Office Based Surgery

[percyeye]

With it getting harder to buy into ASCs and PE taking over the area will younger Ophthalmologists turn to OBS due to the smaller footprint and costs? With more procedures being done with Valium vs IV sedation it seems like a possible option.

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[PLA2]

yes. local vocal anesthesia

 

[dantt]

With it getting harder to buy into ASCs and PE taking over the area will younger Ophthalmologists turn to OBS due to the smaller footprint and costs? With more procedures being done with Valium vs IV sedation it seems like a possible option.

Is it getting harder to buy into ascs than before? This is the first I've heard of this.

 

[Dusn]

Once this becomes a thing, I’d expect reimbursements to be cut further.

 

[MstaKing10]

Once this becomes a thing, I’d expect reimbursements to be cut further.

This. Also safety.

 

[dantt]

This. Also safety.

The reimbursement thing is obviously a serious concern. It seems reasonably safe.

https://www.ophthalmologyadvisor.com/topics/cataracts/in-office-lens-surgeries-approximately-as-safe-as-in-operating-rooms/

 

[MstaKing10]

I say safety in regards to systemic issues, not so much ocular complications. Admittedly I’m a retina guy and require more sedation for my cases and my patients in general are sicker. But boy I would not want to deal with that rare patient who develops anxiety or claustrophobia half way through the case, or worse yet, any kind of systemic issue during surgery in my office based surgery suite without anesthesia on hand. These events are rare, until they happen to you.

 

[Dusn]

And is the patient who develops anxiety or claustrophobia during the case really that rare?

I also get the patient with a BP of 200/100 a lot. But maybe that’s the benefit of office based surgery.. no one even checks the BP?

 

[Hanky]

My days without anesthesia are slightly slower surgically, but the PACU nurses are much happier and the patient is out the door much quicker. Patients don't have to fast, they don't need an IV, and overall, they rave about it. I very rarely have to abort and can usually tell while draping. You could get an IV on everyone in case you need to add nurse administered drugs, but using oral versed or an MKO melt is fantastic. Our ASC is attached, but I would certainly consider office-based surgery otherwise.

Retina without anesthesia would be much more difficult given longer cases and increased need for an immobile patient.

My days with anesthesia are more profitable to the ASC. 30-35 cases bring about $4k in anesthesia collections, while my non-anesthesia days have additional cost (one extra nurse + the drugs) without any collections beyond the cataract bundle.