Eyeworld

EW FEATURE 30 by Michelle Dalton EyeWorld Contributing Editor Bringing new technologies into the fold Whether it's femtosecond cataract lasers or any other piece of equipment, prac- tices need to assess more than just the technology T he scenario is familiar: A new technology is being discussed and debated on the podium, in op-ed pieces, and in various mag- azines, with some heavily endorsing it, others skeptical. So it goes for laser-assisted cataract surgery. But determining whether or not the technology is something a surgeon should incorporate into his or her practice is more involved than sim- ply determining if the technology will improve patient outcomes. "Any time you bring a new technology into a practice, there's going to be 'growing pains,'" said Eric D. Donnenfeld, M.D., partner, Ophthalmic Consultants of Long Island (OCLI), Rockville Centre, N.Y., and clinical professor of oph- thalmology, New York University Medical School, New York. Dr. Donnenfeld is using the femtosec- ond refractive cataract laser at the group's ambulatory surgical center (Island Eye Surgicenter, N.Y.). "The first thing any practice needs to do is make sure it can af- ford the technology," said Robert J. Cionni, M.D., medical director, The Eye Institute of Utah, Salt Lake City. In his case, the group analyzed the volume of patients who required limbal relaxing incisions to achieve the patients' desire for a refractive result. Dr. Cionni recommended quan- tifying and qualifying decisions to implement the femtosecond laser based on performing astigmatic re- duction incisions with the laser. Astigmatic reduction "can be charged as a non-covered service and therefore, outside of Medicare," he said, and determining the num- ber of patients who would opt for astigmatic reduction, with or with- out an elective IOL, will help deter- mine the feasibility of incorporating a femtosecond refractive cataract laser into the practice. Dr. Cionni's group has also esti- mated its annual fixed and variable costs for the laser and, therefore, the minimum revenue needed to break even. "If the volume of patients that opt for astigmatic reduction is large enough to cover that cost, it would then be feasible to incorporate a femtosecond refractive cataract laser into your practice," he said. Dr. Donnenfeld agreed, noting that the financial implications of purchasing and maintaining this laser "are significant. Before any practice considers it, do a financial analysis of the practice," he said. Above and beyond the cost of the laser itself and the click fees, one needs to consider the additional time to perform the procedures, technician training, and use of real estate for the laser within the prac- tice building. Weighing the costs Patients will accept the technology at a price, Dr. Cionni said. "How- ever, if your patients aren't going to accept the price you need to charge February 2011 Laser-assisted cataract surgery July 2011 O f the many potential concerns listed in the survey, financial viability is clearly at the top. Nearly 97% of all re- spondents listed this as one of their top two concerns. This is understandable because of the high cost of offer- ing this new technology, the inability to charge Medicare patients for surgical steps already covered, the lack of data on the refractive benefits, and the uncertainty over how many and how much patients will pay for the potential refractive benefits. It is interesting that, although 28% of respondents clearly want the technology, 19% are skeptical as to the benefits. The remaining 53% are undecided as to whether they will be adopting FS laser refractive cataract surgery. It will be interesting to see how this plays out over the next several years. - David F. Chang, chief medical editor I n talking with surgeons regarding the femtosecond laser for cataract surgery the financial issues seem to be the major concern, and this survey supports that viewpoint. What I find interesting is that 47% of respondents are skeptical (19%) or want to take a wait and see approach (28%). Another 25% "like" the technology but want data to confirm the advantages. It certainly appears that scientific studies are needed to document the potential improve- ment in efficacy and help ophthalmology determine how the femtosecond laser will be incorporated into our practices. - Edward J. Holland, cornea editor Monthly Pulse Keeping a Pulse on Ophthalmology For now, the new laser resides in a room at Ophthalmic Consultants of Long Island that was already reserved for laser procedures Source: Eric D. Donnenfeld, M.D. AT A GLANCE • A complete financial analysis of your practice is warranted before purchasing the system • Practices that perform over 2,500 cases a year likely will be success- ful at implementing the system • Until CMS determines how to qualify the femtosecond laser, surgeons would do best by keeping it separate from Medicare-approved surgical suites

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