Eyeworld

76 | EYEWORLD | WINTER 2025 P RACTICE MANAGEMENT Contact Hovanesian: DrHovanesian@harvardeye.com Kugler: lkugler@kuglervision.com Loden: lodenmd@icloud.com Melendez: rfmelendez@gmail.com Dr. Kugler encouraged this practice champi- on who is leading the charge to visit other OBS suites. He said there are "different flavors of [OBS], and you might have a different design or different ideas if you can see it in action." Dr. Kugler said he made use of the same staff running his laser center, training them when he began doing intraocular surgery in an OBS, and hiring a few additional people to augment. "In my case, I don't have overlap with the clinic staff as much, but some centers do. There are centers that use their clinical staff to cover their surgery as well, which is a model that can work. There are different ways to handle staff- ing, but OBS gives you flexibility because it's your own facility," he said, noting that the same could be done with an ASC as well. Continuity of staff in an OBS is nice be- cause they are more knowledgeable in oph- thalmic procedures specifically. "You go to an external ASC, and no one knows the difference among the IOLs you're using and what a diopter is or what plus is versus minus. But in our office, everyone knows how critical those things are. They're all saying the same thing, speaking Dr. Melendez said that coming to the same facility for consultation and preop testing makes patients less anxious for surgery. They know where to drive to. They know and recognize the staff. There is often a less "hospital-like" feel to the surgery rooms. Reducing patient anxiety in this way, Dr. Melendez continued, reduces the amount of sedation needed. Dr. Kugler pointed out that IV sedation is feasible in an OBS setting if the surgeon prefers, and it is part of a higher-level discussion. "When a facility is designated as a safe place to do sur- gery, what does that mean? It means that the fa- cility adheres to a list of protocols and standards that must be met to make that a safe place to do surgery," Dr. Kugler said. "The term ASC is a Medicare term. It is nothing more than a list of standards that CMS came up with years ago that they determined made the space appropriate for multi-specialty surgery. Office-based surgery centers follow a similar list of protocols that have been optimized for safety and efficiency for ocular surgery. But there's nothing magical that makes an ASC an ASC and an OBS an OBS. They are simply physical spaces that follow a list of rules and standards." An OBS, Dr. Kugler continued, in many ways, is better designed for ophthalmic proce- dures because it's customized as such, while ASCs are often used for both ophthalmic and non-ophthalmic procedures. "One of the disadvantages of ASCs are the onerous requirements that have no relevance to ophthalmic surgery. These extraneous require- ments make them more expensive to build and establish, which is prohibitive for many sur- geons. For practices that already have estab- lished, efficient ASCs, there typically is not a reason to switch to OBS." Dr. Kugler and Dr. Melendez acknowledged that some patients are not candidates for sur- gery in an OBS suite due to health conditions. Setup and staffing To Dr. Kugler, using a consultant experienced in setting up office-based surgery is non-nego- tiable. The other thing you need is a practice champion. "You need someone in the practice to really embrace the project. I don't think you can just delegate it to the practice administrator and say, 'Build us an OBS,'" he said. continued from page 75 continued on page 78 References 1. 2025 ASCRS Clinical Survey. 2. Becker's ASC Review. These 12 states have CON laws that don't restrict ASCs. www. beckersasc.com/uncategorized/ these-12-states-have-con-laws- that-don-t-restrict-ascs/?utm_ source=chatgpt.com. Accessed October 2,2025. 3. Outpatient Ophthalmic Surgery Society. CMS Rejects Facility Reimbursement for Cataract and Other Ophthal- mic Procedures in OBS. ooss. org/2022/11/01/cms-rejects-fa- cility-reimbursement-for-cata- ract-and-other-ophthalmic-pro- cedures-in-obs/. Accessed October 2, 2025. 4. Ianchulev T, et al. Office-based cataract surgery: population health outcomes study of more than 21000 cases in the United States. Ophthalmology. 2016;123:723–728. 5. Kugler LJ, et al. Safety of office-based lens surgery: U.S. multicenter study. J Cataract Refract Surg. 2023;49:907–911. 6. Starns MJ. Complication rates of phacoemulsification with intraocular lens implantation surgery in an office-based set- ting versus ambulatory surgery center. June 2025. 2025 ARVO Annual Meeting. " You go to an external ASC, and no one knows the difference among the IOLs you're using and what a diopter is or what plus is versus minus. But in our office, everyone knows how critical those things are. They're all saying the same thing, speaking the same language." —Lance Kugler, MD

• Cover