February 23, 2016

The Economic Benefits of Prokera®

published on February 23, 2016 by Neel R. Desai, MD, Director Cornea and Refractive Surgery, The Eye Institute of West Florida

It’s not a simple cliché or abstraction to state, for the record, that the best, most profitable, and most enduring business plan is simply, and above all else, doing the best for the patient. Hence, when considering the economics of Prokera® use in practice, we must ensure that we are making calculations based on the appropriate metrics. Are we considering only the myopic calculation of price and profit-margin; erroneously rationalizing that an amniotic membrane is an amniotic membrane?

Or, are we, our patients, and our long-term practice prospects, better off, by focusing on endpoints like quality of healing, speed of healing, and the other metrics of efficiency, time, and profitability that they directly and indirectly impact? In this blog, I will address the rationale (both economic and medical) behind our decision to use the Prokera-line in my Cornea, Cataract, and Refractive practice.

As a basis for this economic analysis, it is critical to acknowledge the clinical superiority, as the two go hand in hand. The cryopreserved amniotic tissue, unique to Prokera, preserves key active biological factors essential for anti-inflammatory, anti-fibrotic, anti-scarring, and pro-healing properties. Having used every brand of dehydrated amniotic membrane now on the market, the science and clinical evidence proves that cryopreserved Prokera achieves faster, better quality healing—this helps patients, of course, but it also positively impacts my clinical efficiency and productivity, and fuels other segments of my practice.

A thriving segment of my practice is largely focused on refractive cataract surgery. Of the patients that come to my office, 40% have some sort of ocular surface disease such as severe Dry Eye, EBMD, Salzmann’s Nodular Degeneration or pterygium. I cannot, in good conscience, offer these patients refractive cataract surgery options as the ocular surface disease would render pre-operative biometry inaccurate and lead to sub-optimal outcomes in patients with higher-than-average expectations. As such, we have developed a protocol for Ocular Surface Optimization Prior to Refractive Cataract Surgery. This entails performing a superficial keratectomy at the slit lamp with immediate placement of a Prokera—a procedure we are calling a Prokeratectomy™, for short.

By confidently optimizing the ocular surface with the Prokeratectomy and achieving reliably fast quality healing without scar or haze, I’m able to more efficiently move patients to the point of cataract surgery decision-making. Using a simple bandage contact lens or dehydrated membrane, which offer passive wound coverage alone, the cornea, in my experience, takes longer to heal, may heal with haze or scar, and further delays the patient’s progress through my long-term treatment plan. Though bandage contact lenses and dehydrated membranes are cheaper in the short-term, I have come to appreciate the long-term financial impact of choosing Prokera instead.

From an economic standpoint, every additional office visit needed to get a patient to complete healing, carries with it a heavy opportunity cost, as I could have seen another new refractive or cataract patient in that time. The calculable cost of just two avoidable additional office visits per week, seeing slow-healing or poor-healing patients, equates to a lost revenue of $100,000 and more per year that could have been generated seeing other new refractive cataract patients. With Prokera, patients can be treated at the initial point of service and are reliably healed, without haze or scar, within 7 days (my usual cycle to each office location) at follow-up—no need for additional visits; no need to replace with another membrane; no need to deal with poor quality healing; no wasted time. With this kind of efficiency, I do what is best for the patient and still earn $400/min, given it takes 35 seconds to perform the superficial keratectomy and 25 seconds to place the Prokera—a sure fire win-win from any perspective.

Furthermore, the added confidence and efficiency in quality healing with a Prokeratectomy, has also directly fueled my ability to offer refractive options to a broader swath of cataract patients, which has tremendous impact on our bottom-line financially. Prior to my conscientious attention to ocular surface optimization, only 35% of patients were candidates for, and elected to have, some form of refractive upgrade with cataract surgery. Since initiating our Prokeratectomy protocol, more patients qualified for refractive cataract surgery options since they have clearer and smoother corneas with more accurate biometry. Now 75-80% of patients are electing to pay out-of-pocket for a refractive upgrade, a benefit for patients and practice alike.

I initially feared if I delayed surgery, in order to first optimize the surface with Prokera, I would lose patients or see fewer refractive patients, but my fears were unfounded. As the above comparative data demonstrates, we’ve actually increased the number of refractive cataract patients we see, and more importantly, the number of happy patients we create. Patients are receptive to and grateful for the effort made to enhance their candidacy for better options and better vision. In helping patients get better outcomes, we enjoy a reputation in the community as thoughtful surgeons who do the best thing for their patients. At the end of the day, this is the best business plan you could ever have.

Neel R. Desai, M.D. is the Director of Cornea and Refractive Surgery, and the Director of The Center for Ocular Surface Diseases at The Eye Institute of West Florida (Clearwater, Largo, St. Petersburg, Tampa).

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