Precise Patient Selection Shapes Practice’s Sterling Reputation

Like the prospectors who heeded the call to go west in search of gold, LASIK surgeon Stephen C. Coleman also set out on a westward path to fulfill his professional destiny. When laser eye surgery was new and he was contemplating which direction to take his career, Dr. Coleman says LASIK pioneer Stephen Trokel, MD, told him, “If you love performing laser eye surgery, go to a high, dry climate.” According to Dr. Coleman, Dr. Trokel explained, “If laser eye surgery is to really take off, it will happen first in a climate where there is less oxygen and it’s harder to wear soft contact lenses.”

The newly minted refractive surgeon took that suggestion to heart, because he felt that performing laser eye surgery truly was his calling. “When I first saw a laser procedure performed, it was like an epiphany,” Dr. Coleman says. “I knew I had to do this.” After his training was complete, he left New York State and settled in Albuquerque, New Mexico, an atmosphere that Dr. Trokel suggested would be hospitable to a practice dedicated to laser vision correction.

“When I came out here … and got started, I became busy relatively quickly, because I had very motivated patients,” Dr. Coleman recalls. “They would say things such as ‘I can’t even wear my contact lenses anymore when I want to cycle.’”

There were hurdles to overcome as well. “There was plenty of skepticism back when laser eye surgery was new,” he notes. Dr. Coleman and Ann Speer, his sister, started from scratch by presenting information about laser eye surgery and its remarkable capabilities to groups ranging from Rotary Clubs to optometry associations. They built a following one patient at a time, and it has grown exponentially via word of mouth through several neighboring states. “The two of us were the entire staff for over a year,” Ms. Speer remembers. “We knocked on doors and talked about LASIK to anyone who would listen back in the day when no one knew what it was.” She adds, “Now, people come from all over the country to have surgery [by] Dr. Coleman because they hear about him from a friend of a friend of a friend who had such a great experience here.”

Fast Forward

Today, Dr. Coleman is enjoying his 21st year as the sole practitioner at Coleman Vision, which remains true to its initial business plan as a practice that provides LASIK and LASIK alone. The practice is known for its unparalleled outcomes. Dr. Coleman says his experience and the best equipment help—he has been a Visx (Abbott) user since day 1—but extremely careful patient selection is key. “In the absence of results, everything else falls by the wayside,” he comments. “When I say ‘results,’ I mean excellent results that are consistent. Ultimately, that is rooted in patient selection; you have to be very picky with respect to [on] who[m] you do surgery.”

Stephen C. Coleman, MD

He says it has been a learning process that “has evolved as much as the technology has … quite frankly. It all comes down to identifying the great candidates for LASIK and consistently having the confidence that you can nail the result. A low enhancement rate is critical as well. When I first started out, it wasn’t uncommon to bring a patient back to tweak the result; it was like [a] part of the process. Now, my enhancement rate is 2%. I’d say, if your enhancement rate isn’t really low, you’re probably not picking the right patients or there’s some other disconnect that needs to be identified.”

In the few instances when an enhancement is necessary, Dr. Coleman treats the patient with the same—if not more—care and attention as every other patient. “Needing to have an enhancement can be a disappointment,” he notes. “It may be due to a healing effect, but it’s inevitable that some patients will think it’s because the surgeon didn’t get it right the first time. That’s why we employ a Nordstrom-type patient relations mentality and ensure that they are embraced and taken care of. No one should walk away … [not] feeling like the priority.”

The Coleman Vision staff embodies this patient-focused policy. “I have never interviewed or hired a single employee,” Dr. Coleman acknowledges. “That has always been done by my sister, Ann, and she has a great sense for people. We have employees who are incredible people.” Hiring and managing the staff, marketing, and essentially everything except surgery fall under the purview of Ms. Speer, director of operations. Frequent staff turnover is a problem that often eats into the profits of small practices, but employee retention is not a problem at Coleman Vision, according to Ms. Speer. “Once they’re hired, they want to stay,” she says. “I think the reason is that I hire people based on their attitude and their work ethic and their ability to be compassionate, and then, we train them to do what we need them to do. We focus on being kind and caring for patients from all walks of life. They are typically nervous and a little intimidated about facing the laser. I tell my employees the most important thing they need to know is to treat every person as if he or she were their [family member].”

Philanthropy

Coleman Vision Tennis Championships Supports Youth Tennis Foundation

Stephen C. Coleman, MD, turned an avid love of tennis into a way to help enrich the lives of New Mexico middle- and high-school students. Soon after the opening of Coleman Vision, an Albuquerque eye surgery practice dedicated to LASIK, Dr. Coleman’s wife, Erica, learned that the defunct Virginia Slims Tour was in search of a backer. The couple decided to sponsor the professional tour, and this year, the Coleman Vision Tennis Championships is celebrating its 20th anniversary.

All proceeds from the Coleman Vision Tennis Championships go directly to the New Mexico Youth Tennis Foundation, a 501(c)(3) tax-exempt organization whose sole mission is to provide education and opportunity to New Mexico youths through the sport. The foundation provides in excess of $10,000 annually in support of after-school tennis programs throughout the state and contributes to travel scholarships to promising young players.

Each fall 3 weeks after the US Open, high-profile players from more than 30 countries around the world participate in the Albuquerque tournament. “I get to be out there watching tennis, which I love, for 9 days straight,” Dr. Coleman says. “There’s kind of an unwritten rule that, if you are on the tour and you go to New Mexico and you wear contact lenses, ‘Dr. Coleman will take care of you. You can spend the night at his house with him and his wife and have a nice dinner.’”

He adds, “I get to hang out with the best tennis players in the world, and tennis programs are funded for kids across the state. It’s a win-win.”

Even from a marketing standpoint, the practice focuses on the patients and the provider as opposed to technology. “Dr. Coleman is committed to having the best and newest technology, but it’s our belief that patients don’t choose to have surgery with him because of that,” Ms. Speer says. “They choose him because they’ve heard that he genuinely cares about his patients and because he gets the best results. Think about it; it’s really always about the doctor. If I go to a dentist because I need a crown, I’m not going to ask what kind of drill he has. I’m going to find out what his patients think about him, because at the end of the day, it’s all about safety and results.”

Unfettered by Health Care Trends

Dr. Coleman was an early adopter of comanagement; he receives a steady stream of patient referrals from a wide informal network of more than 100 optometrists. “Half of my practice lives outside of Albuquerque,” he notes. “We’re drawing patients from Southern Colorado, West Texas, Eastern Arizona, and New Mexico. My office is across the street from a Courtyard Marriott, and we’ve been its biggest client for 16 years. I have learned from the very beginning to rely on optometrists to take care of my patients postoperatively, because only half of my patients live nearby. I built a rapport with my network, and they refer patients to me. I take good care of these patients, with the vast majority achieving 20/20 or better vision. The out-of-town patients spend the night at the nearby hotel, and the next day, I make sure everything’s perfect. Then, they go back home and are taken care of by their optometrist.”

LASIK has seen some tough times during and since the recession, depending on the market and the level of competition. Although his practice has not been immune to economic fluctuations, Dr. Coleman says, “We’ve been relatively consistent with some minor upticks and equally minor downturns. In general, my practice[’s performance] is consistent year over year.”

Interestingly, he has been able to avoid the onerous demands inherent in government intervention. The practice is 100% out-of-pocket cash-pay LASIK, and he participates in neither Medicare nor private insurance. With respect to choosing which patients to treat and how to treat them, Dr. Coleman is beholden to no one. He was unfazed and untouched by the sizable investment that many of his ophthalmic surgeon colleagues shouldered when electronic health records were mandated by the Patient Protection and Affordable Care Act, and he remains unaffected as the GOP works toward its repeal. “When I first started the practice, I got privileges at the local hospitals, but I could [not] get on any of the insurance panels, so I never opted into the bureaucracy of organized health care,” Dr. Coleman says. “In retrospect, it was a really good thing, because I’ve never had to opt out like so many other providers have done.”

One of the two largest groups composing his flourishing patient base consists of children of his first early-adopter patients. These 20-somethings come in for LASIK saying, “I remember when you did my dad’s eyes.” The other group, he explains, consists of women in their mid-40s who are no longer successful soft contact lens wearers because of changes in their tear film. “We have a next generation of patients interested in LASIK as well as this cohort of women who do not want to wear glasses and who tend to be great candidates for monovision with LASIK,” he says.

Balancing Act

Balance is an important element of Dr. Coleman’s practice and life. He has been a lead investigator on 15 FDA studies and remains committed to improving outcomes via postmarket analysis. He is equally committed to his life outside of ophthalmology. “I’ve always wanted LASIK to be something that I do but not [what] define[s] who I am, which has sometimes been a real challenge,” he explains. “The older I get, the easier it gets, but even up until around 8 years ago, before the economic turndown, when everybody was dialing everything up a notch, it would have been really easy to allow it to consume me.”

Dr. Coleman continues, “It would have been very tempting, and it seemed to make sense in a lot of ways, to bring on a partner or open up another clinic. In other words, I could have taken more of my life and devoted it to [the practice], but I purposely pulled back from that. There is an expense to spending more time working with respect to family and interests and traveling. I have decided I am not interested in paying the price.” Dr. Coleman and everyone in his family are tennis devotees (see Philanthropy), and he says that he is the kind of father who does not have to worry that he missed a moment of his children’s lives. “I have outside interests,” he says. “I tend to my family, I travel, and I happen to do LASIK. It is something I do; it is not who I am.”