Eyeworld

EW MEETING REPORTER 65 May 2011 E yeWorld recently hosted its first educational webinar dealing with emerging fem- tosecond laser cataract sur- gery technology. "Certainly this new technology [represents] an exciting time for cataract surgeons, and ASCRS is committed to leading a fair and bal- anced discussion of the potential ad- vantage of this technology for our patients," said Edward J. Holland, M.D., president of ASCRS, and pro- fessor of ophthalmology, University of Cincinnati. Financing the technology Dr. Holland said ASCRS started the webinar with the financial aspect be- cause a survey of ASCRS Annual Meeting attendees showed that most disagreed that there would be a solid path of reimbursement to make the technology economically feasible in practice. "We had a big audience in at- tendance, and I thought the speak- ers addressed some important key issues on finance that a lot of the potential users of the femtosecond laser are interested in," he said after the webinar. "I'm hoping that femtosecond technology can help us elevate out- comes and increase patient satisfaction, which should boost word-of-mouth referrals and perhaps change the whole refractive cataract surgery dynamic," Richard L. Lindstrom, M.D., adjunct professor emeritus, department of ophthal- mology, University of Minnesota, Minneapolis, and founder, Min- nesota Eye Consultants, Minneapo- lis, said during his talk. Dr. Lindstrom said that fem- tosecond cataract technology would not phase out widely used pha- coemulsification. "We'll still have to do the cataract surgery," Dr. Lindstrom said. "[The laser] may give us better inci- sions and better capsulorhexis, en- hancing both the astigmatism and the defocus outcomes. Perhaps it will also enhance safety and efficacy. The main agenda here in America is going to be refractive outcomes." Dr. Lindstrom said the technol- ogy would initially boost costs. Laser acquisition might mean $350,000 with a per-click fee of $300-400. Ad- ditional surgical, patient transfer, and chair time also must be consid- ered. "This [technology] is still in its innovator stage with only a few lasers out in the world," he said. And, reimbursement is still in ques- tion. "We can't say to a patient, 'We've got a better operation and we need to charge you an extra fee'," he said. "But we've always been able to charge a fee for refractive surgery. We have to think of this laser-as- sisted surgery as refractive cataract surgery." That will include a three-step process: document medical neces- sity, establish refractive goals, and determine the tools to use to help the patient meet those refractive goals. The realities of Medicare reimbursement: Outcomes and efficiencies Nancy McCann, ASCRS director of government relations, gave a talk about Medicare reimbursement reali- ties. "Medically necessary cataract surgery is covered by Medicare, in- cluding pre-service, intra-service, and post-service physician work and incision creation, capsulorhexis, and nuclear fragmentation," Ms. McCann said. "We can bill the patient for non-covered services, such as refrac- tion, astigmatism, eyeglasses, and contact lenses, with the exception of one pair of glasses or contact lenses after each cataract surgery with in- sertion of an IOL, and additional items and services to correct presby- opia, such as presbyopia-correcting IOLs," she said, adding that the changing healthcare paradigm will dictate future payouts. "We can't have this discussion without considering the future of Medicare reimbursement," Ms. McCann said. "Where we're going is in the area of quality, outcomes, and efficiencies. The government no longer wants to pay everyone the same based on CPT codes; it's going to be based on outcomes as well as efficiencies. All providers will be ex- pected to provide safe, high-quality, and efficient care to all Medicare beneficiaries for covered services. This new system is considered to be a value-based, budget-neutral pay- ment system, and that will be imple- mented by 2017." Quality and efficiency measures have yet to be developed, she added. Actual implementation of the technology into a practice Eric Donnenfeld, M.D., co-chair- man, cornea, Nassau University Medical Center, East Meadow, N.Y., performed his first femtosecond laser cataract cases recently at Island Eye Surgery Center. "The decision-making in bring- ing this laser to its current status of being up and running was a contro- versial one, with some of my part- ners wanting to take a wait-and-see attitude and others being very ex- cited about the new technology," he shared. "This is certainly a signifi- cant decision for any practice be- cause of the cost involved," he said. Dr. Donnenfeld added that this deci- sion is not simply about "the financial aspect of bringing in the femtosecond laser, but also changing the mindset for surgeons who may not be in a refractive mode and may not be comfortable with doing re- fractive cataract surgery versus con- ventional cataract surgery." Dr. Donnenfeld said everyone on staff must be involved on many different levels of training or "you are doomed to a sub-optimal out- come." He added that his practice is currently not doing outside market- ing for the technology. "I would suggest you have an organized internal marketing ap- proach," he said. "Make sure the people on your staff communicate the value of improved refractive out- comes for the patient." Advertising needs to stay posi- tive, he said. "We do not want to denigrate previous surgical methods in any way," Dr. Donnenfeld said. "I think that will do more harm than good. The goal of refractive cataract sur- gery is to raise the bar for all and to denigrate none. Cataract surgery is probably the most successful thera- peutic operation performed in the United States. I think it will remain that way and improve with the addi- tion of the femtosecond laser." Steven G. Slade, M.D., Slade & Baker Vision Center, Houston, has had the device in his practice since February and said that it reduces time, and he does fewer cases. Dr. Slade said patient acceptance has been very high. "Of all the new technologies I've been involved with, until now I've never had one that I had the pa- tient at the word 'laser.'" Dr. Holland said ASCRS and EyeWorld will continue to be on the forefront of femtosecond cataract surgery discussions. "We feel it's important to have a fair and balanced program," he said. Dr. Holland added that it's crucial that we talk about the positive as- pects of the femtosecond laser, the potential drawbacks, and the aspects that need to be improved. "It's a work in progress. It's an evolution, and we want to be a part of the dia- logue and give the opportunity for further education around this topic." The next interactive webinar, "The Future of Laser-Assisted Cataract Surgery: Clinical Results and Patient Flow," is scheduled for Tuesday, May 17, 9-10:30 p.m. In the next webinar, experi- enced surgeons will give practical in- formation on what they've learned and how they're using the technol- ogy. Attendees can register at www.EyeWorld.org. Editors' note: Dr. Donnenfeld has fi- nancial interests with Alcon (Fort Worth, Texas) and Abbott Medical Op- tics (Santa Ana, Calif.). Dr. Lindstrom has financial interests with LensAR (Winter Park, Fla.), Abbott Medical Op- tics, Alcon, and Bausch & Lomb (Rochester, N.Y.). Ms. McCann has no financial interests to report. Dr. Slade has financial interests with Alcon and Technolas (St. Louis, Mo.). If you'd like to listen to the "Focusing on Finance" webinar online go to: http://eyeworld.org/replay.php Refractive cataract webinar focuses on finances

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