Ophthalmic surgery centers often depend heavily on Medicare reimbursement due to the age of their clientele, meaning administrators must work particularly hard to cut costs to make up for low payment rates. Here Kathy Stout, RN, administrator of The Eye Surgery Center of the Carolinas in Southern Pines, N.C., managed by Surgical Care Affiliates (SCA), and Jan Stivers, eye program manager for SCA, discuss 5 opportunities for cost savings in an eye surgery center.
1. Look for opportunities to save money on supplies and equipment. Supplies and equipment can be a significant expense for ophthalmic surgery centers. Ms. Stout says the most expensive ongoing expenses include equipment maintenance contracts, human tissue and implant costs for cornea and glaucoma cases, and pharmaceutical expenses. Here she offers several strategies to cut supply costs with a few small changes:
• Plan for start-up expenses. Ms. Stout says her ASC's start-up expenses included microscopes, phacoemulsification equipment and retina equipment. She says once the ASC has spent money on these items, the expenses should not come up again for a while. "It varies by physician preference, but in my experience, phaco equipment lasts about 5-10 years. Microscopes can go longer," she says.
She says that as her surgery center was starting out, the physicians attended meetings where supplies and equipment were showcased and then asked the center to trial the products. "We didn't just accept what was brought in," she says. "We made decisions based on what was best for the patient, the physician and our staff."
• Partner with an IV catheter company. Ms. Stout says her surgery center has partnered with an IV catheter company to provide all the ASC's IV catheters, needles, syringes and IV solutions, resulting in a $200 savings every month over the last year. She says SCA leadership searched for companies that offered those particular items and introduced them to the center for a trial before making a final decision. A surgery center can save money by partnering with a company and agreeing to buy supplies in bulk, in exchange for discounts in the vendor contract.
• Use a compounding pharmacy for eye blocks. Ms. Stout says The Eye Surgery Center of the Carolinas has achieved pharmaceutical savings by using a compounding pharmacy for eye blocks. She says the center has struggled recently because of anesthetic drug shortages, meaning the center's medication nurse manager must look for alternatives to traditional drug manufacturers. She says the use of the compounding pharmacy also saves the ASC time because the eye blocks are ready for use upon delivery.
• Purchase cataract surgery supplies in packs. The Eye Surgery Center of the Carolinas purchases cataract surgery supplies in packs for each procedure, rather than purchasing items individually, Ms. Stivers says. "When we package items together per procedure, it can save as much as $75 per procedure," she says.
2. Ask physicians to standardize supplies and implants. One of the most effective ways to save money on surgical supplies is standardization, Ms. Stivers says. "We've found it to be most cost-effective for one center if all the physicians agree on the same supplies," she says. "You can order packs specifically for different physicians, but it's a better cost savings for all the physicians to agree on the items in the packs." She says this also works with pharmaceuticals — purchasing generic across the board can save as much as $25,000 a year.
Ms. Stivers and Ms. Stout recommend sitting down with physicians to discuss alternatives to their current preference items. Ms. Stivers says in an ophthalmic ASC, the cost of supplies per cataract procedure can vary $75-$100 among physicians. "Usually doctors are very receptive to looking at lower costs," she says. "If we have a doctor in a center whose costs are significantly lower than others, our supply chain data can provide information on what that surgeon is using. We let the others look at it and ask if they would be interested in using the new supply." She says physicians are usually quite conscious of cost, especially on procedures with low reimbursement.
3. Don't overlook small savings. Your materials manager should go through every supply you order to determine whether a cheaper option exists, Ms. Stout says. She says the surgery center a made vendor change on corneal knives that netted an annual savings of $323, as well as a change on ocular occluders that netted around $500.
She says when the purchasing coordinator has a new supply to suggest to the surgery center, he brings it to the staff meeting and introduces it to the employees. "We of course present the item to the physicians too," she says. "Everything is done in an orderly fashion to make sure we have the right product."
4. Schedule cataract surgeries in the afternoon and flex staffing. Ms. Stout says her surgery center schedules longer retina and cornea procedures in the morning and saves the afternoon for cataract surgeries, which have more flexible NPO requirements than other ophthalmic surgeries. She says this scheduling also keeps physicians happy and allows the ASC to be more efficient, thereby saving money. "This way, the physicians don't have the stress of having to be back in their office at a specific time, and patients don't have to be up early in the morning," Ms. Stivers says. "The surgeons really appreciate the quick turnover times."
Ms. Stout says in order to keep the ASC efficient, the surgery center uses a flexible staffing model rather than shifts. Because the afternoon is the busiest time, a lot of nurses and techs arrive around 11:30 a.m. and work through the afternoon with the physicians. She says during this busy time, the ASC runs three ORs and turns those rooms over every 2-3 minutes, allowing the physician to move from OR to OR quickly. "I have an RN and two surgical techs, so one tech is helping to turn over and position the patient as the other one sets up for the procedure," Ms. Stout says. She says the surgery center also increases efficiency by using light sedation, which allows patients to leave the ASC around 30 minutes after the procedure.
5. Make the center accessible to patients. Ms. Stivers says surgery centers have to "think proactively about the patient experience," as well as the experience of their family and friends. The center monitors patient satisfaction closely and takes any suggestions for improvement very seriously.
She says all SCA centers also have websites, to make them accessible for patients looking to schedule surgery. "All our centers have websites with forms to make it easier for the patient, with a picture of the location and pictures of doctors on staff," she says.
Learn more about Surgical Care Affiliates.
Related Articles on Ophthalmology:
Ophthalmologist Dr. Gwen Sterns Receives Two AAO Awards
TN's UT Medical Group Adds Three Physicians to Ophthalmology Department
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• Plan for start-up expenses. Ms. Stout says her ASC's start-up expenses included microscopes, phacoemulsification equipment and retina equipment. She says once the ASC has spent money on these items, the expenses should not come up again for a while. "It varies by physician preference, but in my experience, phaco equipment lasts about 5-10 years. Microscopes can go longer," she says.
She says that as her surgery center was starting out, the physicians attended meetings where supplies and equipment were showcased and then asked the center to trial the products. "We didn't just accept what was brought in," she says. "We made decisions based on what was best for the patient, the physician and our staff."
• Partner with an IV catheter company. Ms. Stout says her surgery center has partnered with an IV catheter company to provide all the ASC's IV catheters, needles, syringes and IV solutions, resulting in a $200 savings every month over the last year. She says SCA leadership searched for companies that offered those particular items and introduced them to the center for a trial before making a final decision. A surgery center can save money by partnering with a company and agreeing to buy supplies in bulk, in exchange for discounts in the vendor contract.
• Use a compounding pharmacy for eye blocks. Ms. Stout says The Eye Surgery Center of the Carolinas has achieved pharmaceutical savings by using a compounding pharmacy for eye blocks. She says the center has struggled recently because of anesthetic drug shortages, meaning the center's medication nurse manager must look for alternatives to traditional drug manufacturers. She says the use of the compounding pharmacy also saves the ASC time because the eye blocks are ready for use upon delivery.
• Purchase cataract surgery supplies in packs. The Eye Surgery Center of the Carolinas purchases cataract surgery supplies in packs for each procedure, rather than purchasing items individually, Ms. Stivers says. "When we package items together per procedure, it can save as much as $75 per procedure," she says.
2. Ask physicians to standardize supplies and implants. One of the most effective ways to save money on surgical supplies is standardization, Ms. Stivers says. "We've found it to be most cost-effective for one center if all the physicians agree on the same supplies," she says. "You can order packs specifically for different physicians, but it's a better cost savings for all the physicians to agree on the items in the packs." She says this also works with pharmaceuticals — purchasing generic across the board can save as much as $25,000 a year.
Ms. Stivers and Ms. Stout recommend sitting down with physicians to discuss alternatives to their current preference items. Ms. Stivers says in an ophthalmic ASC, the cost of supplies per cataract procedure can vary $75-$100 among physicians. "Usually doctors are very receptive to looking at lower costs," she says. "If we have a doctor in a center whose costs are significantly lower than others, our supply chain data can provide information on what that surgeon is using. We let the others look at it and ask if they would be interested in using the new supply." She says physicians are usually quite conscious of cost, especially on procedures with low reimbursement.
3. Don't overlook small savings. Your materials manager should go through every supply you order to determine whether a cheaper option exists, Ms. Stout says. She says the surgery center a made vendor change on corneal knives that netted an annual savings of $323, as well as a change on ocular occluders that netted around $500.
She says when the purchasing coordinator has a new supply to suggest to the surgery center, he brings it to the staff meeting and introduces it to the employees. "We of course present the item to the physicians too," she says. "Everything is done in an orderly fashion to make sure we have the right product."
4. Schedule cataract surgeries in the afternoon and flex staffing. Ms. Stout says her surgery center schedules longer retina and cornea procedures in the morning and saves the afternoon for cataract surgeries, which have more flexible NPO requirements than other ophthalmic surgeries. She says this scheduling also keeps physicians happy and allows the ASC to be more efficient, thereby saving money. "This way, the physicians don't have the stress of having to be back in their office at a specific time, and patients don't have to be up early in the morning," Ms. Stivers says. "The surgeons really appreciate the quick turnover times."
Ms. Stout says in order to keep the ASC efficient, the surgery center uses a flexible staffing model rather than shifts. Because the afternoon is the busiest time, a lot of nurses and techs arrive around 11:30 a.m. and work through the afternoon with the physicians. She says during this busy time, the ASC runs three ORs and turns those rooms over every 2-3 minutes, allowing the physician to move from OR to OR quickly. "I have an RN and two surgical techs, so one tech is helping to turn over and position the patient as the other one sets up for the procedure," Ms. Stout says. She says the surgery center also increases efficiency by using light sedation, which allows patients to leave the ASC around 30 minutes after the procedure.
5. Make the center accessible to patients. Ms. Stivers says surgery centers have to "think proactively about the patient experience," as well as the experience of their family and friends. The center monitors patient satisfaction closely and takes any suggestions for improvement very seriously.
She says all SCA centers also have websites, to make them accessible for patients looking to schedule surgery. "All our centers have websites with forms to make it easier for the patient, with a picture of the location and pictures of doctors on staff," she says.
Learn more about Surgical Care Affiliates.
Related Articles on Ophthalmology:
Ophthalmologist Dr. Gwen Sterns Receives Two AAO Awards
TN's UT Medical Group Adds Three Physicians to Ophthalmology Department
Mississippi Vision Correction Center Adds LenSx Laser