Eyeworld

3 Supported by an unrestricted educational grant from Abbott Medical Optics by David Dillman, MD Viable integration models with LACS: Choosing the accessibility model right for your practice to break even, and how many cases they had to perform to gen- erate sufficient profit (Figure 2). An advantage of laser own- ership is greater control over the equipment. However, surgeons need their own ASC and should have sufficient patient volume to support this purchase. Sur- geons may want to use a mobile access service for the first 6 to 12 months to be sure they want to continue using the femtosecond laser. Conversely, a surgeon may purchase the laser with other colleagues in the area, with each paying a portion of costs. Mobile access poses few financial risks. Surgeons should consult with colleagues who have chosen mobile access and contact more than one compa- ny to investigate the terms and conditions of their agreements. Sightpath charges me a per-case fee and requires that I perform a mobile femtosecond laser program for cataract surgery. This mobile access company provided all of the equipment and support needed to install, calibrate, and prepare my practice for laser-assisted cataract procedures. Other companies also provide this service, such as ForTec Medical and Precision Eye Services. Decision-making tools I think surgeons who are not passionate about this technology should not commit to it. Once you have made the decision to move forward, it is important to research each access option to establish the best one for your individual practice (Figure 1). I recommend observing sur- geons who perform many LACS cases and asking them how it impacted their practice. (For more information, see Bartlett et al. 5 ) I was not hesitant to ask surgeons about their monthly costs, how many cases they had to perform whether they can afford this investment. 1 A number of tools can help them break down the costs involved and take the guesswork out of this decision. Exploring options In 2012, when I began thinking seriously about adding LACS to my practice, I visited five surgeons who were performing the procedure. I watched them perform approximately 100 cases collectively and asked them about the pros and cons of the technol- ogy. 2–4 I quickly decided that I want- ed to offer this to my patients. However, based on these conver- sations, I decided that I would not purchase the laser. I had the necessary patient volume, but I did not have an ambulatory sur- gery center (ASC); these surgeons owned ASCs, where they could operate and maintain their lasers. Alternatively, I talked with Sightpath Medical, a mobile access company I had used for cataract and refractive services. Around the time I was considering incorporating LACS technology into my practice, they developed a Various laser access options available for surgeons considering LACS I ncreasing numbers of cata- ract surgeons are integrating laser-assisted cataract surgery (LACS) into their practices, while others may wonder Practice pearl: Surgeons should not enter the LACS world until they firmly think that it is a better way to perform many of the various forms of cataract surgery. –David Dillman, MD continued on page 5 • Surgeon purchases laser • Surgeons in a community purchase laser together • Surgeon chooses mobile access • Surgeon chooses direct access (using femtosecond laser at colleague's ASC) Figure 1. Femtosecond laser access models • How many cases do you perform? • How many cases are required to break even? • How many cases are required to generate sufficient profit? • Were there unexpected expenses? If so, what were they? • If using a mobile service: • How many cases must be performed per OR day? Per quarter? • Are you required to pay a penalty if you do not meet the quota? • Other fees? Figure 2. Starter questions when asking colleagues about their LACS practice " Surgeons should consult with colleagues who have chosen mobile access and contact more than one company to investigate the terms and conditions of their agreements. " –David Dillman, MD

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