Eyeworld

62 | EYEWORLD | MARCH 2021 Contact Cotter: fcotter@vistareye.com Singh: ipsingh@amazingeye.com "Surgeons who are unfamiliar with office- based surgery centers assume surgery is being done in a 'clean room' or traditional procedure room," but Dr. Singh described the space used for office-based ophthalmic surgery as being built and run with processes and protocols that are similar to ASCs. He also mentioned a retro- spective review from a Kaiser Permanente fa- cility in Denver, Colorado of more than 21,000 eyes that showed good visual outcomes and safety, with no cases of endophthalmitis, within what is considered a non-ASC setting. 4 "I am happy to have the ability to use a hospital, I'm happy I have the ability to use an ASC, and I'm happy I have the option to use an in-office cataract suite. I think we need them all. When done right, an in-office cataract suite can be a safe alternative to a hospital or ASC," Dr. Singh said. need time for the patient to wake up to sta- bilize. Due to the efficient nature of cataract sur- gery, Dr. Singh doesn't think the same firewall standards are needed for a standard cataract case. He added that office-based surgery is ac- credited to the license of the surgeon, therefore no non-ophthalmology cases can be done in that space. Dr. Singh also mentioned that he likes the idea of the staff being focused on ophthalmol- ogy rather than being pulled away for other subspecialties as they might be if they worked in a multispecialty ASC. Dr. Singh said he likes that staff members in his office will participate in patient care from the first visit through the last day of postop care, which he thinks helps provide continuity and a sense of ownership/ responsibility for the staff. Safety is no doubt a major concern and a common reason for the pushback against office- based cataract surgery, Dr. Singh said. ATARACT C continued from page 61 ASCRS comments to CMS request for information on nonfacility cataract surgery In 2015, ASCRS offered several comments, with input from a survey of its members, to CMS regarding nonfacility cataract surgery. Here are a few of the key points made by ASCRS: • Even routine cataract surgery can face unexpected complications. As such, "all locations where cataract surgeries are performed would need to be equipped to deal with both complicated and non-complicated cataract surgeries, including in-office surgical suites." • CMS had stated that topical/intracameral anesthesia was most common for cataract surgery, but ASCRS in its comments corrected that most of its members used "intravenous anesthesia or sedation for cataract surgery as an addition to local or topical anesthesia." Some patients, ASCRS continued, need even further anesthesia, so "the use of CRNAs and anesthesiologists during cat- aract surgery is essential." ASCRS also noted the possibility of cardiac events with use of epineph- rine or phenylephrine. "These issues illustrate that intraocular surgery with anesthesia remains an intensive surgery that has significant risks." • ASCRS emphasized the need for "safety standards, infection control, and quality assurance/ benchmarking requirements. There needs to be an assurance of the standard of care in sterility, equipment, staffing and anesthesia." ASCRS stated that these areas need to be similar to that of an ASC and that "regulation of in-office surgical suites at both federal and state levels," as well as development of certification requirements, would need to be addressed. • ASCRS agreed with CMS that office-based surgery could offer physicians and patients more flexibility, especially in states with certificate of need laws. "It may also be more convenient for patients, especially the older Medicare patient population our members tend to treat, to visit one office for the surgery, pre- and postoperative care. Office-based surgical suite cataract surgery might offer a more flexible option for both patients and providers." • ASCRS discussed the need for valuing direct practice inputs for office-based cataract surgery for an accurate nonfacility payment rate.

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