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Steep initial costs associated with femtosecond laser for cataract surgery

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John A. Vukich

WAILEA, Hawaii — Real profitability with femtosecond laser-assisted cataract surgery might not come until 6 years after a practice purchases the necessary equipment, a physician said here.

"It's more of a half-million-dollar question," John A. Vukich, MD, said at Hawaiian Eye 2012.

Practices should expect an initial outlay of about $500,000 for the femtosecond laser system, along with service fees of about 10% per year and a per-use fee of about $350 to $450 per eye, he said.

In other words, the cost for the laser and procedure will be about $130,688 for the first year, when a warranty covers maintenance, before it rises to $186,688 per year for years 2 to 5 and finally falls to about $55,000 per year for maintenance alone in year 6, once the machine has been paid off. That does not include additional potential costs for facilities or marketing, he said.

In order to break even with those expenses, a practice would need to treat 218 eyes at a charge of $1,000 per eye in year 1; 309 eyes at the same cost in years 2 to 5; and 92 eyes at that price in year 6 and beyond, Dr. Vukich said.

One of the most important questions is who will pay that bill, he said.

There is debate over whether use of the laser will constitute an additional charge to the patient, a new code to be billed to Medicare or neither.

"How the cost is recovered remains a central question to the success of this technology," Dr. Vukich said. "And I think many of us are watching for the answer to this as it is a significant issue we have to address."

• Disclosure: Dr. Vukich is a consultant with Abbott Medical Optics, AcuFocus, Avedro, STAAR Surgical and OptiMedica and a stockholder with STAAR Surgical, AcuFocus and OptiMedica.

Hawaiian Eye and Retina 2013 will be held January 20-25, 2013, at the Hilton Waikoloa Village on Hawaii's Big Island. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.