The capabilities of surgical platforms are constantly changing, with companies regularly introducing innovative new devices and features intended to make ophthalmic surgery easier, safer, and more efficient. Investing in state-of-the-art equipment can help an ambulatory surgery center (ASC) maintain its competitive advantage, improve the surgical experience for both patients and doctors, and lead to better patient outcomes. 

However, ASCs must also contend with declining physician reimbursements, greater scrutiny by health-care payors, and increased costs for supplies, staff, anesthesia, and other surgical essentials. These economic realities require ASCs to carefully evaluate and justify every new equipment purchase.

“The process starts when an individual surgeon has a technology that they want to bring on board,” says Inder Paul Singh, MD, who performs surgery at the Eye Surgery Center of Wisconsin in Oak Creek, Wisconsin. “You have to have passion [for a particular device]. You need to believe in its value strongly, because you will have to convince the ASC board and the other surgeons to allow that purchase to happen.”

Dr. Singh and other experienced surgeons say that convincing financial decision-makers to invest in new operating room equipment requires a strategic approach that clearly articulates the platform’s benefits, addresses financial considerations, and aligns with the ASC’s goals. 

Bring Fellow Surgeons on Board

To convince ASC management, it’s often necessary to enlist support from all the surgeons who will use the device. Jeffrey Levenson, MD, is part of a group of surgeons who own a stake in Riverside Park Surgicenter in Jacksonville, Florida, which is owned and managed by a corporate entity. “It can be like herding cats—every doctor prefers a different phaco machine or a different microscope or a different femto unit,” he says. When considering new equipment, Riverside Park will invite manufacturers to bring in their machines for a one-week trial. “That’s where we try to develop consensus between the different preferences that all the doctors hold,” says Dr. Levenson. 

Lawrence Woodard, MD, the medical director of Atlanta Eye Surgery Center in Georgia, agrees that gaining the support of other doctors in the ASC is a critical step. “There are three of us who operate at our ASC, and I am sensitive to their wants and needs,” says Dr. Woodard. “I don’t want to just tell people what to do and make surgeons unhappy, so I try to get everyone on board with the product.”

“The best strategy is to research the desired product, speak with surgeons outside the ASC about their experiences, and then speak with surgeons within your ASC to band together and request the item,” says Hemang Pandya, MD, vitreoretinal surgeon and president of the Dallas Retina Center in Dallas. 

Understand the Budgeting Process

ASCs typically develop an annual budget that includes funding for new acquisitions. The budget may include funds to replace or upgrade equipment that is broken or nearing the end of its useful life. There could also be discretionary funds that can be used for equipment, with opportunities for doctors to suggest new product ideas for consideration at regular intervals throughout the year.

The timing of equipment requests can affect how they are received by financial leaders, notes Dr. Woodard, whose ASC is owned by Surgery Partners. “If I go to the management in November and ask for a $300,000 femtosecond laser, they’re going to push that request off until the next year, unless a piece of equipment breaks down and we can’t perform surgery,” he says. “So I plan accordingly. But for something that’s less expensive, I  can pretty much go to them anytime and say, ‘Hey, I need this, and these are the reasons why,’ and they’ll consider it.” 

“I’ve worked with multiple ASC CEOs and management, and each have their own style,” says Dr. Pandya. “Some are more focused on keeping the surgeons happy, others are determined to cut costs.”

List Benefits to the ASC

Surgeons say they generally consider several things before requesting new equipment. First and foremost, does the platform or device allow the ASC to improve patient experience or outcomes? Second, does the equipment offer the potential for financial gain for the ASC, by enabling procedures that will provide a new revenue stream or increased reimbursement? And third, does the device improve the efficiency or flow of the practice? If the answer to all these questions is yes, the purchase is typically a no-brainer.

The ability of new devices to communicate or connect with others in the ASC has not always played a large part in purchase decisions, surgeons  said. However, as the interconnectability of surgical platforms increases, that seems likely to change. “In recent years it has become much more important to have technology that communicates with other devices,” says Dr. Woodard. “That has definitely been a shift, and it does play a factor in my choice of equipment now. As I look at the future, it will be important to have platforms that protect digital patient health information.”

Sometimes, a purchase can be justified if it makes the surgeon’s work day easier, says Dr. Singh. After having neck surgery, he found it uncomfortable to use the microscope for 30 to 40 procedures a day, so he asked the Eye Surgery Center of Wisconsin to purchase a 3D heads-up surgical display. 

“I said, ‘look, there’s no financial gain here with a heads-up display versus a normal scope, but I bring a lot of cases to the ASC and it’s going to make me more comfortable and help me last longer here,’” Dr. Singh explains. “Considering the surgeons’ health and well-being can bring an indirect benefit to the ASC. However, if the financial difference is huge, it’s not going to work.”

Evaluate Financial Implications

When it comes to the ASC’s bottom line, financial considerations are paramount. Demonstrating a clear financial benefit can significantly strengthen the surgeon’s case. Financial decision-makers need to understand how improved efficiency can increase the volume of surgeries performed in the ASC, thus boosting revenue. Potential cost savings from reduced operating times or lower complication rates should also be factored in.

At Riverside Park Surgicenter, the corporate financial team will help the doctors to create a pro forma financial evaluation, says Dr. Levenson. “We’ll have to give them some idea of how much volume we think we can drive with a new technology—will it bring more doctors, or more cases, to the surgery center? They’ll use that information to put together an excel spreadsheet that shows us how much cost or profit the acquisition is expected to bring to the ASC.”

Help Find the Best Deal 

Once surgeons in an ASC have agreed that they want a particular piece of equipment, they can act as intermediaries between the sales rep and the ASC’s financial officer, says Dr. Pandya. “Speak with the device company representative and request the best pricing possible. Also, request extended warranties and deferred payment. Advocate for the surgery center—especially if you’re invested. Your efforts will also help generate goodwill with your partners and the administration” 

A better deal can also be found if surgeons are willing to agree to use certain intraocular lenses (IOLs) or other products when acquiring the new device. “The manufacturers often try to ‘package’ purchases,” says Dr. Levenson. “The price of a phaco machine may vary if the deal includes the use of certain implants or certain viscoelastics. We often package acquisitions to make them more favorably priced.” 

“There are situations where if you bundle multiple products, you can lower the cost or get more favorable terms,” agrees Dr. Singh. “If there are lenses you like to use, that bundle can make a lot of financial sense for the ASC. The manufacturers like it too, because then they’ve got a long-term revenue stream as they make money from phaco packs or viscoelastic and all those things.” Service contracts can also be negotiated as part of a bundle agreement, he says. OASC