Viewpoint
FROM THE CHIEF MEDICAL EDITOR

High Society

Larry E. Patterson, M.D.

I recently wrote about the importance of being an Academy member, the one group we all should definitely join. But there are other, more specialized groups. You brave souls who treat only children have the American Association for Pediatric Ophthalmology and Strabismus. Glaucoma guys have the American Glaucoma Society. There are the equally creatively named Retina Society, Macula Society and Cornea Society. And the largest subspecialty group is my favorite: the American Society of Cataract & Refractive Surgery. These and others are well known for their educational endeavors as well as political agendas.

But what I want to discuss now applies only to those of you who perform surgery in an outpatient surgery center, or will be in the future. In case you're wondering, that's most of you. This means that most of you should have an interest in the work of the Outpatient Ophthalmic Surgery Society (OOSS).

Just 30 years ago, virtually all ophthalmic surgery was performed in hospital inpatient wards. Today, 66% of cataract surgery is done in freestanding ambulatory surgery centers. What transpired to so indelibly alter the surgical landscape? Technologically, in the late 1970s and throughout the 1980s, extracap and phaco — complemented by broad adoption of IOLs — improved surgical outcomes and reduced risks. Entrepreneurial surgeons, frustrated with the hassles of operating in the hospital, sought control of the operating environment by moving surgical care to freestanding centers. Hoping to capitalize on the opportunity to reduce Medicare costs, in 1983 CMS provided a facility fee (in addition to a professional surgical fee) to certified ASCs.

These visionary ophthalmologists figured they needed a place to network, to exchange ideas, to educate their colleagues and to lobby the government to improve the new federal ASC reimbursement program. Over time, this latter objective became OOSS's raison d'etre, and it became renowned for success in using the government to drive ASC growth. There are now 5,200 ASCs in the US, about a thousand exclusive to ophthalmic services. While the medical community at large has struggled to limit losses in professional fees since the mid-1980s — during my career, cataract fees have dropped from nearly $2,000 to about $600 today — cataract facility fees have increased from $336 to almost $1,000. Under the new ASC system, payments for many services such as glaucoma and vitreoretinal will increase substantially. Virtually every ophthalmic surgery is now eligible for reimbursement in the ASC. OOSS has repeatedly fought off hospital industry efforts to curtail physician ownership of surgery centers.

OOSS is, indeed, a "niche" organization. However, let's face it, it's a pretty darn big niche, and a growing one. I'm biased. I'm privileged to serve as the organization's president. I'm hoping that you and all of my colleagues who aren't currently practicing in an ASC will contemplate doing so — for the benefit of your patients, to enhance your productivity and to improve your bottom lines. In an era of health care reform, ASCs are part of the solution: they improve patient access and quality, and reduce costs. I hope that you will consider joining this very special "niche" society. It is an investment that will pay huge dividends.