Eyeworld

5 Supported by an unrestricted educational grant from Abbott Medical Optics Figure 1. Multi-pronged approach to increase LACS efficiency continued from page 3 certain number of cases per year. However, surgeons with a low pa- tient volume may have difficulty meeting this condition. An advantage of mobile access is that their engineers calibrate the laser every time it is used. In my opinion, surgeons using a mobile access service may be as profitable as a femtosecond laser owner. In my experience, I know exactly what I need to pay to use the laser and the fee I need to charge for the procedure to be profitable. Surgeons also may pursue di- rect access, paying a per-use fee to a practice that allows colleagues to use their femtosecond laser in their facility. Conclusion Surgeons who are contemplating LACS in their practices need to be passionate about this technology. Before choosing an accessibility option, they need to do their homework, weighing the pros and cons of each to determine which fits best in their practice. References 1. Uy HS, et al. Femtosecond phacoemul- sification: the business and the medicine. Curr Opin Ophthalmol. 2012;23:33–39. 2. Qian DW, et al. Femtosecond laser capsulotomy versus manual capsuloto- my: a meta-analysis. Int J Ophthalmol. 2016;9:453–8. 3. Ewe SY, et al. A comparative cohort study of visual outcomes in femtosecond laser-assisted versus phacoemulsifica- tion cataract surgery. Ophthalmology. 2016;123:178–182. 4. Reddy KP, et al. Effectiveness and safety of femtosecond laser-assisted lens frag- mentation and anterior capsulotomy versus the manual technique in cataract surgery. J Cataract Refract Surg. 2013;39:1297– 1306. 5. Bartlett JD, et al. The economics of fem- tosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2016;27:76–81. Dr. Dillman is founder and owner of Dillman Eye Care Associates, Danville, Illinois. He can be contact- ed at Dadomer@aol.com. 2. Hansen MS, et al. Financially efficient cataract surgery in today's healthcare environment. Curr Opin Ophthalmol. 2015;26:61–65. 3. Loriaut P, et al. Femtosecond-assisted arcuate keratotomy for the correction of postkeratoplasty astigmatism: vector analysis and accuracy of laser incisions. Cornea. 2015;34:1063–1066. 4. Vasavada AR, et al. Femtodelineation to enhance safety in posterior polar cataracts. J Cataract Refract Surg. 2015;41:702–707. 5. Roberts TV, et al. Anterior capsule integrity after femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015;41:1109–1110. 6. Mayer WJ, et al. Impact of crystalline lens opacification on effective phacoemul- sification time in femtosecond laser-as- sisted cataract surgery. Am J Ophthalmol. 2014;157:426–432.e1. Dr. Foster practices with Eye Center of Northern Colorado. He can be contacted at gjlfos@gmail.com. • Ensure consistent commitment • Staff takes cue from clinicians • Explain science of LACS • Articulate practice emphasis on LACS • Underscore consistent messaging • Operating room structure affects surgeon time • Laser outside operating room: increased efficiency • Two operating rooms: increased efficiency if one surgeon performs laser portion, other removes cataract/implants IOL Commit to becoming an excellent LACS surgeon Meet with all staff who interact with patients Establish surgical flow to increase efficiency Adjusting fees M y patients pay a bundled fee, including the company's procedure fee, my fee, the multifocal or toric IOL fee, and other necessary costs. Patients sign a financial informed consent, as well as the surgical informed consent, where we itemize the charges (including technology that we are using), charges to Medicare, and Medicare exclusions. We are very transparent when presenting our fees. I feel very strongly about using the femtosecond laser for all of my multifocal and toric IOL cases, but I also thinks it makes some difficult cases easier, such as an extremely dense cataract. If a patient needs LACS in such a case but cannot af- ford the laser costs, I skip my fee if necessary. If they cannot afford my fee and the company's fee, I may drop my charge and split the company's cost with the patient or drop it entirely. When I tell patients that they need this technology, I need to find a way to make it affordable for them.

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