Eyeworld

Step by step: Clinical and practical implementation of laser-assisted cataract surgery 4 by David M. Dillman, MD Mobile laser-assisted cataract surgery I lose money in those cases be- cause I still need to pay per-use fees for the laser, I consider this practice worthwhile. When I initially adopted this technology, I could not afford it, so I explored other avenues. In my area outside Chicago there were no femtosecond lasers, so I could not perform LACS procedures in a nearby facility. I had partnered with a mo- bile company, Sightpath Medical, in 1998, so we developed the first mobile LACS program. This company uses the LenSx plat- form. There are now 2 additional companies that offer mobile LACS programs: ForTec Medical, which uses the Catalys platform, and Precision Eye Services, which uses the LENSAR platform. We performed the first mobile laser cases in 2013 in Hoopeston, Ill., with 2 surgeons sharing access to 1 laser. I per- formed 12 cases the first day. Two years later there are 174 sites in 36 states, with 311 active surgeons and 27 lasers in the field (Figure 2). This program has been used for nearly 23,000 cases. Committing to mobile Although shared access through a mobile LACS program reduces ex- penses associated with purchasing the femtosecond laser, the practice must commit to a specific amount of time, as well as a certain num- ber of cases per quarter and per operating room day (Figure 3). For example, surgeons cannot ask the company to deliver the laser for 1 case on a specific day. In addition, clinicians must purchase disposable docking devices and pay laser user fees for each case. In some instances, surgeons may be required to pay a penalty if they do not meet the quotas specified in their contracts. Conclusion Although shared access through a mobile LACS program requires a commitment, it is less than that required when purchasing a fem- Tapping into the benefits of shared- access models W hen entering the arena of laser-assist- ed cataract surgery (LACS), shared access through a mobile laser program may give clinicians an innovative pathway to offer this technology to their patients. Weighing options When I began investigating this option approximately 3 years ago, I visited 3 facilities and watched 5 surgeons perform approximately 100 LACS procedures. Even more importantly, I talked with them about why they adopted this technology and its advantages for patients (Figure 1). I quickly became a believer. To adopt femtosecond laser technology, surgeons must believe it is a better technology for their patients compared with the tech- niques they used previously—not a moneymaker. I recommend LACS to everyone, but I especially ask patients with complex cases to have this procedure. However, many patients cannot afford it, so I discount my fee by approximate- ly two-thirds in those cases. Some patients cannot afford even the discounted fee, so I perform the procedure at no charge. Although David M. Dillman, MD tosecond laser. The mobile laser program made it possible for us to implement this technology and offer the benefits of this device to our patients. Dr. Dillman is in private practice at Dillman Eye Care Associates, Danville, Ill. He can be contacted at Dadomer@aol.com. Figure 1. Dr. Dillman began investigating LACS by following this process. Investigating LACS • Summer 2012 • Visited 3 facilities, 5 surgeons • Observed 100 LACS cases • Talked with surgeons about advantages of technology Figure 2. In 2 years, the mobile LACS program has grown. Mobile LACS growth March 4, 2013 • 1 site: Hoopeston, Ill. (pop: 5,262) • 2 surgeons • 1 laser • 12 cases March 25, 2015 • 174 sites in 36 states • 311 surgeons • 27 lasers • 22,863 cases Figure 3. Although mobile LACS necessitates a smaller commitment, con- tracts may require surgeons to commit to time and case quotas and pay for other expenses. Potential contract commitments • Certain amount of time • Certain number of cases per quarter • Certain number of cases per OR day • Pay for disposable docking device per case • Pay "user" fee per case • Pay penalty if do not meet quota

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