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Publication Exclusive — Office-based cataract surgery: Pros and cons of a controversial idea
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Welcome to another edition of CEDARS/ASPENS Debates. CEDARS/ASPENS is a joint society of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.
The concept of in-office cataract surgery has garnered much attention recently. While there are many perceived benefits to this, there are also numerous drawbacks. This month, Melissa Toyos, MD, FACS, discusses the pros and cons of office-based cataract surgery. We hope you enjoy the discussion.
Kenneth A. Beckman, MD, FACS, OSN CEDARS/ASPENS Debates Editor
The hardest part about talking about office-based cataract surgery is that the term itself means different things to different people. Just say the words “office-based cataract surgery” and some people immediately envision illicit backroom operations with untrained staff, sketchy lighting and an anesthesia program consisting of a single Valium rolling around in a soufflé cup. To others, office-based cataract surgery means an accredited ambulatory surgery center housed within an existing ophthalmology practice, an entity that can couple the benefits of a proficient specialty staff with the convenience of a clinic. To many, the concept also includes the possibility of same-day bilateral procedures.
Office-based cataract surgery has been a theoretical controversy for many years, and surgeons were understandably wary. Patient safety has been cited as the overall biggest concern. How do you guarantee a “routine” surgery? Many studies show that even “routine” cataract surgery patients have one or more comorbidities. Can ophthalmologists alone handle the liability of routine cases that go awry? The skills needed to interpret rhythm strips and run codes atrophy if unused, and most ophthalmologists abandoned them decades ago when they left their internships for ophthalmology residency. Another reason office-based cataract surgery has been slow to leave the gate is that surgery centers required significant investments of time and money to staff and comply with safety and compliance regulations imposed by Medicare and other agencies. Many surgeons have already made investments in existing centers and are comfortable with the processes and outcomes of operating there. The proverbial elephant in the surgery center is, of course, the current Medicare reimbursement model. As it stands now, CMS pays surgeon fees for cataract surgery in hospitals, ASCs and offices but does not pay facility fees for in-office cataract surgery. With decreasing reimbursements, it is hard to see how a business could remain afloat after eliminating this fee. Adding to that is the fact that Medicare pays for only 50% of the second eye cataract reimbursement when done on the same day, causing declining cataract reimbursements to go into outright freefall.
Click here to read the full publication exclusive, CEDARS/ASPENS Debates, published in Ocular Surgery News U.S. Edition, July 25, 2016.