Opportunities for Growth in Ophthalmology Through Efficiency and Added Services

Surgery centers vary greatly in the ophthalmology services they offer; however opportunities for growth exist by making the services currently offered by the ASC more efficient and adding or expanding ophthalmology services.

Identify areas to boost efficiency
David Kwiat, MD, an ophthalmologist and part-owner of Fulton County Ambulatory Surgery Center in Johnstown, N.Y., says that the biggest opportunity to increase revenue in ophthalmology services at ASCs that already offer these services is by increasing ASC efficiency. "Because we, as physicians, cannot control the reimbursement of many of the services we provide, we must work to be more efficient in the ASC as well as in the office," says Dr. Kwiat.

Dr. Kwiat ensures that his ASC is efficient by using the time between procedures to assist ASC staff with their duties. "I personally assist in the turnover of the rooms and help the staff set up before each procedure," he says. "Doing so cuts down on procedure time and eliminates the need for a part-time employee to assist in room turnover."

Satish Modi, MD, an ophthalmologist and founding owner of Dutchess Ambulatory Surgery Center in Poughkeepsie, N.Y., uses two operating rooms — one used almost exclusively for the right eye and the other for the left — to improve his center's surgical efficiency. "It is becoming increasingly popular for physicians to approach a patient temporally, or from the side, rather than at the head of a patient, which has been the old standard," says Dr. Modi. "Using two rooms — one dedicated to each eye — and scheduling accordingly improves efficiency by cutting out any time that might have been needed to move equipment around between procedures."

Dr. Modi also notes that an excellent and well-trained staff is critical to ensuring procedures and room turnover occur in an efficient manner. "Our staff undergoes a number of drills for every possible complication," says Dr. Modi. "Our staff is trained on what needs to be done in every possible situation, so that we can act quickly and efficiently. Necessary instruments for each possible event are separately sterilized and available in the room"

Expand current services
Another way for ASCs to grow their ophthalmology services is to add the specialty, if it's not offered already, and identify ways to expand the types of procedures they offer. If an ASC does not currently offer ophthalmology services, Dr. Modi suggests ASC owners or administrators consider recruiting a local ophthalmologist to their surgery center.

"Current ASC owners should identify local ophthalmologists that are efficient, have good surgical results and an excellent reputation in the community, and consider bringing them into the ASC as an owner," says Dr. Modi.

Ophthalmologists can perform almost 100 percent of their surgical procedures in the ASC setting. However, ASCs just starting to offer ophthalmology services can reap the most benefits from offering cataract services. The capital costs required to accomplish this are relatively small and recouped quickly, according to Dr. Modi.

"Phacoemulsification, or cataract removal, with intraocular lens implantation is by far the most profitable procedure to perform in the ASC setting," says Dr. Modi. "Ophthalmologists who can perform a procedure in less than 15 minutes can be very profitable, earning up to $600 per procedure in profit, given the facility fee here in New York."

Currently, ophthalmologists perform approximately 2.6 million cataract procedures annually in the United States, according to Dr. Modi, and this number is expected to increase.

Dr. Kwiat notes that there will be an increase of the number of cataract cases in the next ten years as a result of the aging baby boom generation. ASCs that are efficiently providing cataract services are likely to experience growth. "The most profitable procedures are still your cataract surgeries," says Dr. Kwiat. "As a result, doing these efficiently is the best way to grow your ASC."

Certain glaucoma and retina treatments can also increase revenue for an ASC. Although the number of glaucoma cases performed at ASCs are decreasing due to medications and office-based treatments, Dr. Modi suggests that ASCs consider offering Endoscopic Cyclo Photocoagulation, a diode laser used for the treatment of glaucoma. "Patients having cataract surgery with concomitant glaucoma may have this procedure also — the patients need for medication is reduced, and the glaucoma is better controlled," says Dr. Modi. "The procedure only adds about two minutes to the overall procedure time, and the ASC increases revenue by having another medically necessary, billable procedure."

Retinal-related procedures can also be profitable for the ASC. Dr. Kwiat has seen an increase in the number of retinal-related cases and suggests that ASCs add these services if they do not currently offer them. "The addition of retina services, such as pars plana vitrectomies, can increase your revenue," he says.

Additionally, Dr. Kwiat suggests that ASCs should look to increase the number of ophthalmology procedures it performs that are paid for out-of-pocket by the patient. "Increasing your cash business through increasing your volume of elective services and cataract upgrades, such as astigmatism correction or presbyopia correction, takes the insurance company out of the procedure, which can improve your bottom line," he says. Dr. Kwiat also recommends that ASCs consider adding a LASIK division, noting that doing so is another way to increase profitability.

Contact Lindsey Dunn at lindsey@beckersasc.com.

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