don't want to be forced to embarrass themselves by admitting that they may need 12-month, no-interest financing to be able to afford the procedure. But they'll be thrilled if you take the initiative and offer financing as an option.

The simple fact is, financing is one of the best ways to manage the problem of patient concern about the cost of LASIK. For example, we convinced a practice we work with in the Midwest to offer 12-month, no-interest financing. Within 2 months, 35 new patients had taken advantage of the offer. Yes, some of those patients might have paid cash if the financing hadn't been offered. But many of them were clearly relieved when the practice offered the financing right up front and addressed their financial needs in an open and honest manner.

If you decide to offer financing:

• Offer the option early on. Before you get into the issue of LASIK itself, explain that the patient can pay as little as $100 a month for the procedure.
• Try offering online financing. Because your practice isn't a bank, you'll need to work with an outside financial organization to offer this option. Online financing is one of the best alternatives I've seen. (For a list of resources in this area, see "Patient Financing Options," )
• Offer choice, flexibility, and term options. The more options you offer, the more patients will decide they can afford the procedure. For example, you might offer a choice between larger payments with no interest, or an extended payment plan that includes a small interest charge.

Remember: Using credit to make a large purchase more manageable isn't just for patients with tight budgets.

Switch to permission marketing

If you want to succeed with the later adopters, the type of advertising you do will make a difference. Most advertising for LASIK today falls into the category of what I call "interruptive marketing." This is the kind of ad that interrupts what you're doing and tries to get you to think about something else. It's found on TV and radio, on billboards and buses, in newspapers and magazines, when we receive calls from telemarketers, and even on T-shirts.

Interruptive marketing has been the traditional approach to consumers for many, many years, but it leaves a great deal to be desired. (Hardly anyone goes home eagerly anticipating junk mail in their mailbox.) Besides, if you ask someone whether they heard an ad for LASIK during the day, they'll probably say yes -- but they won't have any idea which doctor or practice ran the ad.

A better way to approach prospective patients with an offer of LASIK is "permission marketing." In this format, you ask the prospect's permission to provide information. For example, an ad that includes a postage-paid card for the recipient to send back for more information is a form of permission marketing.

Once the prospective patient expresses an interest in learning more, you can provide information periodically, and you know the recipient will read the information. Plus, he'll know which practice he's interacting with.

In contrast to interruptive marketing, permission marketing is long-term, interactive, personal and relevant, all of which make it appropriate for this new group of LASIK patients. Also, most of these later adopter patients use the Internet and e-mail. Once a prospect tells you that he's interested in LASIK, you can provide a steady stream of information via e-mail designed to overcome his fears and price objections. This is much less expensive than traditional interruptive advertising.

If you'd like to try a program like this in your practice, I recommend taking the following steps:

• Begin by making your practice Web site interactive. Most existing ophthalmology Web sites are informational only; ophthalmology practices often don't have the interactive database management software that's necessary to make permission marketing work.
  Because setting up an interactive Web site for a practice requires some expertise, I recommend getting outside help to accomplish this change.
• Collect e-mail addresses at every opportunity. For example:
  • The information form new patients fill out should ask for an e-mail address.
  • Your ads can say, "For more information, e-mail us at . . ."
  • Collect e-mail addresses at seminars, health fairs and other special events.
  • Create contest involving a random drawing for a pair of designer sunglasses that requires sending an e-mail.
• Send focused messages to the appropriate parties. If your message concerns LASIK, send it to patients and prospects who've expressed an interest in LASIK. (In some cases, it might be appropriate to send messages to a larger group, depending on the subject and intent of the message.)
  The messages themselves should NOT be sales-oriented. Instead, they should focus on overcoming the fear factor through education, and offering solid evidence of the surgeon's expertise.

For more general marketing suggestions, see "LASIK Marketing Strategies," .

Managing change

These days, if you offer LASIK, dealing with change is inevitable. The market is changing, and your new patients -- the later adopters -- have different wants, needs and desires than previous patients.

So, change your practice and the way you respond to your new patients. Remember to:

• Build relationships one on one. Every patient is different. Some patients will have done their homework and won't want you to explain LASIK; others will be counting on your explanation to put them at ease. Be sensitive to individual needs.
• Provide more education. Re-member that this is a surgical procedure, not a retail product, and these patients have more fear. If you don't give these patients enough information to make an informed decision, you'll end up with a lot of unhappy patients.
• Make sure your staff is prepared to deal with this type of patient. These later-adopters require more sensitivity than earlier LASIK patients, and they're dramatically different from traditional ophthalmology patients. Your staff should know how to treat them, how to answer their questions about LASIK, and how to respond to challenges such as being asked why you charge more than "bargain" surgery centers.
• Meet your patients' emotional needs. Address your patients' fears right up front. Offer them financing options. And use permission marketing and an interactive Web site to generate trust and confidence.

Winning the race

I like to compare surviving in the LASIK marketplace to the race between the tortoise and the hare. All of the companies using price advertising and constantly changing ads -- they're the hares. The smart ophthalmologist, who takes a long-term approach to building his practice by building relationships with both current and future patients, is the tortoise.

And as we all know, in the race between the tortoise and the hare, the tortoise wins.

Howard Gottlieb is President and CEO of Eyecare Consultants Ltd., which provides consulting services to ophthalmology practices nationwide.

Eyecare Consultants Ltd. has developed a comprehensive permission marketing system for LASIK practices, which includes the creation of an interactive Web site. For more information, visit EyecareConsultants.com on the Internet, e-mail Eyecarecon@aol.com, or call (203) 389-6962. Two complimentary audio tapes are also available from Eyecare Consultants upon request: "Marketing Refractive Procedures on the Internet" and "Evolving with the Changing LASIK Market."