OASC | TECHNOLOGY

Just Roll With It

USING A MOBILE FEMTOSECOND LASER FOR CATARACT SURGERY IS A SENSIBLE — AND INSTANTLY PROFITABLE — WAY TO BRING THE LATEST TECHNOLOGY TO YOUR ASC.

By Desiree´ Ifft, Contributing Editor

On-demand mobile surgical solutions for femtosecond laser-assisted cataract surgery are allowing ASCs to plow through past barriers to make this state-of-the-art technology available to surgeons and their patients. All types of surgery centers are taking advantage of the mobile and/or rental option. These ASCs can be found in both rural and metropolitan areas and may be ophthalmic-focused or multispecialty centers. While most facilities initially take the mobile approach to phaco surgery because their beginning case volume is too low to justify purchasing a laser, some have passed the break-even point but prefer to stick with the mobile option, appreciating its advantages:

■ the technology is available at the ASC without the large capital expenditure and high annual maintenance fees associated with purchasing a laser

■ revenue is generated with each use; there’s no wait to arrive at a cost-income break-even point

■ the laser is always up-to-date; no worries about upgrading or obsolescence

■ no need to hire additional staff to handle laser operation and maintenance

■ the laser only occupies space in the facility when it’s being used

■ the ASC can use the availability of the laser to attract new surgeons who want to use a femto laser.

Two providers of mobile surgical equipment that have added femtosecond lasers for cataract surgery to their service offerings are Sightpath Medical (sightpathmedical.com) (Figure 1) and ForTec Medical (fortecmedical.com) (Figure 2). In business for 26 years, ForTec’s first mobile equipment offering was a YAG laser for ophthalmology. Today, the company provides mobile technology to more than 10 medical specialties, averaging 60,000 equipment mobilizations per year. Sightpath, which focuses on ophthalmology, recently logged its 2 millionth procedure.

Figure 1. Ben Kohler, a senior engineer with Sightpath Medical, arrives at a surgical site with a LenSx laser (Alcon).

Figure 2. A Catalys laser system (Abbott Medical Optics) is mobilized onto a ForTec Medical truck.

Kelly Clayton first became familiar with the benefits of utilizing mobile laser technology in the context of LASIK more than 10 years ago. Today, he sees the same success with mobile femtosecond laser technology for cataract surgery at Richens Eye Center in St. George, Utah, where he’s the practice administrator. Sharon Richens, MD, who co-owns the Coral Desert Surgical Center, also in St. George, uses a LenSx laser (Alcon) supplied by Sightpath. “The mobile option was really the only option for us when we considered the total overhead of a femto purchase,” Clayton says. “It gave us the ability to introduce the new technology to our patient population without the need for a patient volume that we felt was unattainable right out of the gate. The mobile platform was profitable on day 1 and had we purchased a laser, that would not have been the case. We’ve always been able to meet the minimum number of cases specified in our Sightpath contract. In fact, we quickly exceeded the minimum and began requesting more days with the laser. Patient acceptance has continued to increase because of great surgical results and effective marketing.”

Jeffrey Starkey, MD, who practices with the NEOVision Group in Akron, Ohio, and is one of several owners of the Parkwest Surgery Center, is convinced that femtosecond laser technology has taken a good procedure and made it better, improving his outcomes. “By contracting with ForTec to bring the Catalys laser (Abbott Medical Optics) to the ASC only when I want to use it, I get to use a technology I’m very excited about not carrying the risk of buying or leasing it,” he says. “I don’t have to think about the possibility that I may not like a particular laser platform or that it may become obsolete before I’ve earned return on my investment. At the end of the day, I don’t have to pay for an annual maintenance agreement or keep the laser running and calibrated. ForTec takes care of that.”

How the Mobile Option Works

Drs. Starkey and Richens are the only surgeons at their ASCs using the femtosecond laser for cataract surgery, so they have contracts with the mobile technology companies (as opposed to some situations in which the facility is contracted with the mobile tech company). ForTec offers 1-year contracts, while Sightpath contracts last 3 years. Each company charges per procedure for use of the mobile laser and sets a minimum number of eyes per visit.

Femtosecond Cataract Surgery Days at Parkwest Surgery Center

For December 2014, Jeffrey Starkey, MD, had scheduled ForTec Medical to bring the Catalys femtosecond laser (Abbott Medical Optics) to the Parkwest Surgery Center in Akron, Ohio, on 4 days. He operated on 10 to 14 eyes during each visit. The laser arrives the night before surgery, and the ForTec technician sets it up in a procedure room where the ASC houses a YAG and other lasers. “When we built the center, we had a verbal agreement with a group of pain management doctors that didn’t work out, so we now have this large extra room, right outside the OR door, which works well for our femtosecond laser days,” Dr. Starkey says. “The Catalys has its own fixed bed, so some facilities keep it in an OR, but we move our patients around in a wheelchair.”

The technician calibrates the laser and is present for the entire procedure, helping Dr. Starkey to navigate the screens efficiently. One of the ASC’s RNs is in the OR as well. Dr. Starkey’s surgical coordinator is also at the surgery center on femtosecond laser days. “It’s not absolutely necessary for her to be there, but we like her to be because she’s a familiar face to patients. She talks with them, supports them and keeps them comfortable.” Dr. Starkey usually starts the femtosecond surgery part of the day by consecutively marking three eyes in the prep area. While the first patient is getting prepped and draped, he performs the Catalys part of the procedure on two consecutive patients in the procedure room. After finishing the first case in the OR, he speaks briefly with that patient’s family, marks another eye, uses the Catalys on the next patient and then goes back into the OR. “So it’s mark, femto, phaco,” he says.

Some tips from Dr. Starkey:

• Designate someone in the ASC who can function like a field general, helping the surgeon to figure out the most efficient process for the laser and directing him where to go next.

• Surgeons and ASCs should plan on the femto cases taking twice as long at first as they will after more experience. Schedule enough time to avoid stress about falling behind schedule.

ForTec requires a minimum of eight procedures per visit and 60 procedures annually for the ASC. Surgeons operate on 10 eyes to achieve certification for using the laser. Once the surgeon is certified, the eight-eye minimum isn’t enforced for the subsequent two laser visits. Also, the company doesn’t require the contract to be signed until after surgeon certification. “We try to make it risk-free and as economical as possible for the customer to get in,” says Patrick Filipovitz, ForTec Medical’s VP of Sales and Marketing. Sightpath’s only requirement is that a minimum of six eyes per laser visit be performed. With both companies, the per-procedure price decreases with volume, i.e., the number of cases performed during a visit.

According to Tim Warrell, Marketing Manager at ForTec Medical, how ASCs schedule their laser visits varies. For example, one center has six to eight surgeons using the laser, and they cluster all of their surgeries into 1 week per month. “That’s smart for pricing,” Warrell says. “That type of scheduling, having the laser for several days in a row, can push the cost to below $700 per procedure. It’s higher when the laser is stopping at a location for 1 day a week.” Volume drives down the price for surgeons and ASCs using Sightpath’s services as well. “Our customers average about 10 eyes per stop,” says Joel Gaslin, Vice President of Sales and Marketing at Sightpath. “Some of them, however, have the laser for multiple days at a time. We’re at one ASC, for example, for 3 days every other week. In those latter scenarios, the cost per procedure goes below $700.”

The per-procedure fee includes the services of a technician who travels with the femtosecond laser and is trained by the manufacturer to set up, calibrate, ensure proper operation and, if necessary, repair the laser. ForTec says its technicians also can assist during the procedure by programming the laser settings at the surgeon’s request or helping to manage the flow of patients to and from the laser. Sightpath notes its technicians can assist with the procedures and also specialize in keeping patients calm and comfortable before, during and after the procedure. “The technician is something our customers really appreciate,” says Sightpath’s Gaslin.

Femtosecond Cataract Surgery Days at Coral Desert Surgical Center

In December 2014, Sightpath Medical delivered the LenSx femtosecond laser to the Coral Desert Surgical Center on two separate days. On each of those days, Sharon Richens, MD, operated on about 12 eyes. This year, the laser is scheduled to be at the center 3 days per month. “We coordinate our femto days closely with the ASC and give them our scheduled days a year in advance,” says practice administrator Kelly Clayton. At each visit, the Sightpath technician sets up and calibrates the laser in one of two rooms. One option is a pre-op room that’s used less often than others, mainly for pediatric patients. The other option is an endoscopy room, which is large and only used once per week. “We prefer not to occupy one of the ORs with the laser because working out of just one OR decreases efficiency and profitability for both the surgeon and the ASC.”

He continues, “We’ve found that starting with a traditional cataract surgery as the first case of the day is very helpful. The flow is as follows: While the ASC is prepping the traditional case in the OR, the surgeon is performing the first femto case. The surgeon then performs the traditional procedure in the OR while the first femto case is being moved to the second OR and the second femto case is being moved into position in the laser room. When the surgeon finishes the first case in the OR, she goes back to the laser room for the next femto case and then to the second OR where the first femto case is now ready. She continues to go from OR to laser room until all cases are completed.”

Some tips from Clayton:

• A key factor for success with femtosecond laser-assisted cataract surgery is staff buy-in, including the practice’s optometrists. “We had every member of the staff, over a month period of time, watch Dr. Richens perform femto surgery so they could see the amazing technology in action,” he says. “This got them excited about the procedure but also gave them the ability to talk about it with the patients and their families. Having every staff member out of the office for a half day watching surgery was costly but it was a great way to help them — and in turn patients — see the benifits of this new technology.”

• Clayton also notes, “To really make this project successful and profitable, the practice should have a surgical counselor who can explain the surgical options, including premium IOLs, in detail to each patient. For us, this occurs after the surgeon has seen the patient and made a surgical recommendation. If you have the right counselor, he or she is well worth the expenditure. We have two surgical counselors who are ultimately responsible for helping patients decide on their surgical options based on the surgeon’s recommendation.”

• Marketing can be expensive, but it builds volume. “It has been a huge help in introducing femtosecond technology to our area,” Clayton says. “We were the first to offer it, and we capitalized on this fact. We’ve used print, radio, patient seminars, health fairs, e-mail to our existing patient base, billboards and ads on the side of city buses.”

Value-added Services for Planning and Marketing

Representatives from Sightpath and ForTec understand that the incorporation of femtosecond laser-assisted cataract surgery ASC involves far more than the equipment, so they offer help in making the transition. “We assist with steps in the adoption process so they can get up and running quickly and effectively,” ForTec’s Warrell says. “We provide marketing assistance, such as promotional materials, information and graphics for websites, and tablets with educational animations for patients, and we encourage pre-launch planning meetings for clarification of key issues, such as staff roles.” The company is also hosting 32 educational workshops across the country in which surgeons can learn from opinion leaders and colleagues who have experience with femto.

“We help our customers think in global terms of adding a procedure,” Sightpath’s Gaslin says. “We’re building an inside agency comprising writers, designers, marketing professionals and people who are knowledgeable about market trends. We have a 75-day plan that builds case volume while preparing practices for their femtosecond launch. We cover the ‘four Ps of marketing’ (product, price, place and promotion) by providing practice development tools, including staff education, video tutorials, recorded webinars, internal marketing tools, messaging for the referral network, press release samples and radio/TV scripts, some of which are available through an online self-service portal. We also help in making sure all of the right forms, such as ABNs and informed consent, are in place,” says Clayton of Richens Eye Center. “They’ve seen many practices implement the technology, so they know the good ideas and the bad,” he says regarding Sightpath.

A Durable Solution

Neither Clayton nor Dr. Starkey rules out the possibility that their practices will eventually buy their own lasers, but for now, they’re happy with the mobile option. “ForTec has been great to work with, and the machine has worked impeccably for me,” Dr. Starkey says.

Clayton estimated that 23 cases per month would be the break-even point for Richens Eye Center if it were to purchase a laser. At the end of last year, they were averaging right around that number, and expect to exceed it in 2015. “But we like the Sightpath model and feel the laser technician is a real bonus in that he provides experience and skill. Also, why aim for just slightly above breaking even when considering a purchase option? If Sightpath has the ability to provide us more days in the future, I’m not sure it makes sense to purchase a laser unless the cost to purchase drops significantly.” ■