Innovations in Ophthalmic Outpatient Surgery Opportunities and challenges for ASCs BY MARIA C. SCOTT, MD

What do ophthalmic sur- geons want in an ASC? We frequently hear this question from ASCs that are considering adding

ophthalmic surgery as a specialty. Ophthalmologic surgery is a nat- ural fit for ASCs. The procedure is clean, fast, requires little anesthesia and, post-operatively, patients recover quickly. If done correctly, the patient experience in an ASC far exceeds what most hospitals can provide and at approximately half of the cost. Ophthalmologists love efficiency. If you can turn over a room with little down time, you will have ophthalmol- ogists knocking at your door. Ophthalmologists love toys. Doc-

tors want the latest technology to offer their patients. While the latest technology offers

surgeons the tools they demand, it often comes at a steep cost and, if not managed correctly, can disrupt a cen- ter’s efficiency. For centers that are adding oph- thalmology or expanding their exist- ing ophthalmic ASC, technology is a major issue. How does an ASC justify the expense of new technology, incor- porate it into the center, maintain effi- ciency and manage flow? For example, consider femtosec-

ond laser-assisted cataract surgery (FLACS), one of the most significant and expensive innovations in ophthal- mic surgery in recent years.

In 2011, the LenSx femtosecond

laser was the first to receive approval for cataract surgery by the US Food and Drug Administration (FDA). FDA approval quickly followed for four more lasers—Catalys, LensAr, Victus, and Femto LDV Z8—each with differ-

reduce the out-of-pocket cost to the center. Before making the investment, I would suggest test driving the different lasers. Each has advantages and disad- vantages. Through independent compa- nies, roll-on-roll-off lasers are available. The advantage to the roll-on roll-off is the experienced technical staff available to minimize the learning curve. The down side is the cost per procedure. If a center has the volume, leasing or buy- ing a laser will be more economical. Every good business idea requires

ent features and procedure times. The lasers perform bladeless incisions, a perfect circular capsulorhexis, soften- ing of the lens and arcuate incisions for astigmatism correction. Numerous studies have documented the increased precision and reproducibility of the anterior capsulotomy, reduced phaco- emulsification time, reduction in surgi- cally induced endothelial cell damage, and increased predictability of effec- tive lens position and arcuate incision depth and location.

The femtosecond laser, however, comes with a significant six-digit price tag that necessitates increased fees for each procedure. Without question, the laser has changed the flow, economics and efficiency of cataract surgery. In our center, incorporating the laser added three minutes per case and reduced our throughput by one case per hour. Given that, how does an ASC weigh the benefits of the laser against its cost? What can a center do to reduce those costs and ensure efficiency? Over the last six years, with increased competition, the laser com- panies have become more creative to

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a business plan and, for the FLACS, with its high price tag, service con- tracts and click fees, a good, well-con- sidered plan is critical. FLACS is not typically covered by Medicare or other insurance companies, which means that patients will be paying out of pocket for the procedure. Understand- ing the added lease cost, cone fees, maintenance costs, increase in staff for the laser—typically a circulating nurse and laser technician—and additional time is crucial. Often the laser is used in combination with a premium lens. When combined with the premium lens, the laser can be used for imag- ing. When used with a basic single focus lens, the laser may be charged to the patient only if it is being used for astigmatism correction. Deciding on a charge for FLACS will depend on con- version rates of single focus and pre- mium lens patients and the number of surgeons using the laser. Managing flow is the next step to


Consider these questions: Will the laser be in the operating

room? Some laser surgery can be per- formed as a sterile procedure after the patient is draped.

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.

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