Negotiating Reimbursement in Office-Based Surgery Centers: Q&A with Dr. Cory Lessner and Dr. Andrew Shatz of SightTrust Eye Institute

Surgeons at SightTrust Eye Institute, a recently opened freestanding surgery center in Sunrise, Fla., will perform cataract and premium intraocular lens procedures despite the fact that such procedures are not typically recognized or reimbursed by payors if performed in a physician's office.

Cory M. Lessner, MD, president and CEO of SightTrust Eye Institute, and medical director Andrew Shatz, MD, discuss the strategy behind launching an office-based surgery center, including the process of securing reimbursement for these procedures.

Q: What prompted you to open an office-based surgery center that performs cataract and premium intraocular lens procedures, particularly given that procedures like cataract surgery have not been recognized by insurance companies if performed in a physician's office?

Dr. Cory Lessner and Dr. Andrew Shatz: The idea of opening an office-based surgery center was born from the need to address two major concerns that we had: one financial and the other philosophical. On the financial side, building out an ambulatory surgery center that would follow Medicare's requirements for OR size, elevator weight, egress and others would have necessitated moving our cataract practice off-site, thus separating it from our LASIK center. This would have made it more difficult to share our technical and administrative staff, and would have unacceptably inflated our costs. Additionally, we felt that a cataract and premium intraocular lens-only center could be run more efficiently, with a smaller physical plant and staff than an ASC.

Philosophically, SightTrust Eye Institute has built its reputation as a premium lens center both by providing excellent surgical results and by creating a calming atmosphere for our patients. Since our office is accredited by the Accreditation Association of Ambulatory Health Care as well as licensed by our state Board of Health, we are held to the same standards as ASCs. This should make it appealing for insurance companies to allow their insured members to use our center.

Q: Generally speaking, can you elaborate on the financial and professional benefits of operating an office-based surgery center?

CL and AS: One of the greatest benefits of operating our own office-based center is the ability to perform surgeries in a relaxing environment for both patients and staff. There are fewer layers of governance and management, and changes can be implemented in real-time. Since our office staff also doubles as our surgical staff, there is a continuity of care from the initial evaluation through the post-operative visits that our patients appreciate. Financially, the initial start-up costs of an office-based surgery center are less than those of an ASC, and it can become operational and certified more quickly.  

Q: You mentioned that you've designed a fully accredited facility that follows the same health and safety rules as ambulatory surgery centers. Can you elaborate on these rules?

CL and AS: Our center has recently become accredited by the AAAHC, as well as licensed by the State Board of Health.  As such, we are regulated by the same rules and standards as ASCs. Additionally, we are OSHA certified, and since we do not perform biopsies we do not need CLIA certification.

Q: You also mentioned that your present challenge is to seek recognition from third-party payors and obtain fair reimbursement. What are the steps you will take to achieve this recognition, and how will you work toward establishing fair reimbursement?

CL and AS: We believe that since our center follows the same guidelines as ASCs, and we are performing the same surgeries with the same standards of care, it should be reimbursed at a similar rate. This would allow us to cover rent, staff salaries, disposable supplies and implants. Since an office-based surgery center should be more efficient than an ASC, we would be able to accept a slightly reduced reimbursement, while offering our patients a significantly more enjoyable experience.

In order to change the status quo, we are directly contacting insurance carriers and making our case that they could save hundreds of millions of dollars annually as an industry in whole if they would provide a facility reimbursement for accredited office-based surgery centers. We are also working on showcasing our center to insurance executives so that they can see the benefits of in-office surgery as both a cost-saving enterprise as well as a truly enjoyable experience for their members.

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