The Future of Surgery

Today, robotics has pushed on the boundaries of medicine to be accepted as trusted devices in the operating room.  The new “Da Vinci” system has had a high impact into the surgical world allowing surgeons, controlling robotic arms and viewing three-dimensional images, while operating through micro incision entry points.

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Microrobots are on the horizon as well.  Miniature robots that are swallowed to gather information and/or images so more accurate and perhaps fewer incisions for the patient.

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As new technology evolves, the cataract procedure keeps evolving as well.  Smaller incisions, instruments, intraocular lenses keep pushing forward the newest techniques.  NASA has even provided new technology that can detect the formation of a cataract before it is clinically visible, thus a camera predicting the future arrival of a cataract.

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As the future of surgery, our greatest challenges will still be, to maintain the highest level of surgical outcomes while justifying the return on investment for hospitals and surgical centers.  As our future looks so ever exciting in the world of surgery we dare to look behind at what cost will be following.

Choosing a Cataract Surgeon

Having a good cataract surgeon should be as important to a patient as having good vision. Typically, patients don’t consider their options after the decision is made to have cataract surgery. Ninety-nine percent of the time, a patient either chooses the ophthalmologist they’ve used for eye examinations and/or medications or goes with the surgeon recommended by patient’s optometrist. Here are a few things for patients to consider when choosing their cataract surgeon.

The easiest step is getting recommendations from family, friends and associates who have had cataract surgery. Yes, word of mouth is a good source of information, but we strongly recommend you don’t stop here. In addition, a patient should seek their optometrist input, as well as outside, independent resources.

Family, friends and associates can provide insight into the “before, during and after surgery” aspects of the procedures. In addition, they can shed light on how much vision improved or diminished after cataract surgery. As importantly, it’s good to understand the follow up services received by the surgeon (“MD”) and optometrist (“OD”) in the days and weeks following surgery.

On the advice from an optometrist, one thing to ask is whether or not the OD and MD are in a co-management relationship. Co-management means that the OD and MD have agreed to work together on overseeing cataract patients. With the OD identifying the cataract, he/she educates the patient on cataracts and the steps taken in cataract extraction. The OD then refers the patient to a MD for cataract surgery evaluation. If MD deems that a cataract extraction is necessary, surgery date is scheduled. After surgery and assuming some type of co-management or cataract outsourcing arrangement between OD and MD, patient will see MD maybe once after surgery. If surgery results are good, patient will be referred back to OD for continued post surgical care and oversight of the cataract patient.

In terms of independent resources, it is recommended that you seek information on a surgeon’s educational background, board certification, length of time as practicing ophthalmologist and number of cataract cases performed in last 12 months. Often times, some of this can found on the internet. Alternatively, you may want to call surgeon’s office requesting such information.

Though surgical outcomes by MDs are not available in today’s healthcare environment, it is the government’s long term plan that such information will be accessible to all.

Increasing ASC Profits with Eye Procedures

The key to adding or providing eye services to a center is having a good surgeon, team-oriented staff, cost effective supplies & efficient scheduling. However, this is easier said than done, as if any of these components are deficient, the system runs inefficient and the profits are diminished. So let’s examine each of these four factors to see what a center needs to do in order to add ophthalmic procedures to their center or what changes are needed with existing ophthalmic services in order to improve the center’s profits.

SURGEON: Make sure your ophthalmologist is not only interested in performing eye procedures (i.e. cataracts, YAGs, blephs, etc…), but doing so in an efficient and profitable manner. The ideal surgeon is one who arrives to center on time, takes less than 10 minutes to do a case (“skin to skin”), uses topical anesthesia, operates using two ORs, takes no breaks between cases, schedules all non-cataract procedures either before or after cataract procedures and is conscience about both quality and costs when using IOLs, supplies, micro-instruments and equipment. If your surgeon averages more than 30 minutes (“skin to skin”) to perform a cataract procedure, he/she is probably not the surgeon for your center… that is, if you plan to make money doing eyes. The most efficient center our company has seen is one where by 7:25am first set of 6 patients are lined up in pre-op area with eyes fully prepped for surgery. At 7:30am, surgeon begins 1st surgery, finishes 1st case at 7:36am, and exits OR1 at 7:37am. At 7:38am, surgeon enters OR2, begins 2nd case at 7:39am, finishes 2nd case at 7:45am, and exits OR2 at 7:46am. At 7:47am, surgeon enters OR1 and process begins all over. This particular center is known to average anywhere from 35 to 50 eye cases in a given day (sometimes given morning). Their most efficient day was when they started their 1st case at 7:30am and their last case left the center at 1pm, doing a total of 37 cataracts and 10 YAGs. Talk about a “well oiled” eye machine!!! After hearing this, you’re probably questioning surgical outcomes with this surgical operation – have no fear, outcomes are superior and patients are coming from a 100+ mile radius to have their cataracts removed as they’ve heard wonderful things about this surgeon and the efficient center in which he operates. Remember our patients live in an impatient world where service & efficiency is king.

STAFF: At all times, the team objectives must be (1) quality service to patients and surgeon, (2) streamlined patient movement between stations, i.e. waiting room, pre-op, surgery suite, post op, releasing patient to family member, (3) maintain set system for instrument processing and room turnover and (4) never allow a surgeon to wait for you in the OR, and (5) never stop working until the last patient leaves the center and all paperwork is completed. As mentioned above, our company, Vantage Outsourcing, provides cataract outsourcing services to numerous surgery centers and hospitals We see a lot of variation in staffing for ophthalmic procedures. One of our centers referred to above (doing 35 to 50 cases in less than 6 hours) has the following staffing requirements:

1 clerical staff checking in patients
1 RN in Pre-op area
1 LPN floater in Pre and Post op area
1 circulator in each OR
1 scrub tech in each OR
1 Vantage Outsourcing technician (takes care of equipment and assists in room turnover)
1 RN in Post op
1 float person, who is capable of handling most positions, whether it be assisting in patients’ admissions, room turnover and/or patients’ dismissals

This center truly runs like a well-greased engine with surgeon and staff working like a team from start to finish. If every center staffed and operated like this group, all centers would welcome ophthalmic procedures and would significantly increase their profits in their centers.

SUPPLIES: Cost containment can be summed up in ten words. “Supply functionality & results are everything, brand name is secondary.” Too often, a surgeon and/or staff get caught up in thinking only one supplier can meet their needs or have the superior product. This is simply because this supplier is the only one they have ever used or the supplier’s marketing ploys have worked wonders on the surgeon’s psyche. Besides, who in the world has time to research alternatives to the numerous ophthalmic supplies that a surgeon uses in the surgical suite? One entity that prides itself in being vendor independent is Vantage Outsourcing, a cataract outsourcing company that provides all disposable supplies needed for any and all cataract procedures (including all IOL brands), as well as all brands of cataract equipment, microscopes and micro-instruments. Vantage has saved centers nationwide by significantly reducing their disposable costs and eliminating capital equipment outlays. Areas of costs that can get out of control are IOLs, viscoelastics, blades, procedural packs and drapes. For example, a center could increase their costs by as much as $15 in drapes alone. Another factor of this higher priced drape is that it lacks fluid pockets. So, not only is your center spending $15 more, but it’s incurring more staff time with clean-up and turnover because this higher priced drape doesn’t catch fluids. Keep in mind, a surgeon requests a particular drape simply because that’s what was used in their medical training days. So, sitting down with a surgeon and explaining all aspects of drape costs, could result in increased profits to your center.

SCHEDULING: A good scheduler works hard at having the patients arrive in time to properly prep them for surgery but not too early that they are sitting in the waiting room twiddling their thumbs. Another key function of the scheduler is to work tightly with the pre and post op staff to make sure that each station is fully equipment with the right number of patients in pre-op area getting ready for surgery and those fully prepped and waiting to enter the OR. Finally, the good scheduler will make a mental note of each patient’s family member(s). This helps in knowing who to contact when call arrives from post op nurse that patient is ready for family to join them. On another note, the surgeon can help in minimizing patient waiting room time by prescribing dilating drops to be taken at home the morning of surgery. Having the patient arrive to the center already dilated saves the center supply & labors costs. For one, the patient is paying for the drops and related supplies needed to administer drops, as opposed to the center. In addition, the staff saves time by not having to administer drops when patient arrives to the facility. Most importantly, the patient spends 30 less minutes at the center by administering dilating drops at home.

By evaluating these 4 important aspects of ophthalmic services, your center is guaranteed to provide quality eye service to your patients in an efficient and profitable manner.