Hidden Cataract Costs

Hidden costs are many in cataract cases. It may be an overwhelming task to dig deep into looking at what cataracts are actually costing your facility. But, I can assure you there are many people in the industry (e.g. Vantage Outsourcing) that can help you do this. This is one of the quickest ways to maximize profits and increase bonuses. By evaluating & monitoring ALL costs, you can insure your facility has a long term future in providing cataract services to your patients.

When the term “cost” is used, what do people mean? First of all, there are 3 types of costs:

(1) Direct Costs

(2) Indirect Costs

(3) Fixed Costs

Direct Costs are those costs that incurred while performing a particular case, such as pre & post operative nurses, surgery room staff, anesthesia labor, disposable costs (custom paks, phaco paks/tubing, viscoelastics, lens, blades, cannulas, gowns, gloves, etc…), and instruments used for a specific case. While OSM Dec 2009 cataract costs article goes into great detail the various supplies used in a cataract procedure, I recommend that you focus on the major costs as outlined above and to cover those incidentals (eye pads, exam gloves, tape, warm blanket, surgeon cap, etc…), add $25/case. If interested, you can go to: http://www.outpatientsurgery.net/resources/forms/2009/xls/OutpatientSurgeryMagazine_0912_CataractCostSheet.xls for detailed breakdown of these $25 incidental costs.

Indirect Costs are those costs that you expend on a daily basis when you are operating your facility, but which you cannot tie to a specific case. Examples of these costs are inventory clerk labor, administrative labor that is involved with surgical procedures, employee benefit costs, equipment maintenance costs, equipment repairs, instrument repairs, handpiece repairs, laundry costs, shipping expenses, and lost or damaged inventory. While these costs can be high on a per cases, you can avoid the majority of these by connecting up with a cataract outsourcing service company, such as Vantage Outsourcing.

Fixed Costs are those costs that you have no matter if you do one case or a hundred cases in a given day. Such costs are building costs, equipment costs, utility costs, storage costs, administrative labor involved with back office duties, computer supplies, legal fees, marketing costs, office expenses, rent, and telephone costs. For low volume facilities, this can be quite high.

If you are a high volume facility (>2000 cases/year), disposable costs will be a large part of your case costs. However, capital costs can be a significant part, particularly when you have multiple surgeons and/or your surgeon(s) tends to change their cataract equipment preferences (which happens more often than not, I might add).

In our business, we have seen disposable costs range anywhere from a low of $200 a case to as high as $800 a case. YES, we are talking disposables only! Cataract equipment fixed costs, direct & indirect labor costs and indirect maintenance/repair costs are on top of this. You can see how you can easily have over $ 1000 in case costs when all is said and done. When reimbursement ranges from 900 to $1400 per procedure, profits soon turn into losses.

#1 Priority for Your Front Office Team

A surgeon can be the best surgeon in the area or the world, for that matter. But, if his/her front office isn’t doing its job right, this expertise means nothing. It’s the equivalent of having the best quarterback on the field, but the front line can’t block, the running back can’t run and the receivers can’t catch. A team simply can’t win, with only one effective player. So how effective is your team?

As in football, a front office must know the drills and apply them daily. First, they need good people skills. It’s a MUST that they always put the patient first. As the saying goes, “if Mama ain’t happy, ain’t nobody happy!” How does this apply to your patients? Think about it, if your staff mishandles an issue in the front office, they’ve not only upset the patient, but the patient’s family/friends and everyone sitting in your front office, i.e. other patients and potential customers. If you can do one thing for your staff, teach them how to handle difficult situations. First, train them to live and breathe the two rule standard as an initial reaction to a disgruntled patient: “Rule #1 – The patient is always right, Rule #2 – If the patient is wrong, refer to Rule #1.” By making the patient feel that they are right, the anger and emotions surrounding the situation are diffused immediately. Second, in resolving a patient issue, take them to a private area and work through the patient’s issue in a positive manner. If a staff member has done something wrong, require that the staff resolving this issue with the patient do 4 things: (1) admit wrong doing, (2) openly acknowledge what was done incorrectly, (3) apologize for the mistake, and (4) come up with an action plan that you will implement immediately to ensure this doesn’t happen again. If your staff does this, it’s a guarantee that your patients will come back, as well as become life-long customers and most importantly, tell their family and friends of the great experience they had at your office and/or surgery center and what a top notch ophthalmologist you are.

The second most important duty of front office staff is how they treat each other. The Golden Rule is always a good place to start. This rule is “treat others, as you would like them to treat you.” If you instill this in each and every one of your people and let them know that you expect them to live this daily, your personnel issues will be minimal. In the last year, one of cataract outsourcing team members violate this rule. Rather than treat it as an isolated incident and address with only this particular staff, the supervisor gathered the entire group together the day after the episode and presented them with a one page statement. He read it out loud and had discussions with them what this meant on an individual level, as well as a team. He went over points about how our society, as a whole, has become less professional and respectful of each another. They discussed this and it was agreed that the team needs to work harder in making sure these types of behaviors/attitudes don’t permeated their work environment. They discussed how they could have handled the situation differently. In the end, the supervisor, along with each staff member, signed this document acknowledging their pledge to treat each other professionally and with the utmost respect, at all times.

Another aspect of front office service applies to your facility staff. If you haven’t already done so, you need to encourage, promote, and require your facility staff to treat your office staff with the upmost respect and view them as a key customer. In addition, they need to do the same for all surgeon users’ office staff. Your people must view these groups of people as key customers, i.e. same top notch customer service, as the staff gives the patients. Granted not all physician offices have the greatest customer service-oriented people working their front desks. But, encourage your staff to look beyond this and to keep reminding themselves that a surgeon’s staff is the gatekeeper of the facility’s patients. Again, if these key people are happy, I’ll guarantee you the facility case load will increase.

Finally, your staff needs to be dutiful in completing the tasks of scheduling, pre-certing, registering, preparing patient for surgical protocol and expectations, billing and collecting payments. However you might remind them that if poor customer service exists and/or prevails, there will be no need to pre-cert, register, etc…, as customers will be non-existent. Therefore, the #1 priority must always be customer service to both external and internal customers.

Kipp Fesenmaier Joins Vantage Outsourcing

Kipp Fesenmaier, who was instrumental in the growth of Sightpath Medical (formerly Midwest Surgical Services) into the largest cataract outsourcing business in the United States, has joined the team at Sightpath’s primary competitor, Vantage Outsourcing.

Fesenmaier assumed the position of Vice President of Business Development at Vantage, which is headquartered in Effingham, IL. He will work out of Minneapolis, MN, where he has many established relationships with physicians and facilities. During his 15-year tenure at Sightpath, Fesenmaier was successively employed as technician, Mobile Operations Manager, National Accounts Manager, Vice President of Operations and Vice President/General Manager of Diagnostic Services.

Fesenmaier’s responsibilities with Vantage will include sales for Vantage’s Northern Plains territory, national sales management, vendor relations and strategic alignment of the company for continued growth. “With Kipp’s history of leadership and relationship-based business management, we have added one of our industry’s top professionals,” said Vantage founder and CEO Ann Deters. “We are confident he will help us tremendously in our goal to be the industry leader.”

Fesenmaier lives in Albertville, MN, with his wife Amy, daughters Paige and Libby, and son Reed.

Staying Motivated & Proactive in Today’s Ophthalmic World

Elective case volumes are down in this poor economy; government healthcare plan is reducing Medicare reimbursements even further; and your house hasn’t recovered in value since the 2008-09 real estate down turn. What’s a healthcare person to do?!?  

Like our forefathers, we need to adapt and modify the way in which we do business and expend monies during poor economic times. Perhaps to counter the decrease in cases, you might look to provide added value services to your patients. An example would be to provide hearing tests and hearing aids to your patients. To elaborate on hearing services, here are some little known facts; (1)  50%+ of all senior citizens have significant hearing loss, (2) 80% of them have never been tested for such loss, and (3) hearing aids are the only effective treatment for 90% of such patients.  So think about it — for every 100 patients who come through your waiting room, 50 of these patients have a hearing problem and 40 have done nothing to address it. Baby-boomers’ hearing loss is far greater than earlier generations. Plus, this group is more apt to seek treatment. Hearing services could prove to be a natural fit in ophthalmology.

Another step forward would be to engage the creative side of you & your staff by having brainstorming sessions with your key people. The objective for these meetings would be to come up with ideas for added services, ways to improve efficiencies, and areas for cost cutting.

Most importantly, remember to focus on your blessings, not your misfortunes. It’s a known fact that positive people are more successful (and with less health problems) than negative thinkers. If you have difficulty staying positive, I would encourage you to give yourself daily pep talks and keep telling yourself “I can’t change this bad situation, but I can certainly change my attitude toward it.”

Cataract Outsourcing’s Noteworthy Products for 2009

It is always so interesting to focus on new products each month for our posts.  We as bloggers get the unique opportunity to research products that have very widespread application in the medical arena.  Below is a short list of the noteworthy products of 2009.   I hope you enjoy reading them as much as we enjoyed putting these articles together over 2009.  Be sure to visit these articles in their entirety in the “Featured Products” section.  On behalf of myself and Cataract Outsourcing thank you for your dedicated readership, Happy Holiday, and Best Wishes for 2010!!

ILLUMIN-i System

The ILLUMIN-I  System a significant advancement in Ophthalmic illumination.  The patent-pending ILLUMIN-i module is integrated with a new microscope from Endure Medical and is also available as an upgrade to older optics.

The ILLUMIN-I creates a homogeneous, brilliant red reflex and tremendous detail perception.  The ILLUMIN-i offers triaxial, collimated illumination and multiple angles of delivery that enhance the optical view for surgeons.  This new technology results in a constant, “glowing” red reflex while maintaining contrast and depth of field.  The surgeon perceives fine details and clarity like never before.  www.enduremed.com

Acrysof IQ Toric IOL-Aspheric Excellence

Intraocular lens (IOL) technology is constantly evolving and striving for better performance and outcomes for both surgeons and most importantly the patients they serve.  One of the advancement in IOLs has been the introduction of the Toric lens.  The Toric IOL is designed to correct astigmatism and was first brought into the US market by Starr Surgical in 1998.  Alcon, Inc followed up in 2005 and received FDA approval for their version, the Acrysof Toric IOL, which quickly became the leading Toric IOL in the market.  In March of 2009, Alcon launched the recently FDA approved Acrysof Toric IQ IOL at the American Society of Cataract and Refractive Surgeons meeting in San Francisco, California.  This Toric IOL is unique. It offers a special aspheric optic which is a new innovation in the world of Toric IOLs.

The Acrysof IQ Toric IOL offers a precise astigmatism correction. The aspheric design component of the lens improves both image quality and contrast sensitivity.  This combination creates patients the best opportunity for distance vision without the assistance of glasses.  It was shown in studies that the Acrysof IQ Toric IOL improved functional vision significantly.  Alcon tested their IOL versus a control lens in low visibility environments (such as night driving).  They showed that the Acrysof IQ Toric IOL performed better in 34 of the 36 conditions that were tested.  Significant advantages were found in the ability of the patients to identify pedestrians and warning signs under conditions conducive to both fog and glare.

The Alcon Acrysof Toric IQ IOL aspheric characteristics brings new dimension to the Toric IOL marketplace.  The innovation of this lens creates high quality outcomes for the surgeons and patients alike.  Its ease of use and the Acrysof Toric IOL Calculator that was created by Alcon makes the IOL a very desirable and easy choice for many surgeons implanting Toric IOLs.  www.alcon.com

Acrysof IOL injector-Crestpoint Management

The new injector, the DK7797-2, is a front loading injector designed to accommodate the Alcon “D” IOL cartridge as well as the “B” and “C”.  It is a smooth, single handed delivery, ergonomically designed to fit any sized hand.  The injector can be pre-loaded.  It also comes completely apart for proper cleaning.  Surgeons contacted Crestpoint and asked for a different injector with a smooth mechanism.  Crestpoint (then Duckworth and Kent USA) took the design to Alcon.  Surgeons truly enjoy the efficient and smooth one handed delivery. www.crestpointmgt.com

I.V. House

For many years, Lisa Vallino, RN, had observed other pediatric nurses, as well as constructed herself, makeshift IV covers to help protect and provide comfort for the patients they were dedicated to care for.  These IV covers were created from plastic specimen cups cut in half and secured to the patient with tape.  In 1991, Lisa Vallino and Betty Rozier (Lisa’s business partner and mother) took a leap of faith, applied for a patent and approached a plastics manufacturer to help develop the concept and their dreams.  From this brave step, a plastic u-shaped domed cup was created and I.V. House was born.

The benefits of this product in the healthcare industry are plentiful.  First and foremost, I.V. House promotes patient safety.  By simply protecting the IV site, patient safety and comfort levels are secured.  I.V. House also extends dwell times and eliminates exposed looping issues. This is not only a safety benefit but it will also save on medical costs by preventing unnecessary IV restarts that may create complications and extend the amount of time the patient spends in the hospital.  I.V. House is a single use device and free of latex and DEHP; another effort to avoid complications and promote patient safety.  The I.V. House also allows hospital staff easy access and the ability to monitor the IV site by having a vented and transparent design.  The design also allows for minimum use of tape and in some models no tape at all.  Some of the I.V. House products have an ergonomic designed UltraDressing that fits the patient more like a glove instead of appearing as an uncomfortable medical device.

I.V. House has an extensive line of products.  They have developed a full range of sizes that will correspond to the individual needs of the patients.  There are also varying degrees of how the domes are padded and are designed for the area of the body where the IV site will be located. The I.V. House also has the specialized UltraDressing configurations to be completely free of the usage of tape.  I.V. House has a product that will fit and protect, no matter the needs of the patient.  www.ivhouse.com

Vision Blue

Although capsular staining had been being performed worldwide for a number years, it wasn’t until late 2004 before DORC International received FDA approval in the United States for their product Vision Blue.  This approval allowed US surgeons to finally have a resource that could help with performing a capsulorhexis in less than ideal conditions.  Before the use of Vision Blue, a surgeon may have experienced the inability to adequately visualize the anterior capsule which can result in an incomplete capsulorhexis.  With Vision Blue, the risk of radial capsule tears and other complications are greatly diminished.

With the introduction of Vision Blue into the US market, surgeons have gotten to enjoy the ability to get a much needed assist when performing procedures in which the anterior capsule is associated with a mature cataract or small pupil.  Capsular staining makes the capsulorhexis an easier and safer task when dealt   with such situations.  Ultimately, Vision Blue allows for a much safer procedure and high quality outcomes for the patient which is a win-win scenario for all involved. www.dorc.nl/

ILLUMIN-i System: A Revolution in Ophthalmic Illumination

Recently, Cataract Outsourcing sat down with Rob and Edie Hewlett of Endure Medical, Inc. to find out more about the ILLUMIN-I  System, a significant advancement in Ophthalmic illumination.  Based in Cumming, Georgia, this small company has been in the business of the refurbishment, sales and service of surgical microscopes for over 20 years.  Although the main focus of this interview deals with the Ophthalmic side, Endure Medical is also involved with ENT, neurosurgery, orthopedic, plastics, OB/GYN, and dentistry to just name a few.  They definitely cover a large spectrum of the surgical market and have a comprehensive knowledge of all of those specialties.

CO: Rob and Edie, please tell us a little about Endure Medical, your position with the company, how long you have been at that position, and how long you have been involved in the ophthalmic industry.

RH & EH: Endure is family owned and operated and we’ve been in business over 20 years.  We provide both new and refurbished microscopes for all specialties.  Our company is ISO 9001:2000; 13485:2003 certified, registered with the FDA and has CE approval on our new products.  All of our equipment comes with a 2 year warranty.   While developing our new ophthalmic scope, the Reflex, we began experimenting with different illumination systems.  After many ideas and prototypes, we finally discovered the technology used in the ILLUMIN-i….tested with several local surgeons….made a few alterations and filed the patent.

CO: What is the ILLUMIN-i system?

RH & EH: The patent-pending ILLUMIN-i module is integrated with our new microscope and is also available as an upgrade to older optics.  The ILLUMIN-I creates a homogeneous, brilliant red reflex and tremendous detail perception.  The ILLUMIN-i offers triaxial, collimated illumination and multiple angles of delivery that enhance the optical view for surgeons.  This new technology results in a constant, “glowing” red reflex while maintaining contrast and depth of field.  The surgeon perceives fine details and clarity like never before.

CO: How does the ILLUMIN-i system benefit surgeons?

RH: Provides an incredible view without having to replace your entire microscope.

EH: They can upgrade their current optical system and save lots of money over a brand new scope.

CO: What type of surgeon feedback (both positive and negative) have you had with those using the ILLUMIN-i system?

RH: By far, the feedback is positive.  The ILLUMIN-i is a cost-effective option to other new microscopes.  The optical view is comparable (if not better), but the price is much less.  For rural hospitals and ASC’s, our system is the perfect fit.  The surgeon gets the view he needs and the facility saves the money they need…especially in today’s economy.

EH: Optically, our system is just as good as or better than any other microscope on the market.  This is based on feedback from many of the top surgeons across the country.  We’ve kept our floorstand simpler with a small profile.  Some hospitals and surgeons prefer the larger floorstands with electromagnetic brakes and we don’t offer this feature.  Our design goals were to provide modern electronics for the footpedal and optics while keeping the floorstand simple.  This gives the surgeons the features they need/want and keeps the price under control!

CO: If you could only make one statement in regards to selling the ILLUMIN-i system to a skeptical surgeon what would that be?

RH: We will bring it to your facility, be in surgery and let you see for yourself.

EH: Take a look at our video of several surgeons using the ILLUMIN-i and then let us bring it to your facility and be in surgery…you don’t buy it unless you like it.

CO: Endure offers a variety of products and services, please tell our readers about all you have to offer your customers.

RH: While the ILLUMIN-i is specific to Ophthalmology, our company provides microscope systems and accessories for every specialty and budget.

EH: Along with our microscopes systems, we offer various new video systems (single, 3-chip and HD), replacement parts (new and refurbished), repair services and disposables.

CO: For those readers who are interested in the ILLUMIN-i or any other of your products and services, how can they find out more and get in contact with you?

RH: Our direct number is 800-736-3873 / 770-888-3755

EH: Our website is:  www.enduremed.com, my email is:  edie@enduremed.com ; rob@enduremed.com

Cataract Outsourcing would like to thank Rob and Edie Hewlett and the staff at Endure Medical, Inc. for meeting with us and providing information in regards to the ILLUMIN-I system.

HOW TO Stay In the Ophthalmic Game (with New Healthcare Reform)

With healthcare uncertainty and Medicare cuts staring us in the face, surgeons are a bit apprehensive about what the future holds for them. The best thing to do is stay positive, provide superior service and always be watching for opportunities to grow one’s business.

Having just returned from AAO Show in San Francisco this past week, I was impressed with the upbeat attitude of many surgeons and suppliers. New products and new concepts were introduced, ranging from equipment to IOLs to instruments, and even marketing software.

As an ophthalmologist who is interested in securing one’s future, I highly recommend getting serious about marketing your surgical services and your practice. First of all, good outcomes are a given. Equally important, it’s the service you provide prior to and after the exam &/or surgery that will keep you in the game. Winning physicians will be those who focus on how to market themselves and their business and who serve their patients as if they were their only customer, i.e. not just a patient.

As everyone is aware, to be successful in today’s world, a strong partnership between the ophthalmologist and optometrists is a “must” for increasing one’s cataract volume. Just meeting with ODs at their office doesn’t cut it anymore. Ophthalmologists need to be bringing more to the optometrists’ table. For example, putting on seminars for continuing education or bringing in a marketing expert to evaluate both the MD and OD front office environment are ways in which to enhance and build stronger relations, as well as your OD’s and your business.

Your front office team, whether it’s the receptionist, scheduler, biller or nurse, must have a customer service attitude and aptitude. If they don’t, they could be turning away or turning off your existing customer base, as well as patients who are trying to decide whether or not they want you as their doctor.  No customers, no business – it’s as simple as that. When’s the last time you put your entire staff through customer service training or re-training session? If you were to walk through your office door, would you want to do business with your people?

In terms of looking for new opportunities, all one has to do is keep your eyes and ears open. One approach is to ask your peers what they have found to be successful.  For example, here is one strategy that has proven to be very beneficial to ophthalmologists who own surgery centers. These MDs are minimizing their capital costs by utilizing cataract outsourcing services.  The capital dollars originally planned for capital equipment are being put into marketing, staffing, upgrading their front offices, etc….  By redirecting their capital dollars, surgeons are able to obtain the newest technology (with surgical coordinators, to boot), while allowing more dollars to go toward promoting their business and bringing more patients to their practice. Another is investing in software, such as Glacial Multimedia, that records, tracks and reports how each patient and potential patient are handled by the front office.

Like our parents and grandparents, we too will make it through these difficult times and be better because of it. The last thing we need to do is bury our heads in the sand and give up. Instead, hold your head high, be proud of what you’ve achieved, re-energize yourself and start tomorrow with improving your staff, yourself and your business.

Multifocal IOLs-Adverse Visual Effects and Their Treatment

Multifocal IOLs-Adverse Visual Effects and Their Treatment

Monofocal intraocular lenses (IOLs) have long been the standard in lens replacement after cataract removal.  However, in the last few years multifocal IOLs have established a firm presence in the marketplace.  Monofocal IOLs can only be used to give a single defined focusing point.  This allows a patient the choice to either see distance or close up. Therefore glasses must be used to correct either the presbyopia or myopia.  Multifocal IOLs, of course, allow for multiple areas of focus and allows for spectacle independence.  Although multifocal intraocular lenses appear to be an easy choice for a patient, there have been problems associated with these types of IOLs such as halos, reduced contrast sensitivity, and blurred vision.  These symptoms, though troubling to the patient and the surgeon, have been shown to be resolved the majority of the time.

OSN Super Site recently cited a study in which it was shown, that of 43 eyes included in the study approximately 81% achieved improved vision after a conservative treatment regimen, 7% improved after IOL exchange, and only 12% showed no improvement.  The treatments included excimer, drug therapy, laser iridioplasty, and YAG laser capsulotomy.  The authors of the study, as well as Dr. Jay Pepose in the review of the OSN article stated that YAG capsulotomy should be one of the last treatment choices.  This is due to the possibility the YAG not being effective and if an IOL exchange needs to be done the capsular bag is now compromised and it makes for a much more difficult procedure.  Further studies have shown that patients that have had multifocal IOL implantation may need a 6 month neuroadaption period.  This simply means that the brain needs adequate time to develop or alter neural pathways to improve visual function after the IOL has been implanted.

Although Multifocal IOLs have been shown to have certain post op adversity, one can’t deny the success they have had in freeing a patient from being tied to their glasses.  Nearly all patients either receive treatment or neuroadaptation takes place to accommodate for the multifocal IOL and the adverse visual effect are resolved.  Patient satisfaction and positive outcomes are always the wishes of the surgeons implanting these IOLs.  Proper patient education in the rewards, possible adverse effects, and the treatments of these adverse effects are essential when planning to implant a multifocal IOL.

Making Cataracts More Profitable

Improving profitability in an already efficient operation has its challenges. However as the saying goes, when one stops improving, one stops growing.  The key to improving is to continually evaluating your efficiencies when it comes to patient & staff scheduling, doctors block time, labor mix and related costs, disposable costs and anesthesia expenditures.

Scheduling patients at the right time to make certain you have the right amount of patients in the queue for your staff and surgeon is crucial. Avoiding lateness (whether it’s the patient, surgeon or staff) is the key, along with making sure your surgeon and/or staff do not take breaks between cases.

Efficient staffing of your pre-op, operating room(s) and post op often times involves hiring part-time staff who can pick up the extra load whether it be prepping the patient, scrubbing or circulating in the OR, cleaning instruments, etc…  Staffing your center with more part time staff can reduce your benefit costs and staff overhead. Each function in the center should be done by someone with the proper skills and appropriate pay scale.  It has proven to be very economical to utilize outsourcing services, such as Vantage Outsourcing. They not only provide staff, but also all the equipment, micro instruments and disposables used in a cataract procedures.

Disposable costs are a major cost of doing cataract procedures. Every six months to a year, asking your surgeon/owner to evaluate his/her surgical preferences and consider alternative disposables and/or suppliers can prove to be very profitable. When surgeon asks for a more expensive supply, provide the surgeon with a cost/benefit analysis of adding this supply and the impact of profitability on each of their cases. WIth the expertise of companies such as Vantage Outsourcing, they too can help you reduce our case costs by sharing with you what other facilities and/or doctors are doing and by recommending quality disposable items to use as an alternative to your current costly disposables.

2 OR set up may be good for some, but not for all.  Many surgeons like working in an environment where they go back and forth between two ORs. Vantage Outsourcing generally recommends to their clients that unless the surgeon is doing five or more cases an hour and at least 20 cases a day, we have found that the 2 OR set up to be inefficient. Keep in mind with 2 ORs, the center needs to equip each room with a phacoemulsification equipment and microscope, as well as staff. Unless a surgeon is fast and doing significant volumes, your paid staff and anesthesia person may be waiting on the surgeon to complete cases, which becomes very inefficient and costly to a center.

The easiest way to improving profitability is to increase case volume. This may mean taking time out of your busy day to visit with the area optometric businesses to find out to which surgeon they are referring their patients. Let them know what your center and surgeon have to offer their patients. As part of the outsourcing service, Vantage Outsourcing is able to share with you the referral patterns of ODs in a particular market, in relations to the various MDs. This information is extremely valuable and helpful in determining where a facility and/or doctor needs to put forth their efforts in terms of OD relationships.

In summary, you need to know, evaluate & improve your efficiencies and identify the sources of your surgeon’s referral base, in order to improve your cataract service profitability.

A True Vision: Vision Blue

The delicacy required when performing cataract extraction is truly amazing.  The skill and steadiness of the surgeon’s hands are something to truly admire.  One of the most precise, and important aspects of the cataract extraction procedure is the performance of the capsulorhexis.  When faced with a mature cataract or even perhaps a small pupil this part of the procedure becomes increasingly difficult.  One way to counter this issue is the technique of capsular staining to clearly define the anterior capsule.  When this technique is employed the clear choice for most surgeons is to use Vision Blue (.06% Trypan Blue Ophthalmic Solution).

Although capsular staining had been being performed worldwide for a number years, it wasn’t until late 2004 before DORC International received FDA approval in the United States for their product Vision Blue.  This approval allowed US surgeons to finally have a resource that could help with performing a capsulorhexis in less than ideal conditions.  Before the use of Vision Blue, a surgeon may have experienced the inability to adequately visualize the anterior capsule which can result in an incomplete capsulorhexis.  With Vision Blue, the risk of radial capsule tears and other complications are greatly diminished.

The administration of Vision Blue during a cataract extraction procedure is very simple.  The stain is already sterilely packaged in a 2.25ml syringe in which a blunt cannula is attached.  Following the initial incisions, an air bubble is injected into the anterior chamber.  This is done to minimize any dilution of the Vision Blue by the aqueous.   Once the air bubble is injected the surgeon simply applies the stain with the blunt cannula to the anterior lens capsule.  The chamber is then irrigated to eliminate excess and the capsulotomy can be performed.

Vision Blue has been shown through a number of studies to be safe and with very minimal adverse reactions associated with it.  It was shown to have discolored hydrophilic acrylic intraocular lenses and also noted to inadvertently stain the posterior capsule and vitreous.  The use of Trypan Blue should be avoided if using a hydrophilic IOL.  In terms of the posterior capsule and vitreous staining, the discoloration gradually fades and is gone within a weeks time.

With the introduction of Vision Blue into the US market, surgeons have gotten to enjoy the ability to get much needed assistance when performing procedures in which the anterior capsule is associated with a mature cataract or small pupil.  Capsular staining makes the capsulorhexis an easier and safer task when dealt   with such situations.  Ultimately, Vision Blue allows for a much safer procedure and higher quality outcomes for the patient which is a win-win scenario for all involved.

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