1. YAG laser procedures losing value. Medicare and other payors are reimbursing less for YAG laser procedures as more ophthalmologists perform them in their offices. Reimbursement for YAG and other laser procedures will decline further, prompting more ophthalmologists to perform them in the office rather than the ASC, prompting CMS to further reduce or eliminate facility reimbursement over time. This trend will result in a decline in eye ASC volume that will have to be replaced by other procedures.
2. Retina cases offer opportunities. Retina cases are a great opportunity as payors begin to reimburse ASCs for them, but centers will need to find retina surgeons who work fast enough in an ASC and have a large volume of cases to switch from the hospital. Since all supply costs are included in the reimbursement rate, some cases may not be economically suitable for an ASC setting.
3. LASIK volumes are falling. The recession has bitten hard into discretionary procedures like LASIK surgery, where volume fell 30 percent from 2007-2008 and 20-30 percent from 2008-2009. However, most ophthalmology ASCs are not dependent on LASIK surgery because it is often performed in other outpatient facilities.
4. Growth of premium IOLs. Many ophthalmologists are making up for losses in LASIK by inserting premium intraocular lenses in cataract patients. Premium IOLs require similar skills as LASIK — not just salesmanship but also a willingness to work post-op with the patient to improve vision. Since Medicare started allowing ophthalmologists to charge extra for premium IOLs, about 20 percent of patients have opted for them and in some practices the rate has been as high as 50 percent.
5. Savings on supply costs. With the recession, eye ASCs may be able to find better deals with vendors and persuade their physician-owners to standardize supplies, implants and equipment. If an ASC's capital distributions start to decline, it's easier to get surgeon-owners' attention and buy-in on potential cost savings.
Contact Mr. Parshall at mparshall1@verizon.net.