Roundtables

Eye Surgery Centers: Opportunities, Challenges and Value-Added Procedures By Anuja Vaidya Ophthalmologists and eye center leaders discuss upcom- ing trends in the field. Q: What are some of the challenges that ophthalmolo- gy centers face in the coming year? Mark L. Gonzalez, MD, e Eye Center at MedStar, Washington (D.C.) Hospital Center: First, as in years past, the decreasing reimbursement has been and will continue to be a problem. With high over- head costs, many centers run on a relatively tight per case margin. Any decrease in this margin, when multiplied over the entire years' case load, may result in a significant fiscal stress and can shi the finan- cial outcome of a center. Second, there is the uncertain- ty of the Patient Protection and Affordable Care Act and how this will affect ASC regu- lations. Another challenge is ASC sat- uration. Over the last several years, ASCs have proliferated to the point that in certain lo- cations (usually urban) it has be- come more difficult to re- cruit new physicians in order to increase the center volume and thus profits. Q: Claim de- nials are a big concern for eye centers. What effect do they have on your surgery center? Robert Noecker, MD, New Vision Cataract Center, Nor- walk, Conn.: Denials obvious- ly can lead to non-payment of devices. At a minimum, they increase the amount of money tied up in accounts receiv- able. is can affect cash flow, which can be problematic if there is no cash on hand to pay expenses. is can affect the viability of the ASC and result in less profit for the owners. If deni- als are not caught in a timely fashion, the window for pay- ment can close. Also if these are not monitored closely, re- peat denials can occur on the same procedure with mount- ing losses if not corrected. Q: What are some strategies your surgery center uses to deal with denials? Dr. Noecker: We do regular audits to spot check payment for services. We try to do these on a monthly basis to ensure that if there are denials we either do what we can do to correct them or at least do not do more of the same proce- dures in the facility without an alternative plan for payment. If a procedure is known to have been denied in the past, we try to obtain prior autho- rization from the insurer and while this does not guarantee payment, it increases the like- lihood. Eye Surgery Centers 2 "If a procedure is known to have been denied in the past, we try to obtain prior authorization from the insurer and while this does not guarantee payment, it increases the likelihood." — Dr. Robert Noecker, New Vision Cataract Center retina surgeons, for which they will have to learn a new skill set. We bought new equipment for retina procedures, and we had the representatives here to train the staff. We also visited other retina surgeons to observe. Steven Klein, CEO, Sheepshead Bay Surgery Center, New York: [Some chal- lenges are] availability of operating room time as well as upfront acquisition cost of equipment, instruments and supplies and reimbursement rates. Oth- er challenges are the need for retinal surgeons with volume and identifying types of retinal cases that can be performed in the ASC. [However], payers will force it to happen because it's less expensive in the ASC. Also, with smaller gauge instruments, cases will be performed faster. Paul Lucas, CEO, Georgia Retina, Conyers: Retina procedures are typically much more tedious and time-consuming that the general ophthalmology cases. So, operating room time will be consumed by far fewer cases, which will reduce facility fees. They also require additional equipment such as a vit- rectomy machine. They can also require expensive supplies such as oil. Keep- ing room turnover efficient and managing inventory with minimal quantities are the primary offsets to these dilemmas. Q: Do you think more ASCs will begin performing retina proce- dures in the future? Ms. Phillips: I think that ASCs are not seeing high reimbursement, so it will be a challenge for ASCs to bring these procedures in. Unless they can find retina surgeons who can bring in high volumes of patients, I don't think you will see an increase in retina surgeries in ASCs. Having said that however, we feel that adding retina was a positive for our center. It was a nice addition to providing ophthalmic care, and it's also been a positive for our patients because nobody was doing retina in our area so patients had to travel for over an hour for those procedures. Mr. Lucas: ASCs committed to ophthalmology will no doubt Growing volumes, maintaining strong ties to groups that maintaining a common surgical venue for patients within the will be motivators. Q: Will 2014 be a transformative year for eye centers? Dr. Gonzalez: This is very difficult to predict with increased control of healthcare. The eye centers that are able to successfully of the value-added services will do well while others may struggle profit margins they had experienced in the past. n "The eye centers that are able to suc- cessfully add some of the value-added services will do well while others may struggle to meet the profit margins they had experienced in the past." — Dr. Mark Gonzalez, The Eye Center at Medstar 10 Statistics on Ophthalmology- Driven ASCs By Laura Miller H ere are 10 statistics about ophthalmology-driven tory surgery centers from the VMG Health Multi-Special- ty ASC Intellimarker 2011. Gross charges per case in the West: $6,063 Net revenue per case in the West: $1,302 Gross charges per case in the Southwest: $6,442 Net revenue per case in the Southwest: $1,312 Gross charges per case in the Midwest: $5,861 Net revenue per case in the Midwest: $1,297 Gross charges per case in the Southeast: $5,360 Net revenue per case in the Southeast: $1,198 Gross charges per case in the Northeast: $4,116 Net revenue per case in the Northeast: $1,193 n

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