Ann S. Deters, CEO and Founder of Vantage Outsourcing, discusses six ways surgery centers can perform profitable and efficient cataract surgery.
1. Schedule efficiently. In order to effectively create profitability with your cataract procedures, Ms. Deters recommend scheduling all eye procedures on the same day each week. "Our most efficient surgery centers will schedule anywhere from 5-50 cases on a given day, starting with their least complicated and ending with their most complex cases," she says. "For lower volume surgeons, if a particular doctor doesn't have at least five cases for a particular week, it's advantageous to move these cases to the next week, until you have a minimum of five cases on any given day."
YAG cases are scheduled first thing in the morning, followed by all the cataract procedures and ending with the non-cataract type cases (e.g. blepharoplasties). She says this type of scheduling can be easily implemented by surgery centers, due to the non-emergent aspect of cataract procedures.
2. Improve turnover with adequate staffing. According to Ms. Deters, the most efficiently-run facilities have the ability to provide a dedicated surgical team for each OR. The most effective team composition is staffed with a scrub tech, circulator, instrument tech and equipment coordinator for each OR. In high-volume facilities, where a surgeon is averaging 6-8 minute cases, this configuration allows the surgeon to fluidly move from room to room, thus maximizing OR productivity.
Alternatively, low-volume facilities can reduce staff costs by rotating both the equipment coordinator and instrument tech between rooms. Both line-ups provide adequate staffing for effective surgical support and room turnover, while also effectively managing a center's investment without wasting money. Patient flow can be considerably enhanced by having two nurses in both the pre-op and post-op areas. This too allows for proper staffing to ensure efficient patient flow, which in turn enhances a center's bottom line and patient satisfaction.
3. Understand and analyze per-case costs. Cataract surgeries are generally performed on Medicare beneficiaries, which limit reimbursement for all surgery centers. This low reimbursement forces ASCs to be very cost conscious. "Typically, surgery departments will know their their medical supply and staff costs, but overlook their equipment and 'soft' costs,” says Ms. Deters.
Most centers are surprised when they sit down and determine their per-case costs of equipment upgrades, maintenance and repairs. "Maintenance agreements alone run 10 percent of your equipment costs," says Ms. Deters. Other costs, such as IOL management, inventory financing and storage, should also be analyzed when determining a center's per-case costs for cataract procedures.
4. Wheelchairs versus eye stretchers. Ms. Deters has seen surgery centers save money by choosing wheelchairs instead of eye stretchers for moving patients. "On our busiest day, when we are doing 50 cases, we'll use four wheelchairs to transport patients to and from the ORs," Ms. Deters says. "Obviously, if a facility has already invested and is utilizing eye stretchers, you should continue to do so. However, for facilities that haven't, wheelchairs are more cost-efficient and are a proven means for safely transporting patients."
5. The "magic number": 900 cases annually. Case volume needs will differ for larger, multi-specialty ASCs, but Ms. Deters says single room surgery centers that concentrate solely on ophthalmology need to average around 900 cases per year to be profitable. "This can easily be obtained by one physician," she says. Talk to physicians before they join the center and determine how many ASC-appropriate cases each physician performs every year to ensure case volume.
6. Encourage physicians to expand their market and referral base. Ms. Deters says with Medicare reimbursement cuts on the horizon, ophthalmologists need to look to expand their market and increase their surgical caseload. She has worked with several physicians in setting up satellite clinics within a certain radius to their main practice. The first step is building strong relationships with optometrists in the targeted communities.
Ms. Deters believes this may be particularly useful in communities where there are no surgeon performing cataracts, and senior citizens are forced to travel in order to have their cataracts extracted. "As long as you establish a strong partnership with local ODs and build a solid referral base, a successful satellite client can be built within 6 months," she says.
Related Articles on Ophthalmology:
Study: CME Improves Ophthalmologists' Assessment Ability
Tiny Drug Delivery Device Could Help Glaucoma Patients
Ophthalmologist on the Move: Emily Birkholz Joins Minnesota's Ophthalmology Associates of Mankato
1. Schedule efficiently. In order to effectively create profitability with your cataract procedures, Ms. Deters recommend scheduling all eye procedures on the same day each week. "Our most efficient surgery centers will schedule anywhere from 5-50 cases on a given day, starting with their least complicated and ending with their most complex cases," she says. "For lower volume surgeons, if a particular doctor doesn't have at least five cases for a particular week, it's advantageous to move these cases to the next week, until you have a minimum of five cases on any given day."
YAG cases are scheduled first thing in the morning, followed by all the cataract procedures and ending with the non-cataract type cases (e.g. blepharoplasties). She says this type of scheduling can be easily implemented by surgery centers, due to the non-emergent aspect of cataract procedures.
2. Improve turnover with adequate staffing. According to Ms. Deters, the most efficiently-run facilities have the ability to provide a dedicated surgical team for each OR. The most effective team composition is staffed with a scrub tech, circulator, instrument tech and equipment coordinator for each OR. In high-volume facilities, where a surgeon is averaging 6-8 minute cases, this configuration allows the surgeon to fluidly move from room to room, thus maximizing OR productivity.
Alternatively, low-volume facilities can reduce staff costs by rotating both the equipment coordinator and instrument tech between rooms. Both line-ups provide adequate staffing for effective surgical support and room turnover, while also effectively managing a center's investment without wasting money. Patient flow can be considerably enhanced by having two nurses in both the pre-op and post-op areas. This too allows for proper staffing to ensure efficient patient flow, which in turn enhances a center's bottom line and patient satisfaction.
3. Understand and analyze per-case costs. Cataract surgeries are generally performed on Medicare beneficiaries, which limit reimbursement for all surgery centers. This low reimbursement forces ASCs to be very cost conscious. "Typically, surgery departments will know their their medical supply and staff costs, but overlook their equipment and 'soft' costs,” says Ms. Deters.
Most centers are surprised when they sit down and determine their per-case costs of equipment upgrades, maintenance and repairs. "Maintenance agreements alone run 10 percent of your equipment costs," says Ms. Deters. Other costs, such as IOL management, inventory financing and storage, should also be analyzed when determining a center's per-case costs for cataract procedures.
4. Wheelchairs versus eye stretchers. Ms. Deters has seen surgery centers save money by choosing wheelchairs instead of eye stretchers for moving patients. "On our busiest day, when we are doing 50 cases, we'll use four wheelchairs to transport patients to and from the ORs," Ms. Deters says. "Obviously, if a facility has already invested and is utilizing eye stretchers, you should continue to do so. However, for facilities that haven't, wheelchairs are more cost-efficient and are a proven means for safely transporting patients."
5. The "magic number": 900 cases annually. Case volume needs will differ for larger, multi-specialty ASCs, but Ms. Deters says single room surgery centers that concentrate solely on ophthalmology need to average around 900 cases per year to be profitable. "This can easily be obtained by one physician," she says. Talk to physicians before they join the center and determine how many ASC-appropriate cases each physician performs every year to ensure case volume.
6. Encourage physicians to expand their market and referral base. Ms. Deters says with Medicare reimbursement cuts on the horizon, ophthalmologists need to look to expand their market and increase their surgical caseload. She has worked with several physicians in setting up satellite clinics within a certain radius to their main practice. The first step is building strong relationships with optometrists in the targeted communities.
Ms. Deters believes this may be particularly useful in communities where there are no surgeon performing cataracts, and senior citizens are forced to travel in order to have their cataracts extracted. "As long as you establish a strong partnership with local ODs and build a solid referral base, a successful satellite client can be built within 6 months," she says.
Related Articles on Ophthalmology:
Study: CME Improves Ophthalmologists' Assessment Ability
Tiny Drug Delivery Device Could Help Glaucoma Patients
Ophthalmologist on the Move: Emily Birkholz Joins Minnesota's Ophthalmology Associates of Mankato