FEMTO FACTOR

There’s value in access

Take a big-picture view of alternatives to FS laser ownership.

By Scott LaBorwit, MD

A surgeon’s time and level of convenience become critical in a busy schedule. That may seem obvious, but it’s something you need to keep in mind before getting involved in laser-assisted cataract surgery (LACS). Because the costs related to access are steep, it would be understandable to take shortcuts. Be warned, however, that you may end up paying a high price on convenience later.

In the last two years the number of cataract surgeons using laser technology in surgery has increased exponentially. Due to the significant financial commitment required to get this technology into your surgical center, many partnerships, rental agreements and alliances have been formed. However, surgeons often are finding that although they now have access to the technology, their situation requires serious compromises. Here are some real-life cautionary tales.

THE ART OF THE DEAL

Initially I was alone in my area with LACS, but these days more than 20 local surgeons have joined the club. They obtained their access in a variety of ways: purchase, rent and roll-on/roll-off. Sometimes surgeons formed groups to share the costs; others went to new centers that had a laser.

One new surgeon I know switched surgical centers to gain access to an FS laser one Thursday each month and shared that day with three other doctors. It seemed like a great idea since it demanded no financial commitment long term, just pay as you go. But after about three months, she had to change her schedule and OR day to accommodate the specific day the center had a laser; when her day came, she often was delayed by other surgeons’ times running over.

Another challenge was having to schedule a patient’s second eye a month later. And if the patient canceled or rescheduled, he or she had to wait another month for the surgery. This surgeon found a way out of these difficulties with a new surgical center that owned an FS laser; she could schedule patients twice a month with block time and not share a day.

NOT SO TERRIFIC

Another surgeon gained access to femtosecond LACS by moving to a center 30 minutes further away than his usual center. Not having block time at the new locale, he found it was harder to squeeze in cases. Further, he found that cases didn’t always go as smoothly. Mostly this was because the surgeon was in an unfamiliar place and staff just did things differently. Over time he felt this would improve, but switching centers was an unexpected challenge when the initial decision was made to gain access to LACS.

PENNY-WISE, POUND ...

One group of doctors decided to have a laser “roll on/ roll off” brought into their surgical center twice a month. However, this limited LACS surgery to certain days, creating a struggle among the group about block time. Although the roll-on/roll-off deal was inexpensive as they only had to pay per case with a low minimum required each day, after about four months the volume of LACS cases was much more than expected. They were paying more than twice per month what they would have if they had purchased the laser, and still had 20 months left on their contract.

COMMITTING TO THE TECHNOLOGY

I purchased a femtosecond laser four years ago, expecting to take a loss over five years. My business plan needed 17 cases a month to break even, thus 20% of my patients would hopefully choose LACS. Because I owned the laser, I did not need to juggle my schedule with others. Fortunately, from the start more than 65% of my patients chose LACS, exceeding the needed 17 cases by more than 50 cases each month.

About two years ago, I opened a new surgical center connected to my second office, 30 minutes from my original center with the FS laser. I knew I had to have a femtosecond laser in this new center too; it would be difficult to grow a practice if each patient getting LACS had to drive 30 minutes away. Luckily, owning two lasers was not financially overwhelming because at this point many surgeons were interested in the technology and we partnered in owning both lasers. Additionally, several doctors use both centers and pay as they go, helping defray costs.

Be sure to incorporate the value of your time when considering ways to access LACS technology. Talk to surgeons currently performing LACS to learn the pluses and minuses of their situations. The value of access often exceeds economic consideration; integrate it in any business plan. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His email is Sel104@me.com. Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.