Eyeworld

60 | EYEWORLD | MARCH 2021 ATARACT C Furthermore, unlike OBS, ASCs are subjected to frequent unannounced inspections, which greatly enhances compliance." Dr. Cotter noted that 88% of patients who have cataract surgery in an ASC have at least two comorbidities. His practice sees cancella- tions every day due to previously undiagnosed, serious medical conditions, some of which require a call to 911. "Proponents of OBS claim that they intend to only operate on patients with 'no or low-risk' comorbidities. If that is the case, how can any OBS remain profitable with only 12% of their cataract patients healthy enough for surgery in their office?" Dr. Cotter asked. Dr. Cotter advocates for a uniform set of patient safety standards for office-based cataract surgery "so that patients can be assured that ev- ery facility hosting cataract surgery is safe." To accomplish this goal, Dr. Cotter and several oth- er eye surgeons are working with the Virginia Board of Medicine and the Virginia Legislature to enact legislation that would require basic safety standards for cataract surgery. "Hopefully, once we establish appropriate patient safety standards for the cataract patient in Virginia, then other states will follow until we reach the ultimate goal of uniform patient safety for cataract surgery that currently exists in the ASC." Dr. Cotter emphasized that ASC facility fees for cataract surgery have risen every year. "ASCRS, the Outpatient Ophthalmic Surgery Society, and the American Academy of Ophthal- mology have worked hard to get ASC facility fees linked to hospital reimbursement. Also, these organizations were successful in getting our inflator raised from CPI to the hospital mar- ket basket," Dr. Cotter said. Dr. Cotter also noted that OBS is not eligi- ble for Medicare reimbursement, something he said is unlikely to change in the next few years. "Importantly, if there ever is any Medicare facility reimbursement for OBS, it will only be a site of service differential that amounts to a fraction of the ASC facility fee. That small fee, like our physician fees, will likely drop every year since it isn't tethered to the hospital rate and the hospital market basket inflator." However, Dr. Cotter thinks the perspective of the patient trumps any surgeon convenience. "Would patients not prefer a nurse anesthetist to manage their intraoperative pain and anxiety? Would patients not prefer professional regis- tered nurses preoperatively and postoperatively to assess and monitor them, prepare them for surgery, and explain their postoperative instruc- tions? Would patients not expect that a backup generator was available in case of a power out- age? Would patients not expect airflow handling to prevent airborne pathogens? What about a firewall around the surgical suite?" Dr. Cotter thinks that any reasonable pa- tient would expect those safety precautions are required for any facility hosting cataract surgery. "While these patient safety standards are mandated federally in ASCs, there is tremen- dous variability in OBS requirements from state to state, with no requirement for these basic safety standards in some states. For example, the state of Wisconsin is one of several states that has no law regulating OBS, and there are no licensure or accreditation requirements. continued from page 59 In an OR in Dr. Cotter's ASC, a nurse anesthetist delivers pain/ anxiety medication through an IV, an RN circulator manages the room environment, and a dedicated ophthalmic technician and surgeon concentrate solely on executing the cataract operation. Source: Frank Cotter, MD

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