Chances are, having enough toilet paper on hand isn’t an issue for your ASC. Still, Mr. Peters’ point is well taken: When eye surgeons go to battle against foes like cataracts, it’s vital that they have their “bullets,” i.e., intraocular lenses (IOLs), at the right place, at the right time.

Indeed, the difference between having and not having the right IOL can mean the difference between completing a procedure and having to postpone it for another time. Inventory management is crucial to the success of every ASC. And although it may not be rocket science, IOL inventory management does have its challenges, and slipups and oversights can disrupt daily operations, including surgical schedules.

“If you don’t have an adequate amount of supplies, you could have to cancel cases or cause lots of stress trying to make it through the day,” says Mary Farley, account manager at the Cleveland Eye Clinic in Cleveland, OH, where an estimated 5,000 cataract surgeries are performed annually.

Purchasing vs. Consignment

With respect to acquiring and maintaining their inventory of IOLs, ASCs can choose between two primary approaches: purchasing lenses outright or acquiring them on consignment. Just as it sounds, ASCs can buy IOLs from manufacturers and keep them in stock until they are needed. Under consignment, ASCs obtain IOLs on “loan.” The vendor delivers a specified quantity of requested IOLs, which the surgery center doesn’t have to pay for until they are used.

Most centers rely on a combination of both approaches. Consignment works best with frequently used IOLs, such as standard lenses that are available in a wide range of diopters and cylinders. Purchasing is best reserved for premium IOLs that aren’t used as often.

“We do use a combination of both consignment and special order, as we don’t want to keep lenses on hand that are not ‘turned over’ regularly,” says Debra Bryant, ASC business manager at Northwest Eye Surgeons in Seattle. “We will special order specifically if it is a high or low diopter outside our consignment range.”

One notable advantage to the consignment approach is that the ASC doesn’t have to devote as much of its own money to inventory management, says William Wiley, MD, medical director of Cleveland Eye Clinic.

“It’s always nice to have somebody else own [the IOLs],” Dr. Wiley says. “You don’t have a lot of your capital tied up in that inventory.”

“We have lots of lens consignments, which saves on shipping because we don’t have to overnight or second-day specialty lenses,” Farley adds.

Straightforward as these two approaches are, they have their challenges. One is that both carry “expiration dates.”

Under consignment, for example, an ASC must be sure to use its IOLs within a certain amount of time. If it fails to implant them, the vendor can take back the IOLs and deliver them to another ASC more likely to implant them sooner.

Lenses that are purchased by the ASC, meanwhile, must be used by their expiration date; otherwise the ASC cannot return them to the vendor.

It takes careful tracking by the ASC to ensure it isn’t charged for IOLs that go unused. For this reason, ASCs employ various measures and strategies to stock just enough IOLs to avoid either not having enough IOLs to meet demand or having so many IOLs on hand that they go unused.

Making a List, Checking it Twice—or More

One strategy that Cleveland Eye Clinic uses is to maintain a “lens list” of every IOL that’s been either consigned or purchased.

“I know which lenses I’m likely to be using on any given day, and our staff only has to periodically check the lens list to ensure everything’s there,” Dr. Wiley says. “There may be a rare situation where I’m going to use five 20-diopter lenses but there are only three in the consignment, so it’s always a good idea to check the list and make sure we have them.”

Northwest Eye Surgeons’ ASC technical supervisor, Tawni Wahl, also maintains an IOL log sheet, which does double duty as a reorder form “so we don’t have to have two separate sheets.”

The center also employs different purchase order numbers to clearly identify which of the many lenses in their stockpile are on consignment and which ones are special ordered.

“For example, we do PO#25325C (for consignment), and PO#25326SO (for special order),” Wahl says.

Add Special Orders to the Consignment List

Special-order IOLs are also added to consignment whenever possible at Northwest Eye Surgeons so that the ASC doesn’t have to pay for them until they’re used.

“Special-order lenses have to be tracked and returned within a specific amount of time so that you don’t get charged for them or they are no longer returnable,” Wahl says. “Adding [them] to their consignment ensures that the ASC isn’t billed until the lenses are used.”

Track, Track, Track

Northwest Eye Surgeons also tracks how many of each type of IOL are used over a three-month period and then bases its consignment needs on the results, Bryant says, adding that they “increase or decrease the diopter ranges as needed. Pulling the lenses ahead of time to see where the holes are in the inventory is helpful for tracking and filling the gaps” in the lens inventory, she says.

Bryant strives to get all the surgeons who operate in an ASC “on the same page” with respect to IOL selection. “Using the same lenses greatly decreases the manpower and stress on the staff in trying to manage and maintain [inventory],” she says, adding they also recommend that surgeons order lenses as early as possible before a procedure. “This allows staff to pull the lenses and have everything needed well before the surgery date,” she says.

Farley, meanwhile, buys IOLs in bulk whenever possible.

“I’m also a big fan of doing the bulk purchases because it usually gets you a cheaper price, and you always have supplies on hand, which again saves on shipping costs.”

Going Digital

Inventory management can be quite complex, depending on ASC size and patient volume.

Farley and Bryant both utilize an electronic inventory management system at their respective surgery centers, and both recommend that ASCs acquire and employ the technology. These web-based inventory management systems offer many benefits to ASCs, including the capability to receive and track IOLs; generate purchase orders and create multiple orders simultaneously; electronically generate and submit returned goods authorization returns; automatically generate shipping labels and access shipping history; and generate reports to search and verify accurate inventory counts.

“I recommend using an electronic inventory management system, for sure,” Farley says. “Our system is great for facilities like ours that have multiple lenses in stock. It’s also great for generating reports, saving time on billing, and replacing lenses.”

The electronic system requires staff only to scan lenses in as they arrive and then out as they are used, she says, adding that the management system then takes over, communicating with each vendor for billing and IOL replenishment. “It’s a combination manual and automated system,” Farley says. “The surgical techs still have to scan those lenses in and out, but the system pushes notifications out automatically to the vendors.

“It’s a pretty good system because we have a large inventory of lenses and consignments from a lot of different vendors,” she says, noting that her ASC stocks “thousands” of IOLs at any given time. ■