Eyeworld

EW FEATURE 33 Because of this, Dr. Mackool said that the eventual model he sees coming down the line is that the femtosecond portion of the proce- dure will be performed by a physi- cian other than the phaco surgeon before the patient heads into the OR. What that does is significantly streamline the intraoperating room portion of the procedure. In some surgeons' opinions, this workflow model has the potential to save sur- geons somewhere in the vicinity of close to half their operating room time, but they feel this will likely be offset by the procedural time spent performing the laser steps. While this model would cer- tainly make for a faster workflow, Dr. Slade advised surgeons to step back and question if speed should be the number one concern. "In the past, much of cataract surgery has been about 'how fast can I go?' Why? For every traditional Medicare cataract surgery you get a certain amount no matter what you do, so a lot of surgeons are geared toward trying to be as fast and effi- cient as possible, and trying to do it as economically as possible" he said. On the other hand, Dr. Slade ex- plained, femtosecond laser-assisted cataract surgery is not that. For him, it is for a different group of patients who are refractive cataract patients, and they're expecting something different; they're not expecting to go back into glasses and have their cloudy vision treated, he said. They're expecting to be glasses-free. They're paying a lot of money out of their pocket rather than having Medicare pay it, he said. Making it work Before acquiring the technology, a business plan needs to be put in place that shows a return on the in- vestment for that purchase, Dr. Solomon said. Purchase of the equipment, maintenance, and dis- posables that are used with each and every case should be factored in, he said. In addition, it's probably going to be a little less efficient in terms of case turnover. From a facilities standpoint, if the efficiency slows down, that costs them money so a lot of facilities will want to take that into account and come up with a business model that may say, "If we do 10 a month, our facility cost can be this; if we do 50 a month, it can be this," and figure it out on a monthly, quarterly, and annual basis, Dr. Solomon said. There will also need to be a fa- cility fee that covers the purchase, maintenance, and the upkeep for this technology, and then there'll be a separate physician's fee, which must be a refractive-based fee be- cause cataract surgery is a covered procedure by insurances including Medicare, he said. A practice cannot bill for this technology to perform cataract sur- gery, but it can use the technology and charge a patient for the treat- February 2011 July 2011 Laser-assisted cataract surgery Intraoperative OCT can help determine the relevant dimensions of the anterior chamber Source: William W. Culbertson, M.D. continued on page 34

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