Issue: May 25, 2020
Source/Disclosures
Disclosures: Kieval reports he is a consultant to Johnson & Johnson Vision.
May 19, 2020
3 min read
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Price cut boosts LipiFlow volume

One practice leveraged lower prices for thermal pulsation therapy to strengthen its dry eye center of excellence.

Issue: May 25, 2020
Source/Disclosures
Disclosures: Kieval reports he is a consultant to Johnson & Johnson Vision.
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Thermal pulsation system treatment is an effective procedure that is backed by years of sound science.

In published studies, LipiFlow (Johnson & Johnson Vision) has been shown to deliver sustained improvement in meibomian gland function and dry eye symptoms, increase the duration of comfortable contact lens wear and improve recalcitrant dry eye symptoms after laser vision correction. Symptomatic improvement is higher in patients with less severe meibomian gland atrophy at treatment, so it is ideal to treat patients as early as possible in the course of their meibomian gland dysfunction (MGD).

Even so, utilization of LipiFlow in our practice had been relatively low until recently. I often delayed recommending it to a second- or third-line treatment, simply because of the cost to the patient. I have no qualms about charging patients a premium for cosmetic or refractive services such as blepharoplasty, LASIK and premium IOLs, but I have always been a little uncomfortable recommending an expensive out-of-pocket procedure to treat a medical condition that both my patients and I feel should be covered by insurance. (I felt the same way about corneal cross-linking before that became a widely covered procedure.)

Jeremy Z. Kieval
Jeremy Z. Kieval

However, a significant reduction in the price of LipiFlow activators from the manufacturer in 2019 has changed how we position the procedure in our practice and has doubled our thermal pulsation system (TPS) procedure volume. With the new activator price, we were able to cut the price that patients pay in half, while still making a reasonable profit. The out-of-pocket cost is now more in line with what patients might pay over the course of the year for over-the-counter products and medication copays if they were prescribed an immunomodulator or LFA-1/ICAM-1 antagonist such as Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), Cequa (cyclosporine ophthalmic solution 0.09%, Sun Ophthalmics) or Xiidra (lifitegrast ophthalmic solution 5%, Novartis).

At the lower price point, more patients are able to afford TPS. I am less concerned that they might not see value in the procedure and more comfortable both recommending it as a first-line treatment and suggesting repeat treatments to sustain the benefits over time. An added benefit to the volume increase is that my colleagues and I are seeing good results more frequently, which in turn makes it easier for us to talk to patients about what to expect.

Part of a dry eye clinic

TPS is part of our dry eye center of excellence within the practice. We launched the center in 2016 and hired an optometrist who is passionate about dry eye to manage it. This has allowed me and my cornea, cataract and glaucoma partners to focus more of our time on surgery, while still serving those who are struggling with ocular surface problems. Having LipiFlow elevates the dry eye clinic and brings needed attention to MGD, which the majority of dry eye patients have as at least one component of their disease. It has increased word-of-mouth referrals from patients and local optometrists who do not have access to TPS themselves.

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All in all, the pricing change has dramatically changed our view of what LipiFlow can do for our practice and our patients. My clinical confidence was always high, but now the TPS procedure has become far more accessible to patients and a more integral part of our dry eye clinic.

Tips for success with TPS

At our practice, we have identified three tips to ensure success with TPS:

1. Streamline your processes. We use InflammaDry (Quidel) to test for the presence of an inflammatory marker (MMP-9) in the tear film. Although there is a lot of overlap between evaporative dry eye/MGD and aqueous deficiency/inflammatory dry eye, we tend to start down one path or the other. If the test is positive, we start patients on topical therapy first. If the test is negative, we start with LipiFlow, omega-3 supplementation and warm compresses.

2. Block scheduling. Schedule LipiFlow treatments during specific blocks of time with a dedicated technician.

3. Make it a spa-like experience. Although TPS is a medical procedure, I know from personal experience that it is also relaxing — sort of like a massage for the eyes. We perform the treatments in our oculoplastics suite, which is a quiet, peaceful environment with soothing music and aromatherapy. This has been appealing to patients, who look forward to returning for another treatment.

Disclosure: Kieval reports he is a consultant to Johnson & Johnson Vision.