Many refractive surgery-based ophthalmology practices have experienced difficulty in the wake of economic downturn and industry-wide changes. This has forced practice owners to re-evaluate critical factors and change focus in order to sustain ongoing success. Gaining new market share, maintaining patient volume, and increasing cashflow is vital to sustainability. This article is an overview of key factors to consider.
Business Focus
The business focus of a refractive practice varies by locale and should be considered in a changing market. The dynamics for refractive surgery can operate very differently from the services in the course of a normal ophthalmology practice. In a soft market for many elective eye surgeries, business diversification is necessary as a hedging strategy. Whether a new or existing practice is entering the refractive market, an investment requires serious capital and time resources. Generally, a practice will choose one of three major strategies: co-management only; handling a lower case volume of surgeries performed at a laser center; or developing a full volume in-house refractive practice. Choosing a primary strategy and maintaining a local geographic focus is crucial to establishing credibility within a market. An overextended practice with a wide focus or with remote locations is nearly impossible to maintain without increased financial resources, improved efficiencies and exceptional operational experience.
Market Share Analysis
A market share analysis of most metropolitan areas will yield similar results. A typical area can support one or two major refractive surgery practices and four or five secondary participants. Determining the primary and secondary players is not always straightforward, as private organizations do not typically make their statistics publicly available. A handful of the top practices generally comprise a lion’s share of the case volume within a specific market. The percentage of market share which each practice maintains is relatively static due to a fixed reliance on referrals. Significant changes in market share usually come from major marketing campaigns, the purchase of entities to secure referral sources (beware of Self-referral, Stark, Anti-Trust, etc), or errors from competitors. A practice’s ability to grow individually is as important as the overall growth in volume of the market in which it resides. One of the barriers to entering and remaining successful in many markets is the challenge of gaining even a small percentage of market share. Providers in the established markets are usually well-established players with many years’ experience and use the latest technology to leverage their market share. The key to remaining successful is continually monitoring the playing field and revising internal and external strategies to stay nimble.
Financial Forecasting
Although markets are often unpredictable, financial forecasting is a necessary part of planning the future of a refractive ophthalmology practice. Practice owners must transcend the focus on current numbers and anticipate new trends. The 3-5 year time horizon is important, even though forecasting methods may not always be accurate. Proposed initiatives must be made with cash flow consequences in mind as economic conditions warrant business changes. Practices must be prepared to make rapid shifts; their ability to scale up or down based on market trends and the general economy will dictate survival. Forecasting also involves apportioning for the acquisition of new surgical technology, and equipment considerations must contribute to the bottom line within a reasonable timeframe. New equipment must generate sufficient income to offset ongoing expenditure spent on building brand awareness and developing case volume.
Technology
The demand and marketability of refractive services can also be driven by advances in technology. The most sought after procedures usually include the latest technology, though older technology is still available. Practice owners must make careful capital considerations when deciding whether to acquire new lasers and equipment. They must also weigh the options of leasing equipment versus purchasing, or avoiding both options altogether by paying to use other surgery centers. The painful cash flow consequences of equipment acquisition are especially poignant in today’s economy, as many lasers are sitting idle in a soft market. Some ophthalmologists who do not own lasers may have less of a burden in a soft market, though their profit margins may be slimmer. Physicians with their own laser centers must make careful considerations to accommodate changing markets. In the past, surgeons have been too eager to acquire new technology without evaluating cash flow consequences first.
Market Niche Selection
Selecting and occupying a market niche is important especially in a saturated, mature market for refractive surgery. Niche selection is dependent on the skill of the surgeon as much as the current saturation of each particular niche within a market. Deciding whether to stick with a discount, value, or premium market niche will depend on the patient demographic, demand, and skill of the surgeon. Although a particular provider’s level of skill may warrant a premium niche status, the saturation of that niche can be a barrier to entrance. In addition, practicing within a particular niche involves certain expectations of services, care, and price points. Adjusting prices without adhering to market segment dynamics can be problematic. Simply reducing fees to increase volume can have the effect of reducing profit margins. Capital expenditure and working capital are required for future growth. These expenditures reduce cashflow to equity or invested capital in a refractive surgery practice. Tenure in the refractive surgery market and physician reputation in the community support different niches and price points. Some of the new strategies which have emerged in the last decade deal with difficulties in pricing and market saturation include price negotiation strategies, patient testimonials, live surgery observation, and in-house financing options.
Advertising Budget
It is not uncommon for advertising to be one of the largest expenditures of refractive focused practices. The costs of print, television, radio, and internet advertisement can soar at rapid rates. Newer practices must spend especially significant sums on advertising to build a steady patient flow. After building this initial flow the practice can reduce advertising efforts as their referral base expands. The amount of advertising expenditure depends on local competition, growth goals, and the efforts applied to developing referrals. Consumer advertisement remains a crucial part of the overall marketing mix. The effective use of advertisement in this manner involves the proper tracking of response sources and a reliable follow-up system. Strategies used to convert ad responses into sales include free consultations, free meetings with surgeons, and public seminars.
Staff and Physician Extenders
Properly trained staff is crucial within a practice and effective management techniques are pivotal to honing their ability. Staff affects the ability to deliver continuity of care, good customer service, and the cultivation of a practice image. A typical office may include a refractive surgery coordinator/counselor, support staff, and a surgeon who can manage clinical and management tasks. The proper use of staff and extenders can also be a very effective cost reduction strategy. Hiring a lower cost extender such as an optometrist or medical ophthalmologist will allow the surgeon(s) to maximize their time in the operating room. The staff can help to categorize patients and appointments and direct workflow to the appropriate extender or physician. Greater practice efficiency is achieved by taking fringe work away from the operating surgeon and increasing profit per unit of time.
Patient Referral Base
The referral base is the lifeblood of a refractive dominated practice. Patient-to-patient referral remains the number one source of new patients in almost every mature practice. Maximizing referrals requires staying in touch with past patients and building relationships. This requires good patient database management, regular bulletins, and periodic survey calls. Another vital source of referrals comes from other providers such as Optometrists. Optometry referrals have a large and growing influence on the case sourcing mix in many practices. These referral networks are made through business alliances with optometrists, the sharing of co-management services and fees with optometrists, and buying an optometry practice for sale within the referral area. A practice’s market share can be increased considerably by acquiring additional referral sources. Acquisition strategy must involve careful consideration of self-referral, Stark, and Anti-Trust statutes. A medical practice sales consultant and healthcare attorney can assist with this process.
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