Management Essentials

Is Femto-Phaco in Your Future?

By Farrell “Toby” Tyson, MD, FACS

The answer is most certainly yes. The real questions are how and when. Femto-phaco is currently supported by no fewer than four companies, meaning a lot of time, resources and people are signaling that this is the next big advance in cataract surgery. However, the technology is emerging in poor economic times with a high cost of entry and maintenance. To figure out when and how to implement this technology into your practice, evaluate the initial acquisition, carrying costs and impact of adoption on your practice.

Pricing and Patience

The initial purchase price gives most practices hesitation — there is definite sticker shock when a half million-dollar price tag is in discussion. The cost is a little easier to swallow when the unit is housed and used at a shared facility. If there are five or more surgeons using the equipment, the purchase price drops under a hundred thousand per surgeon. Single-surgeon ASCs will have a harder time amortizing the purchase, which will drive the roll on/roll off model and a greater cooperation between local surgeons.

Whenever new technology emerges, there is a rush of individuals who want to be early adopters. Femtophaco's complex technology does not currently lend itself to mass production, so the first machines will roll out slowly to the market and prices will remain high. Staying patient and waiting as production and competition ramps up could pay off with lower prices. In addition, early “bugs” and “gremlins” should be worked out.

Fees and Billing

Once the decision to purchase has been made, a practice needs to evaluate the yearly costs of ownership of a femtophaco platform. While many surgeons think that the purchase price is the biggest expense, the largest cost over a five-year period is actually the per-use click fees. Aggressively negotiate your click fees and annual maintenance contract to make a system financially viable.

Click fees usually hover around $500 or less, requiring a patient charge near $1000. This technology needs to be made available to all patients regardless of lens type. There will probably be some cannibalization of the lower power toric market by intrastromal femto AK.

Documentation and explanation of any patient-billed procedure needs to be thoroughly researched for a practice or group's pricing structure for femto-phaco and premium lens use. Intra stromal astigmatism treatment is currently the only part of the femto-phaco procedure that can be billed separately from cataract surgery. Femto-phaco will make near-perfect cap sulorhexis and corneal incisions, hopefully leading to more accurate outcomes, but those steps are already paid in your cataract global fees.

Changing Practice

In the past, only 8% of IOL implants were multifocal, meaning most practices have not made a wholehearted effort to integrate premium lenses. This will have to change if femtophaco is to be implemented successfully. An ophthalmology practice will have to change from an eyecare practice to a “Premium Vision Experience.”

Workflow and production will have to adjust to accommodate the femto-phaco: Will the laser be placed inside or outside the OR? Will patients have their procedures done in a se rial or batch fashion? Cases will take longer on surgery day but will hope fully be compensated by happier patients and less complications.

Femto-phaco is the future. This technology will go through its growing pains of adoption just as phacoemulsification did before it. The learning curve will luckily not be as steep, but the costs will still seem relatively high. Time and experience has taught us that with innovation, prices go lower and capabilities increase as adop tion accelerates. The surgeons and practices who know how to embrace change will be well served to tackle the future today. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.