January 08, 2019
4 min read

Presenting ‘premium’ pricing to the patient: A package deal or a la carte

Patients can be offered customized combinations or packages with pricing that includes built-in enhancement if needed.

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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 cataract surgery technology has gained unprecedented precision, surgeons now have the capability to customize their outcomes. The use of new IOLs and femtosecond lasers has given us so many options for customization.

This month, Ehsan Sadri, MD, FACS, and Cynthia Matossian, MD, FACS, discuss their methods for presenting these options to their patients.

We hope you enjoy the discussion.

Kenneth A. Beckman, MD, FACS

An educated patient is an empowered patient

Ehsan Sadri, MD, FACS
Ehsan Sadri

At my practice, we customize vision for each patient. We have a system that we like, which ultimately puts the decision of which protocol/package to buy in the hands of an educated patient consumer.

Each patient is different. An older man with cataracts who is at risk of losing his driver’s license may have in mind the singular outcome of passing the licensing vision test. Another patient may have in mind an outcome that leaves her with spectacle-free crisp distance vision.

We educate patients about what outcomes are possible with different technologies, which empowers them to decide which “advanced” protocols or packages would give them the outcome that they want. As an anterior segment surgeon practicing for 15 years, I consult for a number of IOL manufacturers, so I am agnostic as to which advanced technology IOL is best. The critical point is to make sure that patients have buy-in to the decision and that they know that the surgeon and team are working for their benefit.

We take the approach that a confused patient is a non-buying patient because the decision is too difficult to make. We explain the different outcomes and keep things very basic, so when patients walk out of the office, they can in turn explain what they are getting to their loved ones. If you cannot explain the protocol and the pricing simply and briefly so that the patient understands it, then he or she cannot make a decision and becomes a non-buying consumer.

In presenting package pricing to the patient, I do not use the word “premium” because it has the connotation of higher pricing, almost meaning excess. It makes people think of luxury, which is incorrect. Rather, we use the word “advanced” to denote the ever-improving technologies that we can offer. That is an important distinction.


That improving technology is one of the reasons we offer a package approach rather than an a la carte approach. We can offer a wide range of technology, customized to the patient’s needs, depending on what the patient wants.

What I like about the package approach is if a patient has an advanced IOL and needs a LASIK enhancement, for whatever reason to hit the refractive target, then the LASIK is included and the patient pays no extra. My feeling is that if a patient needs an enhancement, LASIK or something else, it should be included. There is nothing worse than leaving a patient unhappy with fuzzy vision and then having the patient pay to get that fixed. That is a problem. That is a mistake.

Disclosure: Sadri reports he consults for a number of IOL manufacturers, including Johnson & Johnson Vision, Bausch + Lomb and Alcon.

Premium pricing: A la carte menu

Cynthia Matossian, MD, FACS
Cynthia Matossian

According to a Starbucks spokeswoman, there are close to 87,000 coffee combination options estimated by a statistician who took their core beverages and multiplied them by the modifiers and the customization options.

Do not worry — we at Matossian Eye Associates do not want to overwhelm our patients with too many options. Yet, customization is key. Each person scheduled for cataract surgery is a unique customer with different needs, different coexisting ocular diseases and different financial situations. Someone tall with long arms reads at a different distance than someone shorter, who may read at a distance 6 to 8 inches closer. Visual needs vary dramatically based on occupation and associated driving requirements. A night shift bus or limousine driver has different visual needs than a hair stylist who works at intermediate distance all day under well-lit conditions.

Comorbidities also affect the choice of the IOL selected. For example, someone with age-related macular degeneration or advanced glaucoma may not be an ideal candidate for a multifocal or extended depth of focus (EDOF) IOL, whereas these implants may be a perfect choice for someone with no corneal or fundus disease who wants to be less dependent on glasses.

Regarding finances: Never judge a book by its cover. Patients who come casually dressed and perhaps live in a less prestigious zip code may value having to only use their “readers” occasionally compared with a patient in a fancy suit and tie who claims he loves his glasses and insists that they are part of his persona.


Patients want their cataract surgeons to help them navigate the ever-changing landscape of astigmatism and presbyopia-correcting options. That is why we at Matossian Eye offer a la carte options.

Our menu is a mini Starbucks: Each service has a separate charge, all of which is additive. For example, ORA (Alcon) is an extra charge; so is a limbal relaxing incision. If someone has less than 1 D of astigmatism, they may be willing to pay for an LRI. An LRI has a different price point than a toric IOL. Someone with higher cylinder may be willing to pay for a monofocal toric but feels the cost of an EDOF, accommodating or multifocal toric IOL is beyond their financial reach. The a la carte menu provides something for everyone. Because of the many combination options, most of our patients select at least one feature that includes an out-of-pocket charge. To make the monetary transaction even simpler for our patients, we offer CareCredit and Alphaeon Credit financing if patients inquire about payment plans.

Patients want utmost customization rather than an option of “small, medium or large” package choices. It is only through an a la carte surgery menu that we can offer gluten-free, vegan, vegetarian, low-sodium or regular IOL dishes.

Disclosure: Matossian reports she is a consultant for Johnson & Johnson Vision, Bausch + Lomb and Alcon.