Eyeworld

MARCH 2021 | EYEWORLD | 61 C References 1. CMS. Medicare Program; Revi- sions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016. Published July 15, 2015. 2. Daly R. Little appetite for office-based cataract surgery. EyeWorld. 2017;22:80–81. 3. CMS. Medicare Program; Revi- sions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016. Published Nov. 16, 2015. 4. Ianchulev T, et al. Office-based cataract surgery: Population health outcomes study of more than 21,000 cases in the United States. Ophthalmology. 2016;123:723–728. Relevant disclosures Cotter: None Singh: None postop patients, and all of the other pertinent standards to ensure safe and effective care for office-based surgery. Dr. Singh said ASCs have to follow a standard set of federal regulations that cover all specialties; state laws also come into play. Office-based surgery suites, he continued, can be tailored to the safety standards that are most applicable to the procedures performed and equipment used for ophthalmology. He is going to be using a clean air zone unit (Operio Mobile, Toul Meditech) with an integrated detachable instrument tray, to be used in the operating zone. This unit produces a directed, non-turbulent, ultra-clean air flow to the surgical site and to the sterile instruments used during surgery. Dr. Singh said this unit has been shown to lower particle counts surround- ing the sterile field compared to that in hospital and ASC ORs. As for firewall protection, Dr. Singh said this is required for cases that might take longer, as in many non-ophthalmology cases that would A proponent of office-based cataract surgery Dr. Singh performs surgery in a hospital, an ASC, and most recently, he is setting up an office-based OR. He thinks there is a time, place, and situation for each location. "You still need hospitals. There are certain patients who need the infrastructure of a hospi- tal setting, such as those with high-risk comor- bidities," Dr. Singh said, adding that ASCs are valuable as well because they may have more anesthesia options and operational efficiencies. Where Dr. Singh thinks office-based surgery is appropriate is in routine cataract surgery for patients with no or low-risk comorbidities. Dr. Singh decided to include an OR suite in the office he was building because of the flexibility it offered. When he wants to try a new piece of equipment or engage in a research project, he has more control over the process, he said. He is planning on incorporating the latest cataract surgery technology in the suite, including a 3D heads-up display microscope. He also likes the freedom of surgical scheduling, which he said can be a "nightmare" in a hospi- tal or when operating in an ASC with multiple surgeons. Dr. Singh thinks office-based surgery gives him more control over the patient experience as well. He thinks patients like being able to go to the office they're familiar with for surgery vs. a previously unvisited ASC. It can help stress levels before and during the procedure as well, which in turn can decrease the need for IV anesthesia. Dr. Singh's office-based surgery suite will be accredited as a Class B surgery center, which allows for monitored sedation, whether oral or IV. All states require Class B office-based surgery centers to be accredited and/or state surveyed, he said. There are three national organizations that can accredit office-based surgery centers: the Joint Commission, the Accreditation Asso- ciation for Ambulatory Health Care, and the American Association for Accreditation of Am- bulatory Surgery Facilities. Third-party accredi- tation requires quarterly peer-review, Dr. Singh explained. These accreditation standards also require backup power, an anesthesia provider (CRNA, anesthesiologist), a dedicated RN for continued on page 62 Dr. Singh uses the 3D microscope that will be in his office-based OR. Source: Inder Paul Singh, MD

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