Here are 10 points on trends affecting ophthalmology in surgery centers, based on interviews with eye surgery experts and recent news making headlines.
1. High volume is essential for profitability. Unlike orthopedics, which depends on a substantial profit margin to make up for low case volume, ophthalmology is a volume-driven specialty. According to Jeff Peo, vice president of acquisitions and development for Ambulatory Surgical Centers of America, ASCs that want to make a profit with ophthalmology must guarantee high case volume — and cases must be done quickly.
"If you're taking a long time in the [operating room], that profit very easily gets eaten up," he says. While ophthalmology reimbursements have remained steady over the past few years, the average profit per Medicare case is still low. Ophthalmology cases currently average between $100 and $200 in profit in surgery centers.
2. Legislative battles could expand the ability to perform surgery. Several states have engaged in legislative battle recently over whether optometrists should be allowed to perform eye surgery. In September, the Kentucky legislature approved proposed regulations spelling out how optometrists could quality to perform eye surgery. The legislature did so despite threats from ophthalmologists and other physicians, who said the proposed requirements were set too low and would harm patient safety. The proposal required optometrists to take 32 hours of training and perform surgery on one eye before they could perform laser surgery.
In October, the Tennessee Academy of Ophthalmology launched a pre-emptive attack on legislation that would allow optometrists to do surgical procedures, including some involving lasers.
3. The FDA is keeping an eye on LASIK claims. The FDA has warned eye care professionals against making false safety claims and promises about LASIK eye surgery, a move that could affect the marketing plans of LASIK-equipped ASCs. In the agency's letter to eye care professionals, issued in late September, the FDA said it would give ophthalmologists 90 days to update advertising or promotional material that makes false claims about LASIK surgery.
The FDA said the most common problems in LASIK advertising are failing to inform consumers about the risks associated with the surgery, including vision loss, under- or over-correction of vision, dry eye, infection, glare, halos and double vision.
4. Ophthalmic case volume dropped from 2009-2010. According to data presented by Kevin McDonough, CFA, senior manager, and Colin Park, senior analyst, of VMG Health, same-center ophthalmic case volume dropped from 2009 to 2010, falling from 67,937 cases performed to just 65,259 cases performed. This change represented a decrease of 3.9 percent, the third-largest decrease of any ASC specialty.
By comparison, general surgery cases dropped by 8.6 percent, and OB/GYN cases dropped by 4.5 percent; plastic surgery cases, on the other hand, jumped 9.4 percent, and urology cases increased by 6.8 percent. The authors noted that the specialties least affected by drops in case volume were less frequently targeted by hospitals for physician employment. "This is a potential explanation for why we're observing growth in [plastics, urology and ENT] over others," they wrote.
5. Mini-block anesthesia can increase patient comfort. According to Bradford Shingleton, MD, who practices at 32-physician Ophthalmic Consultants of Boston and Cape Code Eye Surgery & Laser Center, mini-block anesthesia can provide a better patient experience than topical anesthesia. Mini-block anesthesia requires a smaller injection, and outcomes data demonstrated to Dr. Shingleton that 5 percent of patients felt less comfortable with topical anesthesia. Because the mini-block is a less invasive form of anesthesia, patients can also recover faster.
6. Developments in laser technology could 'revolutionize' cataract surgery. Two new studies have found that a new, FDA-approved approach to cataract surgery is safer and more efficient than the standard procedure today, according to findings presented at the 115th Annual Meeting of the American Academy of Ophthalmology. The method uses a femtosecond laser and is not widely available in the United States.
One study found a 45 percent reduction in ultrasound energy and a 45 percent reduction in surgical manipulation of the eye, when comparing laser pre-treatment to the standard procedure. The second study examined the loss of corneal endothelial cells following cataract surgery and found no cell loss in the eyes treated with the femtosecond laser, compared with a 1-7 percent loss with standard treatment.
7. More cataract surgeries are expected. Surgeons expect to see more cataract patients in the next few years, as baby boomers age and cause surgery volume to rise. About 40 percent of cataract surgeries are currently performed in surgery centers, and cataract surgeons are expected to continue to move their cases to ASCs as professional fees stagnate. Cataract cases are especially effective in surgery centers because the natural efficiency allows cases to move faster.
The predicted increase in volume is backed by a recent UPI report that found half of the U.S. population has cataracts by age 65. According to the report, cataracts affect more than 22 million people in the United States, and cataract surgery is the most effective procedure to treat the condition, with a 95 percent success rate.
8. Vitreoretinal surgery could become more popular in surgery centers. According to Larry E. Patterson, MD, medical director of Eye Centers of Tennessee, vitreoretinal surgery — surgery affecting the limit between the retina and vitreous body — can be profitable because reimbursement rates for the procedure are increasing. The only issue for surgery centers looking to add the procedure is volume. Because the upfront cost of equipment and supplies is significant, physicians must be able to guarantee a certain level of case volume to ensure profitability.
9. Premium services could increase. Mark Packer, MD, FACS, CPI, ophthalmologist at Oregon Eye Surgery Center in Eugene, says he expects the provision of "premium services," or extra services associated with lens implants and other surgical procedures, to increase as physicians struggle to survive on current reimbursement rates. He says patients can pay for these services out-of-pocket, creating a separate revenue stream for physicians and providing higher levels of satisfaction to patients. He says these premium services may create an avenue to incorporate equipment like the femtosecond laser, an expensive purchase for most surgery centers.
10. Ophthalmologists are still resisting hospital employment. Many surgery centers are suffering due to an increase in hospital employment, but ophthalmology is one of several specialties that seem to be resisting the trend, experts say. According to Christopher Regan, managing director of The Chartis Group, many ophthalmologists do not find value in working in a hospital. Hospitals may also place unnecessary restrictions on ophthalmologists by constraining efficiency and decreasing access to advanced technology.
On the other side of the equation, hospitals may not be interested in ophthalmologists either. "The only time I hear about hospital involvement in an employee situation with ophthalmologists is in trauma coverage," says John Narcross, senior engagement manager at The Chartis Group. Employing eye surgeons is not necessarily attractive to hospitals because the specialty does not generate enough revenue to warrant the expense of a physician salary.
Related Articles on Ophthalmology:
Ophthalmology Seeks Revised Government Assessment of Glaucoma Screenings, Treatment
Ophthalmology in ASCs: Current Trends and Issues
Key Issues for Ophthalmology in ASCs
1. High volume is essential for profitability. Unlike orthopedics, which depends on a substantial profit margin to make up for low case volume, ophthalmology is a volume-driven specialty. According to Jeff Peo, vice president of acquisitions and development for Ambulatory Surgical Centers of America, ASCs that want to make a profit with ophthalmology must guarantee high case volume — and cases must be done quickly.
"If you're taking a long time in the [operating room], that profit very easily gets eaten up," he says. While ophthalmology reimbursements have remained steady over the past few years, the average profit per Medicare case is still low. Ophthalmology cases currently average between $100 and $200 in profit in surgery centers.
2. Legislative battles could expand the ability to perform surgery. Several states have engaged in legislative battle recently over whether optometrists should be allowed to perform eye surgery. In September, the Kentucky legislature approved proposed regulations spelling out how optometrists could quality to perform eye surgery. The legislature did so despite threats from ophthalmologists and other physicians, who said the proposed requirements were set too low and would harm patient safety. The proposal required optometrists to take 32 hours of training and perform surgery on one eye before they could perform laser surgery.
In October, the Tennessee Academy of Ophthalmology launched a pre-emptive attack on legislation that would allow optometrists to do surgical procedures, including some involving lasers.
3. The FDA is keeping an eye on LASIK claims. The FDA has warned eye care professionals against making false safety claims and promises about LASIK eye surgery, a move that could affect the marketing plans of LASIK-equipped ASCs. In the agency's letter to eye care professionals, issued in late September, the FDA said it would give ophthalmologists 90 days to update advertising or promotional material that makes false claims about LASIK surgery.
The FDA said the most common problems in LASIK advertising are failing to inform consumers about the risks associated with the surgery, including vision loss, under- or over-correction of vision, dry eye, infection, glare, halos and double vision.
4. Ophthalmic case volume dropped from 2009-2010. According to data presented by Kevin McDonough, CFA, senior manager, and Colin Park, senior analyst, of VMG Health, same-center ophthalmic case volume dropped from 2009 to 2010, falling from 67,937 cases performed to just 65,259 cases performed. This change represented a decrease of 3.9 percent, the third-largest decrease of any ASC specialty.
By comparison, general surgery cases dropped by 8.6 percent, and OB/GYN cases dropped by 4.5 percent; plastic surgery cases, on the other hand, jumped 9.4 percent, and urology cases increased by 6.8 percent. The authors noted that the specialties least affected by drops in case volume were less frequently targeted by hospitals for physician employment. "This is a potential explanation for why we're observing growth in [plastics, urology and ENT] over others," they wrote.
5. Mini-block anesthesia can increase patient comfort. According to Bradford Shingleton, MD, who practices at 32-physician Ophthalmic Consultants of Boston and Cape Code Eye Surgery & Laser Center, mini-block anesthesia can provide a better patient experience than topical anesthesia. Mini-block anesthesia requires a smaller injection, and outcomes data demonstrated to Dr. Shingleton that 5 percent of patients felt less comfortable with topical anesthesia. Because the mini-block is a less invasive form of anesthesia, patients can also recover faster.
6. Developments in laser technology could 'revolutionize' cataract surgery. Two new studies have found that a new, FDA-approved approach to cataract surgery is safer and more efficient than the standard procedure today, according to findings presented at the 115th Annual Meeting of the American Academy of Ophthalmology. The method uses a femtosecond laser and is not widely available in the United States.
One study found a 45 percent reduction in ultrasound energy and a 45 percent reduction in surgical manipulation of the eye, when comparing laser pre-treatment to the standard procedure. The second study examined the loss of corneal endothelial cells following cataract surgery and found no cell loss in the eyes treated with the femtosecond laser, compared with a 1-7 percent loss with standard treatment.
7. More cataract surgeries are expected. Surgeons expect to see more cataract patients in the next few years, as baby boomers age and cause surgery volume to rise. About 40 percent of cataract surgeries are currently performed in surgery centers, and cataract surgeons are expected to continue to move their cases to ASCs as professional fees stagnate. Cataract cases are especially effective in surgery centers because the natural efficiency allows cases to move faster.
The predicted increase in volume is backed by a recent UPI report that found half of the U.S. population has cataracts by age 65. According to the report, cataracts affect more than 22 million people in the United States, and cataract surgery is the most effective procedure to treat the condition, with a 95 percent success rate.
8. Vitreoretinal surgery could become more popular in surgery centers. According to Larry E. Patterson, MD, medical director of Eye Centers of Tennessee, vitreoretinal surgery — surgery affecting the limit between the retina and vitreous body — can be profitable because reimbursement rates for the procedure are increasing. The only issue for surgery centers looking to add the procedure is volume. Because the upfront cost of equipment and supplies is significant, physicians must be able to guarantee a certain level of case volume to ensure profitability.
9. Premium services could increase. Mark Packer, MD, FACS, CPI, ophthalmologist at Oregon Eye Surgery Center in Eugene, says he expects the provision of "premium services," or extra services associated with lens implants and other surgical procedures, to increase as physicians struggle to survive on current reimbursement rates. He says patients can pay for these services out-of-pocket, creating a separate revenue stream for physicians and providing higher levels of satisfaction to patients. He says these premium services may create an avenue to incorporate equipment like the femtosecond laser, an expensive purchase for most surgery centers.
10. Ophthalmologists are still resisting hospital employment. Many surgery centers are suffering due to an increase in hospital employment, but ophthalmology is one of several specialties that seem to be resisting the trend, experts say. According to Christopher Regan, managing director of The Chartis Group, many ophthalmologists do not find value in working in a hospital. Hospitals may also place unnecessary restrictions on ophthalmologists by constraining efficiency and decreasing access to advanced technology.
On the other side of the equation, hospitals may not be interested in ophthalmologists either. "The only time I hear about hospital involvement in an employee situation with ophthalmologists is in trauma coverage," says John Narcross, senior engagement manager at The Chartis Group. Employing eye surgeons is not necessarily attractive to hospitals because the specialty does not generate enough revenue to warrant the expense of a physician salary.
Related Articles on Ophthalmology:
Ophthalmology Seeks Revised Government Assessment of Glaucoma Screenings, Treatment
Ophthalmology in ASCs: Current Trends and Issues
Key Issues for Ophthalmology in ASCs