BLOG: Office-based surgery: Five things you need to know
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Key takeaways:
- Space, start-up costs, safety, expertise and reimbursement are common concerns surgeons have about office-based surgery.
- Office-based lens surgery is as safe as or safer than lens surgery performed in ASCs.
When surgeons consider adding office-based surgery to their practice, they tend to have questions about five main issues.
Here’s what I tell them they need to know before starting office-based surgery (OBS).
1. Space
“Do I have enough space?” is one of the most frequently asked questions. Invariably, the answer is “yes” because OBS doesn’t require much space. It takes about 700 square feet to put in a single accredited office-based suite with a clean and dirty room or 1,000 square feet for a two-room suite. The space is usually already available; sometimes it’s the former records room that has gone unused since the practice switched to electronic health records. Sometimes it can be added to an existing or planned LASIK suite, which is what we did in my practice. When we built our LASIK suite, we included space to add two OBS suites. We use the same floor plan and same patient flow whether they are having LASIK, corneal cross-linking or cataract surgery.
I have not encountered anyone who could not eventually add an OBS suite to their existing space or, if necessary, expand a bit into other space. Oftentimes when surgeons are thinking about adding an OBS suite, their practice is in the process of moving to a larger facility or adding a satellite site, which makes planning space for an OBS suite that much easier.
Bottom line: Finding space for an OBS suite is not a major hurdle.
2. Start-up costs
The best way to consider if you can afford the start-up costs associated with building an OBS suite is to compare it to an ASC. I am extremely supportive of ophthalmic-specific ASCs — as is the entire iOR Partners organization — for practices that have the volume to support an ASC. If you have the volume to support building an ASC, you should build an ASC. OBS suites are for practices that do not have the practice size, surgical volume or case mix to support their own ASC.
A practice can have a profitable OBS suite that can be functional, safe and effective with 30 cases a month. Clearly, 30 cases a month cannot support building an ASC. You can build an OBS suite with top-tier devices and high-tech ancillary equipment for less than $250,000, whereas building an ASC runs north of $2.5 million.
Bottom line: OBS suites are affordable and cost-effective if you do a reasonable number of surgeries.
3. Safety
Trends suggest a shift from ASCs to OBS suites for ophthalmic surgery over the next 10 years, and naturally eye surgeons are concerned about safety. OBS suites follow accreditation standards by the same organizations as ASCs — namely the Joint Commission and Quad A, which require the same reporting and compliance process for OBS suites as they do for ASCs. The study “Safety of office-based lens surgery: A U.S. multicenter study,” which we recently submitted for publication in the Journal of Cataract & Refractive Surgery, unequivocally supports the safety of ophthalmic OBS.
We evaluated case records of more than 18,000 consecutive patients who underwent office-based lens surgery for visually significant cataract, refractive lens exchange or phakic IOL implantation at 36 participating U.S. sites and found that office-based lens surgery is as safe as or safer than modern lens surgery performed in ASCs or hospital outpatient departments. The rates of postoperative endophthalmitis, toxic anterior segment syndrome and corneal edema were 0.028%, 0.022% and 0.027%, respectively. A second paper is coming out with more than 30,000 procedures.
Bottom line: Office-based lens surgery is as safe as or safer than lens surgery performed in ASCs.
4. Expertise
Your clinical staff must learn how to assist in surgery, and iOR manages that process by training your staff and providing support throughout the process. Once the staff is up to speed, iOR assures that each individual is fully trained to competency. Maybe these staff members have been in the clinic doing refractive exams or scribing, and now on a certain day of the week, they get to be a scrub tech, be a circulator and be on the surgical team. They have the opportunity to see the patient in the clinic, in surgery and then back in the clinic again.
In addition to enhancing the patient’s experience, this dynamic instills a deeper sense of pride among the staffers who’ve gained an expanded role in the practice. Our iOR launch team makes sure that the staff is trained appropriately, that all the necessary supplies are on hand and that everybody is excited to be involved in doing surgery in the office. A critically important part of the expertise issue is that the surgeon already has all the expertise he or she needs. You will be doing the same thing that you’ve done for years. You’ll sit down at the microscope and phaco machine and carry on as usual. The only difference is now it’s more convenient because your office and clinic are on the other side of the OR door.
Bottom line: iOR handles staff training and administrative issues; you do the surgery.
5. Reimbursement
Reimbursement varies by payer, but many insurers recognize OBS surgeries as safe and cost-effective. iOR has been successful in collecting reimbursements from all major payers nationwide, including Medicare. The iOR Partners’ average reimbursement rate is $1,087 per case above and beyond the standard professional fee. How is that possible? We understand the regulatory and billing requirements that you need in order to get reimbursed. We review every case, perform insurance preauthorization and choose the right mechanism for billing that will give you the greatest return for the surgical procedure. Bottom line: By redirecting the payment formerly going to the surgical facility, iOR helps put money back into your practice.
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