Retina surgery now profitable in an ASC setting (continued)
The addition of treatments such as pan-retinal photocoagulation (PRP) opens the door for ASCs to expand their range of services and, potentially, add incremental revenues. For example, the new codes for photocoagulation treatments, such as PRP and iridotomies, now have an average ASC fee of $201.21 (see figure 1 above).
The changes also apply to surgical fees for retinal procedures. Under the new plan, CMS will reimburse other surgical procedures at 65% of the Hospital Outpatient Department (HOPD) rate, at the end of the three-year transition period. This amounts to as much as 125% increase for retinal procedures compared to the 2007 plan. For a pars plana vitrectomy (CPT 67036), the reimbursement level will increase to $1424 compared to last year’s payment of $630.
A model for profitability
With this new CMS plan, ASCs will be able to offer greater treatment flexibility in an outpatient environment. In fact, the ASC can now be used for the majority of retinal procedures and surgeries with almost equivalent reimbursement compared to an office or HOPD. Plus, an ASC can be used more efficiently by general ophthalmologists who already perform cataract surgeries and YAG treatments in this outpatient setting, and will now be able to perform PRP and other procedures at the same facility. This should lead to improved, more seamless patient care.
A typical investment for a complete system, including a Laser Indirect Ophthalmoscope (LIO) and a slit lamp, works out to a monthly payment of approximately $1000*, a payment that can be easily recovered by performing five photocoagulation procedures per month. In addition, retinal specialists or general ophthalmologists who participate in the ASC model will benefit on both ends because they will receive the same professional fee as they do for procedures performed in their office or in the hospital, with the addition of almost the same ASC facility fee.
What technology to choose
With the need to perform both operating room and office-based procedures, an ASC looking to expand into posterior segment procedures should consider photocoagulators that can be used in both settings and allow for easy moving and set up.
Flexibility is key in order to utilize a laser system most efficiently for surgeries and in the office. The dual port Solitaire laser (Ellex Inc. Minneapolis, MN) is a 532 nm portable photocoagulator that is tailored to meet the needs of the ASC. Available in an OR or an outpatient treatment room configuration, the system is available with all the optional accessories that are needed, including LIO, endoprobes, microscope safety filters and the Ellex 30XL laser slit lamp, which is optimized for peripheral retina viewing. The system is delivered with a mobile cart or a table mount depending on which setting is preferred. To provide for optimal workflow in the operating room, it features instant switching between delivery devices to ensure seamless, uninterrupted treatments. With high power output of up to 2W, this system can also be used for anterior segment procedures such as trabeculoplasty and iridotomies.
Long-term outlook
The recent changes in reimbursement really do create a win-win situation for the ASC and the retinal specialist. For the ASC, the changes mean new procedures that can be performed in the center. This can lead to increased utilization, as well as improved operating efficiencies for the ASC. For retinal surgeons, the addition of new laser procedures at ASCs provides greater flexibility to treat more patients. Equally important is the fact that ASCs offer improved workflow compared to a HOPD setting and a streamlined admission process, making the patient’s visit much more enjoyable.
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