November 15, 2017
5 min read

What is needed for practices to run efficiently?

Cynthia A. Matossian, MD, FACS, and Denise M. Visco, MD, offer a look at the approaches used in their organizations.

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Welcome to another edition of CEDARS/ASPENS Debates. CEDARS/ASPENS is a joint society of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.

As the population ages, ophthalmology practices continue to get busier. Staying efficient and providing adequate education for patients have become more difficult. It is essential to have a system in place to manage the busy practice. This month, Cynthia A. Matossian, MD, FACS, and Denise M. Visco, MD, discuss their systems to make their practices run efficiently. We hope you enjoy the discussion.

Kenneth A. Beckman, MD, FACS

Education needed for staff and patients

Patient education is a critical piece to ensure practice success, patient satisfaction and five-star online reviews.

It all starts with a business blueprint.

Cynthia A. Matossian

1. Most ophthalmologists have limited time to personally complete the education leg during the patient visit. Because this task is delegated to staff, it all starts with staff training. Adequate training is key to having confident, well-informed technicians who can easily explain complex nuances of implant options and surgical procedures to our apprehensive patients. Frequent, scheduled staff in-services are a must.

2. At the time of their preoperative measurement visit (this is a separate appointment from the cataract consult, allowing time for the ocular surface to improve with a personalized treatment plan designed by the cataract surgeon), patients are given an iPad to watch preselected modules through CheckedUp. While the technician is entering their demographic data into the IOLMaster biometer (Carl Zeiss Meditec), Cassini topographer (i-Optics) and OPD III aberrometer/topographer (Nidek), patients have time to review cataract surgery-related topics such as presbyopia correction, astigmatism management, limbal relaxing incisions, ORA (Alcon) and more. This keeps the information fresh in the minds of the patients before the surgeon enters the room to review the test outcomes and make a customized IOL recommendation.

3. All the digital images are networked into our exam rooms and displayed on large screens. The surgeon personally reviews the various maps such as point spread function, higher-order aberrations, Placido disc mires to demonstrate dry eye disease and astigmatism patterns on the OPD III axial map. The patients “see” their bowtie astigmatism and get a better understanding of why a toric IOL may provide clearer vision with less dependence on spectacles. Another feature that is easy for the patients to “see” is their pre-existing dry eye disease with warped black and white Placido disc rings. This way, patients understand that they have a pre-existing condition and do not blame the surgeon for “giving” them dry eye disease after cataract surgery.

4. To further underscore the visual range provided by the IOL selected by the patient, we created a graphic display within the consent about the aimed refractive target of each implant choice.

With this multipronged educational approach for both staff and patients, we continue to achieve high customer satisfaction and staff retention.

Disclosure: Matossian reports she is a consultant to Marco/Nidek, Alcon, CheckedUp, i-Optics and Zeiss.


Maximize value for patients

Any system of education must be developed specifically for the practice and the patient population it serves. By focusing on your customer experience and designing the operational flow around patient needs and desires, a successful health care delivery model can be developed that helps us understand our patients, set expectations and deliver a great experience.

When considering patient experience, ask yourself: Is your organization designed to maximize value for the patient?

Denise M. Visco

Maximizing value begins with understanding the patient journey through the health care facility. Develop systems to facilitate patient engagement so clients can feel good about their care and confident in their surgical choices. For patient engagement to be truly effective, strategies must be integrated into the core of health care delivery processes. According to a brief written by Kaiser Permanente and the Mayo Clinic, “Patients should be afforded the opportunity for meaningful input in the health care decisions that affect them.” Our practice begins engaging with education.

As our critical patient engagement tool, our education process is regularly evaluated through the lens of the recipient. Several years ago, Eyes of York took the next step and improved our system to “pave the last mile.” In addition to creating visually cohesive education and marketing materials, we looked at consistent, simplified messaging for treatment protocols, beginning with the first phone contact and continuing with education points reiterated throughout a patient’s 360-care episode. The staff has been trained, so each touchpoint of care maintains consistency and professionalism with information delivery.

New patient appointments are given a choice to either receive a three-page information packet or view our practice website. Pre-appointment phone calls answer questions and set expectations before visits, thereby creating our client’s first opportunity for learning. Upon arrival, the progression continues through testing, technician workup and educational counselor encounters. Our practice uses a combination of video elements and specialized handouts to reinforce talking points. When the surgeon enters the room, patients should understand two things:


1. What exactly is the service that the organization provides?

2. What value does the service hold for them?

Our surgeons have all images available on the computer for patient exams and discussions. Our providers encourage questions, and I specifically talk to patients about their partnership with me. The physician connection with the patient is the foundation for sustained engagement, and our educational methods facilitate this relationship. As elaborated in DeBenedette’s article on influencing care outcomes, “Patients who feel that their physicians treat them with respect and fairness, communicate well and engage with them ... are more active in their own health care.” This equates to happier, more compliant clients that become practice promoters.

Our customer experience delivers information to patients about our high-quality surgeons, facility and outcomes. Additionally, clients receive simplified medical models to understand their diseases and how we will treat them. We want to create processes to not only expedite the necessary work that must be done but also minimize the stress on the patient. The delivery of value changes over time with advances in medical technology and innovation. However, the goal is to always make the care delivery pathway as easy and seamless as possible.

Disclosure: Visco reports no relevant financial disclosures.