Finding Success with Premium Products and Self-Pay: Starting the Conversation

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11 min read

In this episode of Interventional Mindset, Preeya K. Gupta, MD, and Darrell E. White, MD, review approaches to discussing premium products with patients.

Integrating premium products and services can afford ophthalmologists many new and tailored treatments for pseudophakic patients who also need refractive correction.
When explaining upgraded services, such as premium intraocular lenses (IOLs), to patients, it’s key to frame the discussion around the enhanced experience and visual outcomes associated with these lenses.

Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.

Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.

Speaking with patients about premium products: Where to start?

Before considering how to discuss premium IOLs with patients, surgeons should first turn inward to identify if they feel confident in their ability to execute their current offerings to patients. Converting patients to premium products requires that the surgeon feels assured of the value of their expertise and services. Dr. White emphasized that this goes beyond clinical offerings, as the staff and practice environment are also critical elements of the patient experience.
Starting from a strong foundation allows surgeons to integrate whatever technology is of interest to them because it will only enhance the strengths of their practice. To ensure the patients of your expertise and knowledge in premium IOLs, Dr. White recommended that surgeons make the treatment outcome and success the focus of the conversation. It’s also helpful to outline how the eyecare practitioner (ECP) will measure the success of the treatment post-operatively, such as with repeatable imaging and diagnostic tests.

Offering upgraded services makes the patient’s experience unique and different from what they would have at any other practice or institution.

It is vital to remember that in the patient’s mind, the premium product offered and the patient’s experience of this service are inextricably linked. To factor this in, surgeons should center the patient’s feelings during the treatment process, which can be done with investments in staff training and the office. While newer or smaller practices may feel that it is difficult to compete with large institutions, Dr. Gupta explained that surgeons can still provide an individualized experience to patients that bolsters and transfers the sense of the value of the treatment.

Pearls for converting patients to premium products

Practices that offer premium services need to have an internal infrastructure that supports the surgeon in offering upgraded products to patients. Every person in the practice needs to believe in the value of these products and be invested in the process of creating an exceptional experience for the patient.
Staff education in premium services and empowerment in facilitating conversations with patients are critical support pillars to increasing conversions. Keep in mind that as a surgeon, you are providing an experience to the patient, and every individual at your practice is influential in the patient’s overall experience.

Creating a unique patient experience

Dr. White reflected on how he communicated to his staff the impact of their work on the practice’s success with a “field trip.” Everyone at the practice went to a nearby Holiday Inn for lunch, and all the staff were instructed to become “secret shoppers.” They were told to be observant of how their enjoyment and experience of lunch were impacted by the waiters and environment. Finally, the staff was asked to take note of anything that could be changed which would positively impact the customer experience.
Afterward, the group went to a mall and similarly went to stores to seek services through the eyes of a customer. The goal of the outing was to help the staff clearly differentiate between the feeling of seeking services from somewhere interested in taking care of them versus how that compared to the experience of going somewhere where their service is taken for granted. This poignantly provided a demonstration of how to provide a unique patient experience.
Additionally, Dr. Gupta highlighted that the process of discussing premium products starts the second you pick up the phone to set up an appointment for the patient. Having staff dedicated to managing phone calls ensures that patients have a positive experience from the first step. It’s a simple measure that ECPs can invest in to tell patients that you want to help them.

The critical role of staff in discussing premium services

Who you hire for the practice is important in creating an inviting space that makes patients feel welcome. Broadly, healthcare spaces are known for being sterile and cold feeling; to combat this, everyone at the practice has to metaphorically row in the same direction to create a warm, excited feeling in the office. Surgeons can distinguish themselves and their practice by investing in the patient experience both aesthetically and in the staff.
At Dr. Gupta’s practice, she aims to hire one person more than is required in-office to accommodate shifts in business and the hiring market. She remarked that everyone comes to the practice with a different skill set; however, there are clear expectations around conduct and professionalism that are major considerations in the hiring process.

It is expected all staff are kind, helpful, and friendly to patients and with each other.

While it is possible to teach office management skills relatively easily, it is much more difficult to teach the communication skills needed to interact respectfully and warmly with patients. Similarly, Dr. White emphasized that at his practice, they focus on hiring for personality with staff, as the overarching goal is to create an elevated experience for the patient.
He recommended creating a “cache of memories” of how patients feel while undergoing various procedures and using premium products in order to use empathy to guide the process. Converting patients to premium products requires understanding the process and providing ease and comfort wherever possible with this understanding. Even if a patient is not interested in an upgrade, as long as the surgeon provides consistent and caring service, the patient will return.

How to counsel patients on premium products with care and expertise

When integrating premium technologies, a surgeon might feel that they should limit who they present this information to; however, Dr. White explained that in his experience, it’s best to discuss it with every patient who could benefit from the procedure.
His approach to recommending premium products is similar to the “refractive experience train,” which is a mental exercise for patients to understand the long-term process of improving their vision. In this setup, the passenger (i.e., the patient) receives a ticket to a train with no set end location. The only marked destination is the ultimate premium service or product that the practice can offer. For example, if a patient comes in with a visually-significant cataract that meets all the criteria for insurance coverage of the basic costs of the procedure, at Dr. White’s practice, this patient is treated as if they have already made the decision to upgrade the implant to a presbyopia-correcting IOL.
In order to prevent miscommunication with patients, early on, the staff and surgeon(s) let the patients know that they are making the assumption that the patient is seeking out an upgraded service. For this assumption to be made, the surgeon needs to have a reasonable expectation of a successful outcome. Part of the reason for increased success rates of IOL implantation is that through trial and error, surgeons have honed their understanding of who is the best fit for which specific premium IOL.
Keep in mind that patients should never be made to feel guilty for not seeking premium products or services. To return to the metaphor of the refractive experience train, passengers are always allowed to disembark the train at any point that feels like the most comfortable departure place for them. When the patient decides to disembark the train, the universal response from surgeons and staff should be supportive of their decision and make them feel happy with the choice.

The value of a strong recommendation from a surgeon

When Dr. Gupta started integrating in-office therapies for meibomian gland dysfunction (MGD), the procedures were not covered by insurance leading her to only speak to patients who she perceived to be highly likely to upgrade to a premium service. However, she very quickly learned that after becoming confident in the procedure by performing it many times, her recommendation became much stronger because she believed in the beneficial qualities of the treatment.
Now, Dr. Gupta mentions these treatments with all MGD patients because of their proven ability to treat the underlying cause of the condition. Similar to Dr. White, she emphasized the importance of not pressuring patients who are not interested in premium products. Doing so will negatively impact the patient’s experience; instead, it’s better to be supportive of their decision.
Ultimately, upgrading to a premium service is a decision only the patient can make. By creating a supportive environment with education-forward discussions, a surgeon can give patients the language and tools to understand how each option will affect their vision and long-term health.


For surgeons looking to increase their practice’s offerings, such as with premium IOLs or MGD treatments, it is critical to be confident in their ability to perform the procedure and feel comfortable talking to patients. Also, surgeons should invest in the practice space, as it acts as evidence for making informed judgments in creating a comforting and professional environment.
The pearls mentioned above are essential activities that surgeons should get in the habit of doing, but it’s not advised to start them all at once. Instead, surgeons can pick one thing and grow from there. Dr. Gupta recommended starting with ironing out the phone process or patient flow and then moving to staff education on premium services. The layers will build up until, eventually, the practice is converting more patients to premium services than was originally thought possible.
Preeya K. Gupta, MD
About Preeya K. Gupta, MD

Dr. Gupta earned her medical degree at Northwestern University’s Feinberg School of Medicine in Chicago, and graduated with Alpha Omega Alpha honors. She fulfilled her residency in ophthalmology at Duke University Eye Center in Durham, North Carolina, where she earned the K. Alexander Dastgheib Surgical Excellence Award, and then completed a fellowship in Cornea and Refractive Surgery at Minnesota Eye Consultants in Minneapolis. She served on the faculty at Duke University Eye Center in Durham, North Carolina as a Tenured Associate Professor of Ophthalmology from 2011-2021.

Dr. Gupta has authored many articles in the peer-reviewed literature and serves as an invited reviewer to journals such as Ophthalmology, American Journal of Ophthalmology, and Journal of Refractive Surgery. She has also written several book chapters about corneal disease and ophthalmic surgery, as well as served as an editor of the well-known series, Curbside Consultation in Cataract Surgery. She also holds several editorial board positions.

Dr. Gupta serves as an elected member of the American Society of Cataract and Refractive Surgery (ASCRS) Refractive Surgery clinical committee, and is also is the Past-President of the Vanguard Ophthalmology Society. She gives presentations both nationally and internationally, and has been awarded the National Millennial Eye Outstanding Female in Ophthalmology Award, American Academy of Ophthalmology (AAO) Achievement Award, and selected to the Ophthalmologist Power List.

Preeya K. Gupta, MD
Darrell E. White, MD
About Darrell E. White, MD

Darrell White, MD, is the president and CEO of SkyVision Centers in Westlake, Ohio. He successfully planned, launched, and built his patient-centered eyecare business, in addition to creating a unique business and marketing model for the integration of multiple types of practitioners. Dr. White is a consultant for Bausch & Lomb as well as a member of the editorial board for Ocular Surgery News.

Darrell E. White, MD
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