Roundtables

Also for some of the newer devices and procedures, the manufacturers have contract- ed with third parties to aid in prior authorizations or helping to clear up denials. We have found these to be very helpful in assisting with prevent- ing and resolving denials. Q: Do you think insurance compa- nies will become stricter re- garding claims in the future? Dr. Noecker: Yes, it seems to be a growing trend that patients will bear more of the cost of procedures in the future. We see more resistance to getting paid with newer procedures or procedures that are out of the norm. It seems to take longer for the newer procedures to gain acceptance at the payer level compared to years past. Q: What are some of the best value-added ser- vices for eye cen- ters? What must they consider when add- ing these? Dr. Gonzalez: Speaking from a perspective of a mainly general ophthalmol- ogy ASC, one must really look at the cost effectiveness of adding new services. Many centers have looked at adding treat- ments such as laser cataract surgery, endoscopic cyclo- photocoagulation and other minimally invasive glaucoma treatments. As always, if a center can get its physicians to perform minor laser proce- dures at the center rather than in the office, that provides added income to the facility. Q: Some centers are looking at bringing in retina proce- dures. What are the advan- tages and challenges to ac- tually incorporat- ing retina into ASCs? Linda Phillips, Southgate (Mich.) Surgery Center: One of the biggest ad- vantages is that it offers the opportunity to be a full-service ophthal- mology center. is is an advantage in terms of market- ing to patients and allows your center to offer comprehensive quality care. e other ad- vantage is that for a lot of the retina procedures the reim- bursement is higher, so it does help with your bottom line. e biggest adjustment will have to be made to the staff 's training; particu- larly, the nursing staff in the OR. ey will have to have things ready for the 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, Sheeps- head Bay Surgery Center, New York: [Some challenges 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 ex- pensive in the ASC. Also, with smaller gauge instruments, cases will be performed faster. Paul Lucas, CEO, Georgia "ASCs committed to ophthalmology will no doubt consider retina. Growing volumes, maintaining strong ties to groups that offer retina and maintain- ing a common surgical value for patients within the provider group will be motivators." — Paul Lucas, CEO, Georgia Retina Eye Surgery Centers 3 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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