The time is now
Vitreoretinal repairs can be added to the schedule at ophthalmic ASCs
or even multi-specialty centers relatively easily, and a conjunction of
changes in recent years has even cleared some previous barriers.
"Years ago, retina reimbursements were about the same as cataract
reimbursements, but retina supplies were more expensive," says Glenn
deBrueys, CEO of Somerset, N.J.-based American SurgiSite Centers,
which operates 11 eye surgery centers in 5 states. "Now retina is 60%
higher. Supplies are still more expensive, but the margin is a decent
margin."
In addition, retina cases can be extremely time-consuming. Over the
past 2 decades, though, technology's advances have picked up the
pace. Smaller-gauge instrumentation has brought microincisional
techniques, and their improved healing outcomes, to retina cases.
Vitrectomy cutters capable of thousands of cuts per minute boost effi-
ciency and accuracy. While the end results don't match cataract case
speeds, they've drawn the attention of ambulatory surgeons and
administrators. "Retina surgery time has significantly diminished,"
says Mr. deBrueys. As an example, he cites pars plana vitrectomy,
which takes 30 or 35 minutes today compared to 75 minutes 25 years
ago.
These changes have leveled the playing field for retina in outpatient
settings, but cost-benefit analysis is still necessary to select the most
promising procedures, says Caroline Ivanovski-Hauser, CASC, admin-
istrator of the Bergen-Passaic Cataract Surgery and Laser Center in
Fair Lawn, N.J. "Almost all retina cases lend themselves to the same-
day setting, except those cases that use very expensive implants and
supplies," she says.
Using perfluorocarbon liquid or silicone oil, for instance, will add
several hundred dollars to a case's expenses, which could easily
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