Pennsylvania report: Lens and cataract surgeries in ASCs more than doubled

The procedures ranked second among the five that are done most at ASCs, state agency says. Experts see a growing national trend.

Issue: November 15, 2006

ByErin L. Boyle

The number of lens and cataract procedures done at ASCs in Pennsylvania more than doubled between 2000 and 2005, according to a recent report. Overall, outpatient procedures in the state rose 34.5%, with 73.9% of the growth at ASCs.

The Pennsylvania Health Care Cost Containment Council, an independent state agency, released in October volume two of its annual report on health-care facilities. The document focused on non-general acute care hospitals (rehabilitation, psychiatric, long-term acute care and specialty care centers) and ASCs. The first volume, on general acute care hospitals, was released in April.

Ophthalmology at ASCs

In 2005, 575,984 (26.5%) of 2.2 million outpatient diagnostic and surgical procedures were done at ASCs in the state. In contrast, in 2000, ASCs handled 164,690 procedures, or 10.2% of the 1.6 million outpatient procedures, the report said.

With 25 ASCs opening between June 2005 and May 2006, the statewide total now stands at 202, the report shows.

Lens/cataract procedures done at ASCs in the state totaled 102,940, or 17.9% of all ASC procedures in 2005. Lens/cataract procedures were second to colonoscopy/biopsy, which totaled 113,243, or 19.7% of all ASC procedures in 2005, according to the report. Comparatively, lens/cataract procedures done at hospital outpatient units in the state totaled 64,262, or 4% of the 1.6 million hospital outpatient procedures in 2005.

In 2000, ASCs handled 49,275 lens/cataract operations, or 29.9% of all ASC procedures. Lens/cataract surgery was the most-performed ASC procedure in 2000, whereas hospital outpatient units handled 95,158 lens/cataract operations, or 6.6% of the 1.4 million hospital outpatient procedures.

Efficiency, savings and quality

William L. Rich III, MD, FACS [photo]
William L. Rich III

The number of ophthalmic procedures done in ASCs nationwide promises to grow rapidly, especially retinal procedures, American Academy of Ophthalmology Medical Director of Health Policy William L. Rich III, MD, FACS, said in a telephone interview with Ocular Surgery News.

“I think it’s good for the physicians and society,” Dr. Rich said. “Ophthalmology has always been a major player in ASCs. Cataract surgery is the second most commonly performed procedure in all ASCs. Even with the restrictions on access to certain procedures in the ASC, ophthalmic ASCs are still a huge percentage of all single-specialty ASCs.”

The number of operating rooms devoted to ophthalmic procedures will increase rapidly in the next few years because of proposed Medicare rules that would allow more procedures to be done in ASCs. In 2008, the Centers for Medicare and Medicaid Services will allow all procedures to be done in ASCs, if they are deemed safe and do not require overnight hospital stays.

Surgeons will benefit as more procedures are allowed in ASCs, Dr. Rich said.

“The advantages to ophthalmologists are that they will have more efficient patterns of surgical care,” he said. “They won’t have to be doing a cataract in the ASC and maybe doing a filtering procedure somewhere else, or doing some retinal procedures in the ASC and some in the hospital outpatient department. Ophthalmologists will have the ability to increase their productivity through the efficiencies of use in an ASC.”

The new Medicare fee schedule will benefit retinal surgery significantly, Dr. Rich said.

“Now, with the new fee schedule set to go into effect in 2009 for ASCs, it will be very profitable for ASCs to offer operating room space to retinal surgeons,” he said. “I think you’re going to see a rapid expansion of the number of major retinal procedures performed in ASCs.”

Medicare beneficiaries will also benefit, as ASCs handle more ophthalmic procedures, Dr. Rich said.

“It’s a win-win,” he said. “Currently, the patient has to go to an outpatient facility to have a cataract done. The fees are substantially higher in the outpatient department. So, if we can switch them into the ASC, it’s a tremendous benefit for beneficiaries.”

In Pennsylvania and many other states, the growth of ASCs is an “outstanding health policy development,” American Association of Ambulatory Surgery Centers Executive Director Craig Jeffries said in a telephone interview with Ocular Surgery News. However, a few states temper that growth by requiring practices and groups to have “certificates of need” before opening ASCs. Pennsylvania is not one of the states requiring a certificate of need.

Still, where the growth of ASCs is unfettered, cost savings and improved efficiency result, Mr. Jeffries said. He cited a study showing that if all ASCs were eliminated, Medicare would pay an additional $500 million for services currently offered at ASCs.

“Medicare pays less in the ASC than they do in the hospital,” Mr. Jeffries said. “That means that the consumer pays less.”

In Pennsylvania and other states, physicians have led the development of ASCs, improving efficiency and health-care quality, Mr. Jeffries said.

“By operating in ASCs instead of hospitals, physicians gain the opportunity to have more direct control over surgical practices,” he said. “These are important success ingredients. They get to schedule procedures more conveniently for patients. They assemble teams of specially trained and highly skilled staff for the ASC. [Employees] tend to stay there a long time. There’s not a lot of turnover. They ensure that the equipment and supplies being used in the ASC are best suited to their specialty.”

About 12% to 15% of member facilities of the American Association of Ambulatory Surgery Centers are single-specialty ophthalmic ASCs, Mr. Jeffries said.

“We [AAASC] clearly understand and represent their interests,” he said. “Physicians are striving for, and have found in the ASC, the professional autonomy over their work environment and over the quality of care that has not been available to them in hospitals.”

For more information:

Craig Jeffries can be reached at the American Association of Ambulatory Surgery Centers, P.O. Box 5271, Johnson City, TN 37602; 423-915-5271; fax: 423-282-9712; e-mail: craigjeffries@aaasc.org.

William L. Rich III, MD, FACS, can be reached at the American Academy of Ophthalmology, Governmental Affairs Division, 1101 Vermont Ave. NW, Suite 700, Washington, DC 20005-3570; 202-737-6662; fax: 202-737-7061; e-mail: hyasxa@aol.com.

Reference:

Financial Analysis 2005, An Annual Report on the Financial Health of Pennsylvanias Non-GAC Facilities, can be read at the Web site of the Pennsylvania Health Care Cost Containment Council: www.phc4.org/reports/fin/05.

Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology and focuses on regulatory, legislative and practice management topics.