10 Ophthalmology-Driven ASCs to Know
Northern Virginia Eye Surgery Center (Fairfax, Va). William Rich, MD, a partner in this ASC, went through a 20-year struggle with nearby hospitals and Virginia's strict certificate of need process before the ASC finally opened in May 2008.
Dr. Rich is medical director for health policy at the American Academy of Ophthalmology in Falls Church, Va., and has 25 years experience in health policy. But he was unable to win approval in his first CON application in the late 1980s, partly because a hostile hospital twice bought up space where he planned to house the proposed ASC, he says.
His second application in 2007, however, successfully met the state's tough CON process. Among the many application requirements, applicants need to document scheduling difficulties at local hospital ORs and show a commitment to charity care. He submitted the hospital documentation and the testimony for his charity commitment could not have been more golden, coming from a nun who ran a charity clinic.
The one-OR ASC hosted 2,400 surgeries in its first year. Thirteen doctors in two groups use the facility, performing cataract surgery, DSAEK corneal transplant surgery, penetrating keroplasties (PKPs), YAG operations and occasionally blepharoplasties. Dr. Rich ascribes the ASC's success to "committed, efficient docs using the same kind of equipment and lenses." In the future he plans to "slowly increase efficiency" and fill the Friday schedule. www.novaeyesc.com
Mattax-Neu-Prater Eye Center and Surgery Center (Springfield, Mo.). Leo T. Neu, III, MD, was a pioneer in outpatient retinal surgery, starting it when this ASC first opened in 1999. He recalls that he did it for his own convenience, not the money. "It had become difficult to block of time in the hospital OR," he says, noting that income from the procedure was negligible.
"Medicare wouldn't recognize outpatient retina, so you wouldn't get a facility fee," Dr. Neu recalls. "You'd get a physician fee, but it was also low. It wouldn't cover the cost of the equipment." Now many other ASCs are beginning to host retina because Medicare has begun paying the facility fee and that payment, along with higher physician reimbursement for the procedure, finally made retina economical in an ASC.
The facility has two ORs but the second is used only for LASIK. Four doctors use the ASC, each with his own day, Monday through Thursday, then LASIK procedures are performed on Friday. All of the surgeons perform cataract surgery, two perform LASIK surgery, one glaucoma surgery and Dr. Neu is the only physician performing retinal surgery.
Since cataracts and retina are covered by Medicare, Dr. Neu says they are not affected by the recession. Cataract volume has been rising in the past few years, retina volume has held steady and LASIK volume has been off since the recession started, he says. www.mattaxneuprater.com
St. Luke's Cataract and Laser Institute (Tarpon Springs, Fla.). This six-OR ASC saw a decline in cases when the recession struck in Oct. 2008, but volume started rising again in Feb. 2009. Then in the third quarter of 2009 volume was higher than in the same quarter for the past two years, according to ASC Administrator Brad Houser.
Some 9,000-10,000 cases annually are performed by 11 surgeons, nine of whom are employed by the ASC's affiliated ophthalmology practice in the same building. The practice operates out of five locations in the Tampa Bay area. Three of the ORs are dedicated to cataracts, one to retina and other procedures are cornea, glaucoma and oculoplastics. Surgeons also perform a few hundred LASIK cases a year in the practice rather than the ASC.
Mr. Houser says the cataract surgeons have agreed to consistent protocols and use the same instrumentation and intraocular lenses. "That makes us more efficient and gives us better bargaining power with suppliers, which reduces costs," he says. A former circulating nurse functions in a new position of turnover nurse for the cataract ORs. The ASC typically performs 50-75 cataract cases a day. She double-checks everything in the chart before the surgery to make sure nothing is missing. "This makes us more efficient and improves quality," Mr. Houser says. "The money she saves us far exceeds the cost of her salary."
Volume is 60 percent Medicare fee-for-service and 35 percent Medicare "Advantage" managed care plans. About 20 percent of cataract patients choose the more expensive presbyopia-correcting intraocular lenses, which Medicare partially covers, with the rest of the price paid by the patient out-of-pocket. Mr. Houser says the more expensive presbyopia-correcting IOLs are growing in popularity with patients. www.stlukeseye.com
Winchester (Va.) Eye Surgery Center. When this one-OR ASC opened three years ago, Jodie Looker, RN, was hired away from the hospital that had been contesting the facility when it was in planning stages.
As the new clinical director, Ms. Looker went from supervising a large, hospital-based ASC, with 130 surgeons performing operations and about 60 employees reporting to her, to a facility with 10 employees and four surgeons. But she says she's as busy as ever. While many administrative functions at the hospital's ASC were absorbed throughout the organization, there is no one to do that at the ASC. Ms. Looker personally takes care of infection control prevention, employee health and human resources, and spends up to 30 percent of her time in direct patient care.
The ASC now logs 3,000 surgeries a year, with volume rising recently with the addition of a fourth surgeon.
Ms. Looker advises new ASCs to hire an experienced, competent staff. "You have to have people who are familiar with the surgical specialties," she says. Several of her employees were also lured away from the hospital-based ASC. Her technology tip: attach an inpatient monitor to each eye-stretcher. In this way, "the monitor goes wherever the patient goes, which saves time," she says. "You don't have to detach and reattach the monitor each time." www.winchestereyesurgerycenter.com
Laser and Surgical Services at the Center for Sight (Sarasota, Fla.). This three-OR facility is a high-volume ASC, with eight surgeons performing 14,000 procedures a year, half of them cataracts and the rest cornea, glaucoma, retina, oculoplastics and full facial plastic surgery. Two of the surgeons are owners and the other six are employees, but they will soon be allowed to buy into the ASC as well as its affiliated clinic, the Center for Sight.
Surgery volume fell slightly last winter and spring, due to the recession, but has rebounded in the past six months and volume for the year is higher than last year. While cosmetic surgeries have shown a slight decline, functional plastic surgeries have increased.
Although the ASC must legally be separate from the clinic, patients do not see the difference and get just one bill, says Chief Administrative Officer James Dawes. The Center for Sight provides comprehensive eye care using both physicians and optometrists. It not only offers eyeglasses and contact lenses but also runs a dispensing center for hearing aids, with an audiologist and a hearing instrument specialist on staff. Mr. Dawes says hearing loss is closely related to vision loss.
"Our business model, in the simplest terms, is that we're in the quality of life business," he says. "We offer our patients a glasses-free lifestyle, a chance to see younger, look younger and hear younger."
Mr. Dawes lists some keys to the ASC's success:
- Selection of surgeons. They are all "first-round draft picks," coming from the best medical schools and training programs.
- Continuous in-house staff training. Designated staff members function as a clinical instructor, front-office instructor and customer service instructor for 180 employees at the clinic and ASC. All new employees go through customer service training, every employee participates in ongoing training and a company-wide customer-training program takes place every two months.
- Hotel-like atmosphere. "We see ourselves as the Ritz Carlton of healthcare," Mr. Dawes says. "We want the facility to be aesthetically pleasing and relaxing for our patients." An outside cleaning service attends to bathrooms and lobby areas during the day.
- Tracking employee performance. The organization tracks and reports selected performance benchmarks and patient satisfaction to all of our employees on a weekly basis. "This has to be done on a real-time basis to have any meaning," Mr. Dawes says. www.centerforsight.net
Surgical Eye Center of Morgantown (W. Va.). This two-OR facility, which opened in 1997, is the only ASC in West Virginia that is recognized by the Joint Commission. Seven surgeons perform 2,000 surgeries a year and they also use an attached laser room. Only one of the ORs is used full-time — four days a week. The ASC hosts glaucoma, cataract, corneal surgeries, plastic lid surgeries, YAG operations, muscle surgeries and intacs for keratoconus, but not retinal surgery.
Five of the surgeons are in the same group, Regional Eye Associates, with offices in Pennsylvania, Maryland and southern West Virginia. Monongalia General Hospital is a minority partner, but "the hospital pretty much has nothing to do with us," says Heather Huffman, administrative director of the ASC.
Ms. Huffman attributes the ASC's success to its eye surgeons. "The surgeons have great people skills and exceptional technical skills," she says. "The staff and the patients adore them." Staff and physicians consistently earn high patient satisfaction scores in the 98-99 percentile range. "Patients also consistently comment on the speed and quality of care with which they are treated at our ASC, and most prefer it to any previous hospital experience," she says.
Ms. Huffman says Stephen Powell, CEO of both the ASC and Regional Eye Associates, is "always thinking of what is going to come next." Mr. Powell has been recognized by a local business publication, BIZ magazine, for providing full-service eye care and reaching out to rural areas. She says the ASC is about to buy two new phaco-emulsification machines and in early 2010 it plans to buy a new autoclave. www.readocs.com/lasik-west-virginia/surgical_center.htm
Eye Center of Columbus (Ohio). Pam Canfield, executive director of this ASC, says the surgeon-owners of this four-year-old ASC had the foresight to embrace all specialties and levels of ophthalmic care in what they call an "eye mall." It includes an optical shop, pharmacy, deli, the Central Ohio Lions Eye Bank and the Eye Center Foundation, which provides educational opportunities for technicians, optometrists and ophthalmologists.
Ms. Canfield says the six-OR facility, with one refractive room and three procedure rooms, opened in 2005 and is used by 48 surgeons who logged more than 9,000 cases in 2009. "The patients appreciate not having to go to the hospital for eye surgery," she says.
The ASC has brought billing and other financial functions in-house under a business manager who is a certified coder. "It has made a huge difference," Ms. Canfield says. "Within nine months of making this move, by the end of 2007 and into 2008, we were able to move out of the red and into the black." This included renegotiating payor contracts to reflect more transparency and improved reimbursement. www.theeyecenterofcolumbus.com
Dulaney Eye Institute (Towson, Md.). The center opened almost 15 years ago and boasts some star players in ophthalmology. Leeds E. Katzen, MD, introduced the YAG laser to the United States and was one of the first in the country to use phaco-emulsification. Bert M. Glaser, MD, was a pioneer of outpatient retina surgery who has been performing retina cases at the ASC since it opened in March 1995.
Andrea Hyatt, the ASC administrator, says the 21 ophthalmologists who use the facility come from nine competing practices yet they fully cooperate on key decisions such as OR scheduling and capital purchases. "They are a very cohesive group that is willing to leave egos behind them for the success of the center," she says. "They have certainly realized the benefits to themselves, their practices and their patients."
The ASC will log about 7,800 procedures in 2009, an increase over 2008. The surgeons collectively perform anterior segment, glaucoma, corneal transplants, ocular-plastic surgery and retina procedures, but they made a decision years ago not to take on LASIK surgery and have stuck to it, she says. The ASC has recently replaced a retina laser and is getting ready to replace a sterilizer. www.omnieyespecialists.com
Eye-Q Vision Care (Fresno, Calif.). This center has two ORs, used by nine surgeons, with a volume of around 5,000 procedures annually, excluding LASIK. It hosts cataracts, glaucoma, cornea and some pediatric eye surgery and added retina in 2003.
The center is owned by Eye-Q Vision Care, which also owns an ophthalmology practice closely affiliated with the center. CEO Scott Bridgeman says readers of the Fresno Bee have selected it the best eye practice in the area for five consecutive years. Eye-Q has also been selected for the past three years as one the top five Fresno companies to work for.
"Our goal is to have the latest technology in our ASC, whether it is equipment or supplies, to provide our patients with the opportunity to have the best possible outcome," Mr. Bridgeman says. The ASC just purchased three Spectralis OCT machines from Heidelberg Engineering, at a total cost of about $375,000. www.eyeqvc.com
New Vision Cataract Center (Norwalk, Conn.). New Vision, which opened in 1999, has two ORs and a LASIK room in 8,000 square feet of space. It is housed within the practice of Spector Eye Care, which is owned by Scott Spector, MD, who also owns the ASC.
Dr. Spector performs about 95 percent of the ASC's cases. He offers cataract surgery, lens implants and all types of laser eye surgery for correcting nearsightedness, farsightedness and astigmatism including LASIK and epi-LASIK. Spector Eye Care is staffed by a team of ophthalmologists, optometrists and technical staff who perform general eye examinations, examinations for cataracts and cataract surgery, lens implants including near vision presbyopia correcting multifocal intraocular lenses and other services.
Mark Spector, Dr. Spector's brother and administrator of the practice, says the center has low employee turnover, even for the per diem employees who only come in on surgery days. He says the economy has affected LASIK volume but not the volume of cataracts. www.spectoreye.com
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