1. Increasing volumes as the population ages. ASCs can expect an increase in demand for ophthalmic surgical procedures as Baby Boomers begin to age, says Richard Lee, MD, an ophthalmologist at Eastbay Eye Specialists in Oakland, Calif., who performs cases at EyeMD Laser and Surgery Center, also in Oakland, and is a member of the American Academy of Ophthalmology.
"The number of Medicare patients is expected to double in number over the next two decades as Baby Boomers begin to age, which will keep ophthalmology very busy," says Dr. Lee. "Surgical volumes [for ophthalmology] are expected to increase 30-50 percent over those years."
2. Continued focus on efficiency. ASCs that continue to focus on efficiency should experience continued success, say several ophthalmologists.
"Improving efficiencies and an increased focus on cost containment will allow ASCs to keep up with pressures of continued reduced reimbursements," says Cary Silverman, MD, an ophthalmologist at River Drive Surgery Center in Elmwood Park, N.J.
ASCs' costs are traditionally lower than hospitals for ophthalmology cases, and the savings ASCs offer should continue to bring eye cases to ASCs.
"The average facility fee at an ASC is $1000-$1,100, with hospital fees running up to three times as much in some cases, says Dr. Lee.
3. Growing case loads slowly. Even adding only one additional case per day can have a big impact on profitability.
Dr. Lee says his ASC worked to add an additional case per day for subsequent years, allowing volumes to grow slowly.
"There is this pressure to attract only the best and the fastest physicians for an ASC, and that's fine until you run out of doctors," says Dr. Lee. "You don't need to do that. As you become more efficient, adding one more case a day can build your volumes over time."|
Because of the principle of marginal costs, Dr. Lee's ASC was able to generate a 60 percent increase in profitability from just a 16 percent increase in surgical volume in 2009, he says.
4. Multi-focal implants with cataract procedures. Physicians can offer improved patient outcomes and increase ASC revenue by offering patients a high-end muti-focal implant while undergoing cataract surgery, says Peter Colquhoun, MD, an ophthalmologist at Southwest Michigan Eye Center in Battle Creek, Mich., and a physician-owner of Brookside Surgery Center, also in Battle Creek.
Although the price of lens implants are bundled into payments for cataract surgery, if a physician and patient select a higher-end multi-focal implant, such Alcon's ReStor IOL or Abbott's ReZoom IOL, ASCs, at least in Michigan, can balance bill a patient for the additional cost of the lens, says Dr. Colquhoun. Balancing billing allows for cataract patients, who are often covered by Medicare, to receive the highest-level technology — a technology that Medicare would otherwise deny, he says.
5. Retinal procedures. While cataract surgery remains the most poplar ophthalmic procedure within the ASC setting, expanding to retinal procedures, such as pars plana vitrectomy, can be profitable if centers are willing to invest in the equipment needed to perform these cases. Shorter procedure times and less-invasive techniques have made retinal procedures now appropriate for the ASC setting.
"There is a long history of the ASC being mainly relegated to cataract surgery, with retina surgery traditionally being done in hospitals," says Pravin Dugel, MD, an ophthalmologist at Retinal Consultants of Arizona in Phoenix who performs cases at Spectra Eye Institute in Sun City, Ariz., and member of the AAO. "Changes in instrumentation and reimbursement have made retinal procedures applicable for the ASC-setting, and that's where growth [for ASCs] lies."
Equipping an ASC for retinal procedures may cost as much as $200,000-$400,000, but can be "fantastic investment" if the physicians are committed and dedicated to the program, says Dr. Dugel.
6. Glaucoma procedures. Glaucoma procedures may also be a way for ophthalmology service lines to expand their offering and attract more cases.
Dr. David Kwiat, MD, FACS, an ophthalmologist at Kwiat Eye and Laser surgery who practices at Fulton County Ambulatory Surgery Center in Johnstown, N.Y., says his ASC is focusing on adding glaucoma procedures such as cyclophotocoagulation.
"For an ASC like ours that focus mainly on anterior segment surgery, adding glaucoma procedures should prove beneficial," says Dr. Kwiat. "The patient benefits as well with a less invasive glaucoma treatment option and less postoperative difficulties."
Dr. Colquhoun says his practice is considering recruiting a glaucoma specialist in the coming year, who could then perform some procedures such as implantations of mini shunts to treat glaucoma, at the ASC.
7. Oculoplastics. Although the volume of plastic surgery has dropped dramatically with the economy, Dr. Colquhoun expects some of that business to rebound in 2010. "With the economy improving in the next year, we are hoping lid corrections and other elective ophthalmic procedures, such as LASIK, will increase," he says.