Convenience and the potential for additional revenue make it an attractive option.

When you perform cataract surgery, you want all the instruments you need close at hand. If that’s the case, wouldn’t you want the actual location of the surgery — the surgery suite — close at hand as well?

That’s one of the main ideas behind iOR Partners, a firm that works with ophthalmic practices to develop office-based surgery (OBS) suites. The firm helps physicians identify opportunities for performing surgery in the office, with an emphasis on cataract surgery.

iOR Partners provides expertise in space planning, accreditation and compliance, insurance reimbursement and staff training. It oversees the entire process — initial planning, suite development and ensuring compliance. To date, the firm has established dozens of these suites across the U.S.

OBS can result in a range of benefits: gaining independence from third-party entities; greater convenience and efficiency for both surgeons and patients; and higher revenue potential. Let’s look at each in turn.

DECLARING INDEPENDENCE

At its core, OBS places control in the hands of the surgeon instead of a third party such as a hospital or ASC. The surgeon does not have to rely on the cooperation of those facilities.

Here’s an example from Alan W. Brown, MD, founder, Surgical Eye Care, Wilmington, N.C.: During roughly the past 5 years, the time to travel round-trip from his house to a hospital where he could perform surgery increased from 20 minutes to over 90 minutes, when the main county trauma center hospital moved all anterior segment surgeries to another county surgery center then moved them again to a small associate hospital. Presumably because other surgical specialties are more lucrative, the local hospitals have a long history of progressively distancing themselves from ophthalmic surgery, he notes. “We looked into office-based surgery because we no longer felt valued by the hospital system.”

In addition, Dr. Brown and his partner became frustrated with hospital delays in providing up-to-date phacoemulsification technology. “We finally realized that the only way we could offer our patients the best in eye surgical care was to take the leap into office-based surgery,” he says.

Similarly, Young H. Choi, MD, medical director, InVision Ophthalmology, Birmingham, Ala., turned to OBS as he considered building his own ASC in Alabama, which is a certificate-of-need (CON) state. He met with iOR Partners at the November 2017 AAO annual meeting. “A light bulb just went off,” he says. “Why do an ASC when I can easily build out a surgical suite and start doing cataract surgery immediately?”

Dr. Choi converted a large LASIK suite to add cataract surgery and saw his first patient in February 2018. After a few months, he realized “this is going to work incredibly well.”

EFFICIENCY AND EARNINGS

With OBS, a surgeon gains greater control of his or her schedule. “Convenience of scheduling is huge,” says Daniel Durrie, MD, Founder, Durrie Vision, Overland Park, Kan., and chairman of the board, iOR Partners. “Now you can control your own schedule. You’re not working around a block schedule, so your staff and your time is much more efficient.”

“It’s extremely convenient” for patients, adds Dr. Choi. As his is a boutique practice, he offers same-day cataract surgery, with evaluation and surgery on the same day. That is especially appealing to patients who are coming from a distance.

As for earnings, “the barrier of getting into office-based surgery is a lot less than building out your own ASC,” says Dr. Choi. “So, you can immediately start having an additional revenue stream.”

JOINING THE WAVE

With such benefits, OBS may seem like a no-brainer, but it’s not suitable for every practice. One major consideration involves surgery volume. iOR Partners estimates a practice should average 40 cataract procedures per month.

Another is space, which runs between 750 square feet (for one OR) and 1,250 square feet (for two ORs), says iOR Partners. But space, notes Dr. Durrie, usually does not pose an issue. “We’ve not had a single instance where we could not find a solution for space.” Often, he notes, an existing space within the practice can be reallocated to OBS.

“This is a full OR, just like they would have in an ASC,” says Dr. Durrie. “It can be slightly smaller, because it’s ophthalmology-specific.”

Also, notes Dr. Durrie, OBS is best used by ophthalmologists who are “really interested in the growth of their practice.” These surgeons are interested in “being in the next wave, just as ASCs were in the ’80s and ’90s. OBS is certainly the wave right now.”

As to what the practice must invest, various arrangements exist. Most common is a turnkey approach — iOR procures equipment for a monthly lease to the surgeon and the practice pays a fee per case for services including space design, licensure, accreditation, compliance, supply management and revenue cycle management.

Besides cataract surgery, surgeons can perform other procedures in OBS suites, such as blepharoplasty and MIGS procedures, notes Dr. Durrie.

REIMBURSEMENT AND SAFETY

iOR Partners says that it has been successful with reimbursements from commercial, private pay, Medicare Advantage and Medicare across all types of procedures, and Dr. Choi confirms that he has received payment as well.

As for clinical safety, a 2016 study published in Ophthalmology of more than 21,000 cases found that “office-based efficacy outcomes were consistently excellent, with a safety profile expected of minimally invasive cataract procedures performed in ASCs and HOPDs.”

Dr. Choi maintains that the standard of care is not being sacrificed. “The data is out there that shows that it’s safe. My personal data that I’ve collected shows me that it’s just as safe.”

COVID SPARKS INTEREST

iOR Partners has seen greater interest in OBS since the onset of the COVID-19 pandemic. Dr. Durrie attributes this to two factors. First, COVID-19 shut down practices for months, which made ophthalmologists think, “How can I control my most important procedure?” In most practices, this is cataract surgery, says Dr. Durrie.

Second, says Dr. Durrie, “It made us all think again. People are saying, ‘I think it makes sense to do my surgery in the office. Is that possible?’ The interest level grew, because we had the time to think about it.”

“Patients are very interested in the OBS option as a means to avoid any association with an institution caring for COVID patients,” notes Dr. Brown.

In dealing with COVID, OBS provided Dr. Choi flexibility. “I don’t have to worry about another entity making decisions that may affect my ability to catch up on my backlog.”

EXPANDING FREEDOM

“OBS allows us to now give our patients the latest in surgical instrumentation in a significantly more convenient setting,” says Dr. Brown. “In a word, the biggest benefit to the iOR/OBS model would be ‘freedom’ — freedom to operate when we want and how we want.” OM