Costs are rising at a rate faster than reimbursements can be made, creating major challenges for surgical organizations. Ambler Surgical, together with members from its Advisory Board of ophthalmic industry experts, suggest the following list of high supply costs in ophthalmic surgery and ways to provide cost-cutting solutions for these expenses.
Cost #1: Equipping an ASC to Perform Ophthalmic Procedures
Equipping an ASC to perform ophthalmic procedures can be overwhelming to those unfamiliar with the specialty. "The planning and readiness phase is time-consuming and laborious, and personnel salaries can be exorbitant and unpredictable," says Annquinetta Dansby-Kelly RN, the past president of the American Society of Ophthalmic Registered Nurses.
Solution: Hire employees with ophthalmic experience to save time and money on training and make the most of salary dollars. "Evidence shows that a significant amount of time and money is utilized during the employee's training period, in which you are paying two people to do the job of one," says Ms. Dansby-Kelly.
Cost #2: Capital Equipment
The procurement of capital equipment such as phacoemulsification and vitrectomy multi-purpose units and as well as microscopes with video monitoring can account for a significant portion of the budget, says Ms. Dansby-Kelly.
Solution: Consult with surgeons before finalizing any major equipment purchases to avoid miscommunications with compatibility. "Many surgeons are not comfortable using different types of machines, so their input is critical when making purchase decisions," says Ms. Dansby-Kelly.
Cost #3: Pharmaceuticals
Changes in government regulations have greatly restricted the accessibility of pharmaceutical drug samples. Centers must now purchase these drugs directly, which increases budgetary expenses.
Solution: In many cases, generic drugs provide significant savings over brand name drugs while still delivering the same quality of patient care, but there are some risks, says Marty Anthony, president of Ambler Surgical. "According to The High Cost of Saving Money: Risks Associated With Generic Drugs, generic ophthalmic medications are appealing as cheaper alternatives to brand name drugs up front, but the risk of inconsistent formulations and different inactive ingredients can lead to more costly side effects in the long run."
Cost #4: Retinal Supplies
Retinal supplies are high cost items, but the reimbursements have improved.
Solution: Standardize the supplies you use. "If you can get all your doctors to agree to the same viscoelastics and intraocular lenses, your supply companies will make good deals for packs that include all supplies," says Jeanne Butcher of Ocala (Fla.) Eye Surgery Center. "The hard part is getting all of your doctors to agree, because if they don't, then you're faced with buying additional items outside of your custom packs that typically don't receive a volume discount."
Cost #5: Disposables
Disposable retinal forceps, graspers, and scissors for the 25G and 23G posterior segment surgeries are additional high cost supply items, says Cherry Maloney, RN, of UAB Callahan Eye Hospital in Birmingham, Ala. The price of these items continues to rise as technology improves, yet there is no corresponding increase in reimbursement. "Reusable instruments comparable to these are available, but they are extremely hard to maintain with a high volume of surgeries," says Ms. Maloney. "The reusable ones are also very expensive to maintain, since an average repair can cost up to $400."
Solution: Continually search for the least expensive cost on lower-importance supply items that are standard for most surgeons, such as cautery cables, cauteries and cannulas. "With this strategy, you can keep cost per case below reimbursement and still provide the surgeons with the very important items that they want," says Ms. Maloney.
Cost #6: Surgical Instruments
Instrument purchases are the greatest, ongoing expenditure that never goes away, says Ms. Dansby-Kelly. "The initial cost of ophthalmic surgical instruments can be relatively high, and their lifespan varies dramatically based on their care and handling," she says.
The quality of surgical instruments is dependent upon the raw materials used in production — typically stainless steel, which has three different grades of quality, says Mr. Anthony. It is important to know what materials are used in making your instruments, so you can avoid damaging them, he says.
"Electrolytic deposition of metals may occur when instruments manufactured with incompatible metals are mixed during the cleaning process," Ms. Dansby-Kelly says. "Carbon particles will oxidize causing damage to the metal. This process reduces the life of the instrument."
Titanium, a more expensive metal that does not rust and lasts longer with proper care, is also used to manufacture instruments. Titanium is often the preferred metal of choice, because it is more durable and less corrosive than stainless steel.
Solution: To maximize the lifespan of surgical instruments, it is important that all staff members who use them are taught proper care and maintenance. Improperly trained personnel can damage the instruments incurring additional repair or replacement costs, says Mr. Anthony. It is also important to purchase instruments from a reputable vendor that provides a wide variety of the most commonly used ophthalmic instruments, high-quality products, competitive pricing and an instrument guarantee.
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Cost #1: Equipping an ASC to Perform Ophthalmic Procedures
Equipping an ASC to perform ophthalmic procedures can be overwhelming to those unfamiliar with the specialty. "The planning and readiness phase is time-consuming and laborious, and personnel salaries can be exorbitant and unpredictable," says Annquinetta Dansby-Kelly RN, the past president of the American Society of Ophthalmic Registered Nurses.
Solution: Hire employees with ophthalmic experience to save time and money on training and make the most of salary dollars. "Evidence shows that a significant amount of time and money is utilized during the employee's training period, in which you are paying two people to do the job of one," says Ms. Dansby-Kelly.
Cost #2: Capital Equipment
The procurement of capital equipment such as phacoemulsification and vitrectomy multi-purpose units and as well as microscopes with video monitoring can account for a significant portion of the budget, says Ms. Dansby-Kelly.
Solution: Consult with surgeons before finalizing any major equipment purchases to avoid miscommunications with compatibility. "Many surgeons are not comfortable using different types of machines, so their input is critical when making purchase decisions," says Ms. Dansby-Kelly.
Cost #3: Pharmaceuticals
Changes in government regulations have greatly restricted the accessibility of pharmaceutical drug samples. Centers must now purchase these drugs directly, which increases budgetary expenses.
Solution: In many cases, generic drugs provide significant savings over brand name drugs while still delivering the same quality of patient care, but there are some risks, says Marty Anthony, president of Ambler Surgical. "According to The High Cost of Saving Money: Risks Associated With Generic Drugs, generic ophthalmic medications are appealing as cheaper alternatives to brand name drugs up front, but the risk of inconsistent formulations and different inactive ingredients can lead to more costly side effects in the long run."
Cost #4: Retinal Supplies
Retinal supplies are high cost items, but the reimbursements have improved.
Solution: Standardize the supplies you use. "If you can get all your doctors to agree to the same viscoelastics and intraocular lenses, your supply companies will make good deals for packs that include all supplies," says Jeanne Butcher of Ocala (Fla.) Eye Surgery Center. "The hard part is getting all of your doctors to agree, because if they don't, then you're faced with buying additional items outside of your custom packs that typically don't receive a volume discount."
Cost #5: Disposables
Disposable retinal forceps, graspers, and scissors for the 25G and 23G posterior segment surgeries are additional high cost supply items, says Cherry Maloney, RN, of UAB Callahan Eye Hospital in Birmingham, Ala. The price of these items continues to rise as technology improves, yet there is no corresponding increase in reimbursement. "Reusable instruments comparable to these are available, but they are extremely hard to maintain with a high volume of surgeries," says Ms. Maloney. "The reusable ones are also very expensive to maintain, since an average repair can cost up to $400."
Solution: Continually search for the least expensive cost on lower-importance supply items that are standard for most surgeons, such as cautery cables, cauteries and cannulas. "With this strategy, you can keep cost per case below reimbursement and still provide the surgeons with the very important items that they want," says Ms. Maloney.
Cost #6: Surgical Instruments
Instrument purchases are the greatest, ongoing expenditure that never goes away, says Ms. Dansby-Kelly. "The initial cost of ophthalmic surgical instruments can be relatively high, and their lifespan varies dramatically based on their care and handling," she says.
The quality of surgical instruments is dependent upon the raw materials used in production — typically stainless steel, which has three different grades of quality, says Mr. Anthony. It is important to know what materials are used in making your instruments, so you can avoid damaging them, he says.
"Electrolytic deposition of metals may occur when instruments manufactured with incompatible metals are mixed during the cleaning process," Ms. Dansby-Kelly says. "Carbon particles will oxidize causing damage to the metal. This process reduces the life of the instrument."
Titanium, a more expensive metal that does not rust and lasts longer with proper care, is also used to manufacture instruments. Titanium is often the preferred metal of choice, because it is more durable and less corrosive than stainless steel.
Solution: To maximize the lifespan of surgical instruments, it is important that all staff members who use them are taught proper care and maintenance. Improperly trained personnel can damage the instruments incurring additional repair or replacement costs, says Mr. Anthony. It is also important to purchase instruments from a reputable vendor that provides a wide variety of the most commonly used ophthalmic instruments, high-quality products, competitive pricing and an instrument guarantee.
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