A panel of surgeons who have been involved with office-based surgery (OBS) shared their experiences and insights during a well-attended instructional course at the ASCRS meeting in Boston on Saturday morning. The panelists, who each represented a practice of a different size, style and region, included John W. Josephson, MD, ABO; Omar Shakir, MD, MBA; Dagny Zhu, MD, ABO; David A. Mittleman, MD, ABO; and Alison R. Tendler, MD. All disclosed consulting fees from iOR Partners, a company that helps doctors to implement office-based ophthalmic surgery suites. The physicians discussed the pros and cons of office-based surgery, addressing questions about safety and surgical outcomes as well as things to consider before implementing a surgical suite at a practice.
Dr. Tendler, who has had an office-based surgical suite in Sioux Falls, S.D., for 5 years, reviewed data from more than 68,000 successful OBS procedures, which showed safety outcomes consistent with hospitals or ambulatory surgical centers (ASCs). A big difference is that 99 percent of OBS cases utilize class A anesthesia (light oral sedation). “We want great outcomes, but we also want our patients to be safe and comfortable,” said Dr. Tendler. “Research shows that mild sedation is usually a better course of treatment for the patient. We would not be doing this if we didn’t think it was safe.”
Dr. Shakir, a cataract and retina surgeon at Coastal Eye Surgeons of Greenwich, Conn., discussed accreditation, insurance and reimbursement. He noted that the Joint Commission has agreed to work with iOR Partners on accreditation, and that OBS suites follow the same rigorous standards as any other licensed surgical facility. “There’s a partnership there with the Joint Commission,” he said. “They understand that this has to happen.” He also noted that the Ophthalmic Mutual Insurance Company and other national carriers have agreed to provide malpractice insurance under the physician’s license, as opposed to a facility license.
Dr. Zhu described how she bought into a small refractive practice with a surgical suite, NVision Eye Centers in Rowland Heights, California, after completing her fellowship. “It was nerve-wracking to go from a hospital to completely office-based, but if I can do it as a young physician, you can too,” she said. She cited several advantages of OBS, including the ability to offer surgery 5 days a week, bilateral cataract surgery, same-day surgical work-ups and repeat diagnostic exams, and the ease of adding urgent or emergent cases.
Startup costs and other considerations for implementing a surgical suite in the office were reviewed by Dr. Mittleman. The operating room will need about 700 square feet, with another 200 square feet for other areas. The cost of renovation versus a building addition must be considered, as well as equipment, supplies, informational technology infrastructure, licensing and permits, and staff training.