May/June 2011 PS250 Survey

Issue: May/June 2011

Do you have ownership in or plan to own your own ASC?

Perspective

Although admittedly somewhat surprised, I was very happy to read that nearly two-thirds of all ophthalmologists responding either own or are part owners of their ASC. I believe this is the future of surgical eye care and will absolutely allow the surgeon greater control of his schedule, his patients, his time allocation and even his surgical outcomes. At the same time, it affords the surgeon an additional revenue stream to supplement diminishing reimbursement while overhead costs continue to spiral upward. Once relegated to the least favorable OR times, forced to accept 30-minute turnover times and even told we “lost money” for the hospital, we now are being courted by hospital administrations to bring our cases back to their ORs and even chastised for diverting these time- and cost-efficient procedures away from their facilities. In fact, and unbeknownst to many eye surgeons, we in the privately held ASC setting are currently being reimbursed nearly 45% less than the hospital for the exact same procedure. (What an obvious cost savings for Medicare.)

For those wishing to build a new facility, I would encourage you to strongly consider obvious issues such as start-up costs and projected case load, as well as federal and state regulatory issues, such as certificates of need. However, seek help and advice from others — you do not need to reinvent the wheel. Those looking to buy into an existing ASC should carefully assess purchase price and percentage ownership in relation to proposed volume, ability to address specific equipment needs, availability of OR times, etc. Those who currently own an ASC should look at increasing revenues by expanding services, including retina, which recently has become a much more profitable area with newer technology, more efficient surgery and higher facility fees. The Outpatient Ophthalmology Surgical Society, an organization composed of nearly 400 members (all ASC owners) whose mission is to support and assist ASCs in all aspects, can be a very valuable resource in these areas, as well as a tremendous opportunity for networking.

As many of us who currently own an ASC will attest, expanded regulatory demands from certifying agencies with highly inconsistent interpretation by surveyors of an ever-increasing number of mandates have kept us on our toes and in need of constantly updated information and improved communication through media just like this. Thank you, Premier Surgeon. — Bradley C. Black, MD

Do you have a preferred surgical microscope?

Perspective

The Zeiss Lumera microscope provides truly astonishing clarity, brightness and resolution. The very finest details, such as minuscule shreds of cortical debris and lens epithelial cells, are thrown into sharp relief. The outstanding image quality depends, of course, on the optical elements, but principally it depends on the dual stereo coaxial illumination. The brilliance of the red reflex provides a particularly vivid view of the lens capsule and the various layers of the lens. Every surgeon I know who has used it comes away amazed. Seeing the structures in the eye in such detail creates new respect for anatomy and facilitates greater care, enhances surgical technique and improves our ability to evaluate new technology.

In light of these facts, it is no surprise to me that the Lumera microscope has the lion’s share of responders’ votes in this survey. Leica surgeons tend to have a hard time moving to Zeiss due to differences in optics and design. Endure has a very nice dual stereo coaxial microscope with a significantly better price point than the Lumera. — Mark Packer, MD, FACS

Disclosures: Dr. Black is a consultant to Alcon. Dr. Packer has no relevant financial disclosures.