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BLOG: Three essentials for in-office cataract surgery to grow
After you first talk to a patient about cataract surgery, what’s the most frequent question you get? For me, it’s, “How soon can we do it?” Wouldn’t it be wonderful if a surgeon could look at his watch and say, “How about 10 minutes?”
Just a few years ago, the concept of in-office cataract surgery would have raised many eyebrows, but as we explore in this issue’s cover story, the future of this procedure may be more real than we think. Some basic standards need to change for this to become feasible, though.
1. Equipment companies must support less expensive, reusable supplies. Most of the cataract equipment we use in the U.S. only comes with single-use disposable tubing. These same machines in other countries have approved reusable tubing, and rates of infection and other complications are comparable. Re-sterilizable tubing can be used maybe 20 times and is considerably less expensive. To meet tighter cost controls for any in-office surgeries, companies will need to shift their “standards” back toward sterilizable cassettes and phaco tubing.
2. Payment models need to change. According to reimbursement specialist Kevin Corcoran, Medicare reimbursement for a surgeon performing cataract surgery is the same whether he/she performs the procedure in the hospital, ambulatory surgery center or office. If payers desire to save money, pushing procedures out of the ASC and into the office makes lots of sense, but surgeons will only consider this if the surgeon fee in the office makes up for the cost of added equipment and supplies and the loss of ASC income because so many of us own our surgery centers. There is some precedent for this. In GI, vascular surgery and pain management, CMS has sought to move procedures out of hospitals and into less expensive ASCs. To incentivize this, it increased ASC reimbursement dramatically for certain procedures. Not surprisingly, more surgeons started doing those procedures in ASCs. Indeed, a similar arrangement could be made to increase the surgeon fee for cataract surgery, depending on where the procedure was performed.
3. Malpractice carriers will have to support in-office cataract surgery. Every case of infectious endophthalmitis is a tragedy, yet its likelihood is unlikely to be any greater in the office than a formal operating room, as long as careful sterility standards are followed. Malpractice insurance companies will need to embrace this fact and be prepared to stand behind doctors when a postoperative infection does happen in the office setting.
Time and further study will tell whether shifting cataract surgery to an office setting compromises patient safety/convenience or enhances it. Some with experience, such as a few Kaiser Permanente systems, claim its benefits are clear. As more data accumulates on its safety, it’s likely that in-office surgery will be better supported by our health care system. The system will save costs, and as with ambulatory surgery centers, surgeons who practice with efficiency should continue to be able to earn a living practicing the craft they love so well.