Borrowing a Page from the Cataract Surgery Manual
Custom surgical packs for LASIK are a viable option for some practices.

As an increasing number of practices find it necessary to crunch and recrunch their LASIK financials, some are finding that they can reduce their cost per case by using custom surgical supply packs.

Dr. Peter Hersh, director of the Cornea and Laser Eye Institute at Hackensack University Medical Center and the UMDNJ-New Jersey Medical School, recently began purchasing custom LASIK packs, and it has saved his practice 15 to 20% in expenses. Searching for ways to trim costs and operate more efficiently, he and his staff took a step-by-step look at their LASIK procedure and the supplies they were using. "Initially, we were overordering, buying too many drapes, for example, and needing to stock too many glove sizes," he said. "So we've saved money in switching to custom packs, and made our technicians' jobs easier as well. Not having to open all of the supplies separately saves them several minutes per case."

The packs the practice currently uses contain:

• balanced salt solution
• drapes
• gauze pads
• merocel sponges
• surgeon and assistant gloves
• Mayo-stand covers
• microkeratome blades.

The practice is now in the process of fine-tuning what it orders. The surgery team is trying out a small number of newly configured packs before committing to a larger order. Dr. Hersh said starting slowly is a cardinal rule for practices switching to LASIK custom packs.

"Only order what you know you'll need," he said. "If you stock too large a number of packs and then decide to change something in your technique, you can get stuck with materials you don't need and will have to stock the new supplies separately. For example, now that it's time to reorder packs, we've decided to switch from BSS to lactated ringers for irrigation. I feel ringers solution is more friendly to the epithelium, and more cost-effective, too, when we buy them separately in large quantities."

Dr. John Doane, of Discover Vision Centers in Kansas City, has been using custom LASIK packs for about 4 years, primarily for the convenience of his staff. "They open one pack and most of everything we need for the procedure is in there. In essence, we've outsourced a tedious job," he explained. Dr. Doane has changed the contents of his packs over the years. He no longer includes Merocel sponges, for example, because he found the extra step made them change shape.

Analyze the potential benefits

While switching to custom packs creates a cost savings for some practices, for others it may not. At Eye Centers of Florida, where Dr. David C. Brown and other surgeons perform a high volume of cataract and all types of refractive procedures, LASIK isn't isolated from other supply-driven procedures.

"Most of the LASIK supplies are also used in some capacity in the many other surgeries performed daily," said Gina Stancel, administrator of the Surgicare Center. "So, combining inventory and supplies allows us to take advantage of very good high-volume discounts, and that represents more of a cost savings for us than packs would. Specialty items for LASIK consist only of the microkeratome blades and the suction tubing. And we've had tremendous help reducing our cost per case because more companies are now offering blades."

Stancel said that if a surgeon performs LASIK, but doesn't have his own ASC, using custom packs could be an advantage. "He wouldn't have to keep inventory and have somebody constantly fighting the price war."