EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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February 2011 March 2013 Cataract/IOLs, femtosecond cataract Steven Vold, M.D., founder, Vold Vision, Fayetteville, Ark., discussed using the femtosecond laser in their practices and how they bill for its use, as well as how charges may affect patient choice. Billing for femtosecond laser use According to the ASCRS•ASOA policy, "the allowable Medicare reimbursement for cataract surgery does not change according to the surgical methods used." Therefore, reimbursement for a cataract procedure would be the same whether a femtosecond laser or another method is used. The only way a patient can be billed extra is if he or she is receiving an additional service, such as a premium refractive IOL, and in this case, a doctor must first discuss the extra out-of-pocket costs with the patient and gain consent in advance. What most physicians are doing with regard to the femtosecond laser is utilizing it in two arenas, in their premium practice and in complex cases, Dr. Stonecipher said. In complex cases, surgeons might choose to use the laser, despite it costing them more to do so. "The bottom line is, you can't charge extra for the laser," he said. However, he said the femtosecond laser is extremely important because of the value it offers in surgery. "I truly believe that it allows me to achieve better outcomes," Dr. Stonecipher said. "I have data to support that. It's safer and faster in terms of rehabilitation for [patients'] vision." Although extra charges cannot be billed to the patient for cataract surgery, they can in cases where a patient opts for a premium IOL or astigmatic keratotomy. In these cases, doctors would have to explain this exception to patients upfront. Dr. Stonecipher said it's important to have an Advance Beneficiary Notice (ABN) before the procedure to let a patient know about any charges or procedures that Medicare deems unnecessary and therefore will not pay for. "In those patients, you have to let them know that you are charging them above and beyond what Medicare will pay," he said. Dr. Stonecipher said he has a billing sheet that he goes through with each patient to spell out in "grave detail" all aspects of billing that a patient will be required to pay. He said it includes how much is owed, the cost of the lens, the copay price and premium charges that may come up, among other extra things that a patient would need to know before agreeing to a surgery. "It's all spelled out, so [patients] know what they're going to pay before and they're comfortable, and there are no surprises postoperatively," Dr. Stonecipher said. Dr. Vold said that when it comes to the femtosecond laser, everyone has his or her own way of using it. "What I tell patients is that we have a new technology that allows greater precision in our cataract surgery." He said at this point, it is hard to show just how useful the new technology is because there hasn't been a lot of results data presented yet. "We have been looking at our data," he said. "It appears that we're getting 85-90% of patients within plus or minus .5 D of astigmatism in sphere, and I do think that's an upgrade from where we have been in the past." He said these results also include intraoperative aberrometry. Dr. Vold said his practice does not charge for the laser use. "We tell [our patients] that we think this makes a difference, however we do not pass that charge onto them," he said. Since use of the femtosecond laser is not covered under Medicare, Dr. Vold said his clinic covers the cost when it is deemed necessary, but he said the high cost of using it is the reason that it cannot be used for every patient. Patients are charged for the intraoperative aberrometry but not for the laser, he said. EW FEATURE 111 "For anyone who's getting a premium package, then we would throw in the laser," Dr. Vold said. Dr. Vold said his practice has three different elective packages that offer services beyond what Medicare pays for. These premium packages are a distance package, an astigmatic package, and a presbyopic package. These include the femtosecond laser, among other treatments. The presbyopic package, he said, corrects for near and far, and in addition to the laser, includes intraoperative aberrometry, premium lenses, and the need for any future adjustments. He said there is a distance package that includes intraoperative aberrometry and pre- and postop measurements, and the laser is also included with this package. The presbyopic, distance, and astigmatic packages all include corneal topography, corneal pachymetry, and six months of follow-up. Dr. Vold said that he believes the femtosecond laser not only will have the ability to help with cataract surgery but potentially with corneal surgery and glaucoma as well. He said he thinks that with time it will be "more than just a one-trick pony." continued on page 112 Poll size: 235 b. I do not take into consideration the posterior corneal astigmatism. b. I do not currently use a femtosecond laser for cataract surgery but am considering purchasing one this year. c. I would like to but do not have the ability to take the posterior corneal astigmatism into consideration. c. I am not interested in the femtosecond laser for cataract surgery this year. d. I will not be interested in the femtosecond laser for cataract surgery for at least one year. EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send a 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email daniela@eyeworld.org and put EW Pulse in the subject line—that's all it takes. Copyright EyeWorld 2013