Eyeworld

MARCH 2021 | EYEWORLD | 59 C YES CONNECT at the time reemphasized to CMS that given the often elderly patient population, frequently with multiple comorbidities, "cataract surgery should not be trivialized." In the final rule for CY 2016, CMS did not assign nonfacility PE RVUs for cataract surgery, but wrote in part: 3 Advancements in technology have sig- nificantly reduced operating time and improved both the safety of the procedure and patient outcomes. As discussed in the proposed rule, we believe that it now may be possible for cataract surgery to be furnished in an in-office surgical suite, especially for routine cases. Cataract sur- gery patients require a sterile surgical suite with certain equipment and supplies that we believe could be a part of a nonfacility- based setting that is properly constructed and maintained for appropriate infection prevention and control. CMS stated that it would "use this infor- mation as we consider whether to proceed with development of nonfacility PE RVUs for cataract surgery." No further changes have occurred in the years since. EyeWorld spoke with two ophthalmologists on the topic of office-based cataract surgery. One, Frank Cotter, MD, is opposed to office- based cataract surgery unless it meets basic patient safety measures appropriate for cataract surgery and required of ASCs. The other, Inder Paul Singh, MD, was in the process of finishing up his own office-based OR suite in January. Concerns for patient safety, reimbursement potential, and more Dr. Cotter acknowledged that there is a poten- tial attraction to office-based surgery (OBS) for some cataract surgeons. OBS offers greater flexibility for the surgeon in many localities and ownership opportunities in ASCs are often complicated by onerous certificate of need laws and expensive buy-ins, he explained. The pros and cons of office-based cataract surgery For the private practice ophthalmologist, nothing can be more frustrating than trying to obtain ownership in an ASC, operating in a hospital, building an ASC, or just trying to find a place to operate that will give you block time. With that said, there are different models coming into play over the coming years. This is a hot topic among young eye surgeons and has drawn CMS attention in the past. Are these in-office surgery suites going to be held to the same safety standards? Do they offer the same guidelines that traditional hospi- tals and ambulatory surgery centers do? This is all yet to be determined but will become critical in the future of eyecare. I think this single factor could make or break many partnerships going for- ward. It will also be a difficult task in recruitment of young eye surgeons. This article highlights the pros and cons of cataract surgery performed in the office setting. —Michael Patterson, DO YES Connect Co-Editor I n 2015, CMS included a request for infor- mation on office-based "nonfacility" cataract surgery in its proposed revisions to 2016 Medicare Physician Fee Schedule payment policies. 1 In response, ASCRS surveyed its members to learn their thoughts regarding nonfacility cataract surgery. The survey re- vealed a nearly equal split: 52% were willing to perform cataract surgery in an office, while 48% were not. 2 With input from the survey, ASCRS submitted comments to CMS, noting patient safety as an important factor, cautioning CMS to "think through all possible complications and is- sues" that could be associated with office-based cataract surgery." ASCRS also acknowledged the possible benefits that office-based cataract surgery could provide physicians and patients, namely flexibility in scheduling, convenience, and importantly, access for physicians who live in states with certificate of need requirements and who don't have access to ASCs. As a procedure with a "high level of in- tensity," ASCRS wrote on various factors that CMS should consider, including patient safety, management of unexpected complications, an- esthesia, and certification requirements. ASCRS by Liz Hillman Editorial Co-Director About the physicians Frank Cotter, MD Roanoke Valley Center For Sight Vistar Eye Center Roanoke, Virginia Inder Paul Singh, MD Eye Centers of Racine and Kenosha Racine, Wisconsin continued on page 60

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