10 Interesting Stats About Ophthalmology and Cataract Surgery in ASCs

Here are 10 interesting statistics about ophthalmology and cataract surgery in ASCs.

1. The average 2007 Medicare sub charge (submitted charges divided by allowed services), average allow charge (Medicare-allowed charges divided by allowed services, including co-pays and deductibles paid by patient), and average payment (Medicare payments divided by allowed services, not including co-pays and deductibles paid by patient) for post-cataract laser surgery (CPT 66821) is:

• Average sub charge: $1,006
• Average allow charge: $307
• Average payment: $241

2. The average 2007 Medicare sub charge (submitted charges divided by allowed services), average allow charge (Medicare-allowed charges divided by allowed services, including co-pays and deductibles paid by patient), and average payment (Medicare payments divided by allowed services, not including co-pays and deductibles paid by patient) for cataract removal, insertion of lens (CPT 66984) is:

• Average sub charge: $2,827
• Average allow charge: $966
• Average payment: $766

3. Ophthalmology represented 15 percent of the case volume for the total number of cases performed in 230 licensed freestanding ASCs performing one million cases.

4. Of those centers performing less than 3,000 cases, ophthalmology represented 20 percent of the case volume for the total number of cases performed in 230 licensed freestanding ASCs performing one million cases. For centers performing 3,000-5,999 cases, it represented 13 percent of the case volume. For centers performing at least 6,000 cases, it represented 16 percent of all cases.

5. The average revenue per case for ophthalmology was $4,350 in gross charges and $1,153 in net revenue 230 licensed freestanding ASCs performing one million cases.

6. Of the 230 licensed freestanding ASCs performing one million cases, 177, 359 of these cases were ophthalmology. The 28 centers that had 1-2 operating rooms (OR) performed averaged about 301 cases. The 122 centers that had 3-4 ORs averaged about 692 cases. The 78 centers that had more than four ORs averaged about 1148 cases.

7. Approximately 23 percent of all single-specialty ASCs are ophthalmology centers, second only to gastroenterology (28 percent).

8. Approximately 38 percent of all single- and multi-specialty centers reported providing ophthalmology, second only to plastic surgery (39 percent). The average procedure volume was 1,696 ophthalmology cases per facility, second only to gastroenterology with 3,710 cases on average per facility.

9. Ophthalmology has seen significant growth in market share in ASCs. From 2000 to 2008, ophthalmology had the most growth at 27 percentage points, followed by gastroenterology at 26 points.

10. Lens and cataract procedures is the most commonly performed ambulatory surgery in hospitals, performed 431,000 times (rounded to the nearest thousands) in 2003. This comprised 8.7 percent of overall ambulatory hospital surgeries.

Note: CPT codes are copyrighted by the AMA.

Sources: Items 1-2: CMS.

Items 3-6: VMG Health 2008 Intellimarker. To receive a copy of the VMG Health Intellimarker, visit www.vmghealth.com.

Items 7-9: SDI’s 2008 Outpatient Surgery Center Market Report. To learn more about SDI and this report, go to www.sdihealth.com.