Surgery center reduces cost of cataract with IOL
Rockford (IL) Ambulatory Surgery Center reduced its cost for cataract phacoemulsification with intraocular lens (CPT 66984) from $741 to $557 by working with ophthalmologists and staff to perform the procedure more efficiently.
Such cost savings can pay off under the proposed outpatient prospective payment system for surgery centers. Under the proposed ambulatory payment classifications for ambulatory surgery centers (ASCs), the reimbursement will be $863 for CPT 66984. An efficient ASC will expend $890 in cost to perform this procedure, according to Ambulatory Surgery Guidelines, published by Seattle-based Milliman & Robertson. (For ordering information, see resource box, p. 54.)
And reimbursement already has dropped for that procedure: from $1,083 to $889 for Rockford, according to George Arends, MD, assistant medical director. However, the center started its cost-savings efforts before the reimbursement dropped, Arends adds. Cataracts have always had high costs, in comparison to other outpatient procedures, due to equipment and medications, he says.
"So we’re trying to get costs in line and bring them down so we can continue to do the procedures for our surgeons," he says. "You can’t do a case if you lose more than you make on the case."
The center took these steps to reduce its costs:
• Anonymously compared surgeons’ costs. The managers compiled each surgeon’s cost, then individual surgeons were shown their costs compared to their peers, who were listed anonymously. "We asked if there was some way they could consider making changes to their medications or make a lens change to become more in line with the less expensive and more efficient cataract surgeons," Arends says.
The response? "Not uniformly good," he says. "However, when you present them with the opportunity to work with the surgery center or work at the hospital because we can’t afford to keep them anymore, they all changed."
• Went to less expensive supplies, equipment, and medication. All the surgeons have accepted a reusable phacoemulsification machine that uses reusable tubing. The AMODiplomax machine is manufactured by Irvin, CA-based Allergan. The machine that was used previously had a pack cost of $60 to $85 per case, Arends says. That amount has been reduced to $8 per case, he says.
Rockford also was able to negotiate a better lens price by buying in bulk from Allergan. "We try to keep the lens cost below $50 a lens," Arends says. With the cooperation of the surgeons, Rockford changed the viscoelastic it used and now pays less than $30 a case, which is down from $53 to $85 a case.
• Maintained a stable staff who share in the profits. Rockford has two circulating nurses and one scrub tech for cataract procedures. A stable, dedicated staff probably has been the most significant factor in reducing costs, Arends maintains. "They know their jobs. They don’t have to break in someone new."
The staff work from 7:30 a.m. to 3 p.m., with only a half-hour break for lunch, he says. Having a staff who enjoy their work is key, Arends adds. "If they don’t enjoy it, you don’t go fast and you don’t make money." The staff are members of a profit-sharing program and are given the opportunity to recommend cost savings, he says.
• Achieved efficiency in the OR. At Rock-ford, surgeon OR time is 12-18 minutes a case, and 25 minutes elapse from the time a patient is wheeled into the room until the next patient is wheeled in. There is essentially no turnover time between cases. The center had eye-operation carts fitted with a footboard on which all the monitoring devices are located. The monitors are attached to patients in the preoperative area. "When they leave pre-op, they come directly to the OR with the monitors in place, so they’re set to go," Arends says. The nurses don’t need additional time to reattach monitors or reposition patients from one bed to another, he points out. You need cooperation from your surgeons, Arends says. "If your surgeons dash off every five minutes to make a phone call, it won’t work."
Efficiency is the key, Arends emphasizes. "You can have cost savings in your medications and materials you use, but all in all, your biggest cost is personnel cost."
At Rockford, patients are in recovery 15-30 minutes and go home. "If you keep operating and recovery time down, that’s where you save money," he adds.
For information on reducing your costs for cataracts with intraocular lens, contact:
• George Arends, MD, Assistant Medical Director, Rockford Ambulatory Surgery Center, 1016 Featherstone Road, Rockford, IL 61107. Fax: (815) 226-9990. E-mail: georgea515@aol. com.
For information on obtaining Ambulatory Surgery Guidelines (Healthcare Management Guidelines: Vol. 3), which cost $460 plus $10 shipping and handling, contact:
• Milliman & Robertson, HMG Client Services Desk, 401 Second Ave. S., Suite 400, Seattle, WA 98104. Telephone: (888) 464-4746. Web site: www.milliman-hmg.com.
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