MESSAGE FROM THE PRESIDENT: Ophthalmology Cases Give ASCs a Chance to Shine

Message from the President

Larry Taylor

Larry Taylor, CASC, president


Ophthalmology Cases Give ASCs a Chance to Shine

Ophthalmic surgical procedures have been the mainstay of surgical practices in ASCs for many years. Since the likelihood of cataract procedures is tied to the aging process, a great majority of cases are covered by Medicare. By age 65, more than 90 percent of the US population will have a cataract surgery. Women have more cataracts than men, and it is projected that the number of people with cataracts will double to 50 million by 2030. That is a lot of people who will need great surgery centers and surgeons to provide this service. I will be one of them.

The reimbursement for high-volume cataract procedures has remained stable. From 2012 to 2019, the payment has changed by only $2.10 per procedure. In 2019, the payment for most cataracts nationally is $961.69. The good news is most of us have two cataract surgeries. That leads to a great customer service opportunity for our staff and surgeons. Medicare spending follows this trend and cataract surgery continues to be in the top five CPT codes performed based on Medicare ASC expenditures. When Medicare expanded its coverage in ASC reimbursement in 2008 to a wider array of ophthalmic surgical procedures, a larger population migrated to ASCs. The ASC site of service is a wonderful environment for these cases based on clinical outcomes and financial benefit for the patient and Medicare, as the gap between hospital outpatient department (HOPD) and ASC payments for these procedures remains quite large.

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Considerations for ophthalmic procedures from a financial perspective require the members of an ASC’s management team to consider where they spend their money. The variety of financial considerations ranges from capital purchases and leases to roll-on/roll-off arrangements and bundled services. Depending upon your situation, available funds and volume, the delivery of services can be easily evaluated. Take a look at all the variables, your schedule, standardization and physician preferences to lay out your plan. Once you evaluate all the options, you will clearly see the appropriate vehicle.

This is just another great opportunity for ASCs to demonstrate the safe environment and superior clinical outcomes they deliver and the cost-effectiveness of that care.

Larry Taylor

Larry Taylor, CASC
President of ASCA’s Board of Directors