Eyeworld

74 | EYEWORLD | WINTER 2025 P RACTICE MANAGEMENT OPENING DOORS by Liz Hillman Editorial Co-Director About the physicians John Hovanesian, MD Harvard Eye Associates Laguna Hills, California Lance Kugler, MD Kugler Vision Omaha, Nebraska James Loden, MD Loden Vision Centers Nashville, Tennessee Rob Melendez, MD, MBA Founder/CEO Juliette Eye Institute Albuquerque, New Mexico they understand the need and appeal for OBS among some surgeons. "I'm a fan of the concept of OBS, although we don't have one because we have a very effective ASC that we've had for 30 years that is an efficient place for us to operate as a prac- tice, and it's a part of our business that's vital," Dr. Hovanesian said. Some of the advantages he acknowledged of OBS are convenience and familiarity for the patient, continuity of office staff, and scheduling convenience. Dr. Loden has two ASCs, but for a short pe- riod of time, while the second was being built, he performed surgery at an OBS. He specifically spoke about the advantage of OBS in certain states where a certificate of need (CON) is re- quired for a new ASC. Nearly two dozen states have this requirement, making it more difficult to establish an ASC. 2 "In states that have major CON restrictions, you basically have to do office-based," Dr. Loden said. "There are many northeastern states where you cannot get a certificate of need, and you're going to have trouble doing premium IOLs. You're not going to have femtosecond lasers in a lot of hospital outpatient departments. You're not going to have premium technology, and if you do, they're going to charge you so much for it that you just about lose your profit margin." If you're able to have an ASC, Dr. Loden continued, it's financially beneficial because you can bill for the facility fee, something that's not possible (yet) for OBS. Facility reimbursement for OBS has been proposed to CMS in prior years but has thus far been rejected. 3 Dr. Hovanesian said for those who already own an ASC that's easy to manage, that's com- fortable, and is providing good results, there's not much reason to change to OBS. "But if you are looking at various regulatory, financial, and operational challenges there, and you think, 'This ASC is not worth having,' then maybe you do make the switch. … If you're in a CON state, I'd probably build an OBS." Safety of OBS Several studies have established OBS as safe. A large-scale, retrospective study of 21,501 cataract surgeries performed at Kaiser Perma- nente in Colorado found "efficacy outcomes Opening the door to office-based cataract surgery: considerations and comparisons A ccording to the 2025 ASCRS Clinical Survey, 49% of respondents perform surgery in an ambulatory surgery center (ASC), 26% at a hospital outpatient department, and 6% at an in-office surgical suite. 1 Office-based surgical suites were up 2% compared to 2024. The reason for growth in office-based sur- gery (OBS) for cataract procedures is multi- factorial. The technology and techniques have improved to instill confidence in the safety and efficacy of office-based cataract surgery, with a growing body of data to support it. Economic and patient expectation factors are major influ- encers for OBS adoption among some surgeons as well. Why an OBS Rob Melendez, MD, MBA, built and began operating in an in-office surgical suite in 2020 because he wanted to offer patients a more personal experience than what he felt could be offered at an ASC. "I wanted to create a premium practice," he said, noting that he wanted a spa-like atmo- sphere that also offered the convenience of being in a familiar location with more avail- ability for surgery (more surgery days). "The office-based surgery concept lends itself to an enhanced patient experience." Lance Kugler, MD, began performing of- fice-based cataract surgery in 2017, primarily for economic, efficiency, and service-related reasons. Prior to OBS, he performed cataract surgery at an ASC but thought it didn't offer pa- tients the same level of service that his in-office LASIK patients experienced. For ICL (STAAR Surgical), RLE, and refrac- tive cataract surgery in the ASC, Dr. Kugler said he experienced complications around billing as cash-pay procedures. "Try as hard as they could, they couldn't figure out how to handle the payments as seamlessly as we could in our own center. I also wanted to have control over the schedule. I had block time at the ASC, which meant I was limited and had to cram people into that day. In our OBS, we have complete flexibility and control over all of it." John Hovanesian, MD, and James Loden, MD, both operate at an ASC but shared how

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