Ophthalmology continues to benefit from a steady stream of innovations—allowing cataract surgeons to deliver excellent postoperative outcomes with greater safety, speed, and efficiency.
However, the adoption of any new technology faces a number of hurdles—particularly in situations where there is an opportunity to evolve the standard of care across multiple practices utilizing a single ambulatory surgery center (ASC).
Overcoming these challenges requires a systematic approach that leverages the leadership and experience of early-adopting technology champions, employs consistent and comprehensive communications with all participating practices, and provides administrative support to secure reimbursement.
Case example in action
The integration of phenylephrine and ketorolac injection 1%/0.3% (Omidria, Omeros Corp.) into cataract procedures performed by the Island Eye Surgicenter, Westbury, NY, is one example of this process in action.
The dedicated eye surgery center is a new 27,000-square-foot, state-of-the-art facility with about 18,000 ophthalmic procedures performed each year. The facility has six operating rooms; two femtosecond laser devices (Catalys Precision Laser Systems, Johnson & Johnson Vision); 15 preoperative stretcher locations; 12 postoperative positions, and an 80-seat waiting room, plus ample equipment and supply storage areas.
The 45-plus surgeons who operate at the center come from practices throughout Long Island and the Tri-State area, attracted by the facility itself and a highly trained staff. Many of these surgeons participate as principal investigators in research studies of new technology, and the facility is often among the first ASCs in the country to offer the most advanced surgical or therapeutic tools to surgeons and patients.
The center also hosts physicians visiting from other parts of the country and from around the world, who come to learn from surgeons’ experiences with new interventions.
The dissemination of new technologies or techniques is more complicated than simply changing the protocol in a single practice, because the center is a free-standing facility utilized by surgeons from many independent practices. It is in everyone’s interests to ensure the diffusion and uptake of new technology that improves post-surgical outcomes and patient satisfaction. That has been the mission of the owner-physicians from day one.
The first step in this process is the early and active involvement of a technology champion.
One of the center’s founding surgeons, Eric D. Donnenfeld, MD, was an investigator in a phase II clinical trial for the phenylephrine and ketorolac injection 1%/0.3% and an author of several articles describing the results of clinical studies following its FDA approval.
He began to utilize the product routinely in his own cataract procedures, and by this example, became an advocate for its adoption among other surgeons at the center.
Recognizing that many of these physicians had other favored pre- and intraoperative regimens for controlling miosis, Dr. Donnenfeld conducted a “real-world” study with three colleagues at the center, comparing outcomes in 260 cases in which phenylephrine and ketorolac injection 1%/0.3% was used to 381 in which intracameral epinephrine was employed (prior to the commercial availability of phenylephrine and ketorolac injection 1%/0.3%) in a retrospective review.
Results of this study (presented at the 2016 meeting of the American Society of Cataract and Refractive Surgery) showed that use of the phenylephrine and ketorolac injection 1%/0.3% was associated with a four-fold reduction in complications, shorter case length, and less use of pupil expansion devices—all of which resulted in significantly improved patient outcomes, reduced surgical complications, and cost savings. Patients also had significantly greater improvement in uncorrected visual acuity on the first postoperative day than those who received epinephrine.
The next step is communicating this evidence and experience on a regular basis to all surgeons affiliated with the center.
We begin with a comprehensive memo that provides a complete overview of the product or device and describes its clinical and economic benefits. Each time a new paper is published or data are presented at a national meeting, the findings are sent to every surgeon at the center and also posted throughout the facility.
Though company representatives remain an important source of information about new products for these surgeons and practices, providing our own background and regular updates is an effective and efficient way to evolve surgical practice across the group.
The last step is providing administrative support to ensure that appropriate reimbursement is received for utilization of new technologies. Since the ASC has financial exposure for all charges related to the surgery, the center confirms patient insurance coverage to the procedure.
In the case of the phenylephrine and ketorolac injection 1%/0.3%, the center initially focused on Medicare patients, for whom the product’s pass-through status assured reimbursement.
However, as commercial coverage improved and with the availability of a reimbursement support program (OMIDRIAssure)—including a component by which Omeros, on behalf of the patient, covers the gap between the acquisition cost of the product and the amount paid by the patient’s commercial plan—the center has increased the number of patients who can receive this medication as part of their covered cataract benefit.
As a result, the use of the phenylephrine and ketorolac injection 1%/0.3% has increased steadily across affiliated practices and surgeons. Of course, the choice of surgical technologies and treatment modalities is ultimately decided between the surgeon and the patient.
The center’s process for integrating new approaches is not meant to force surgeons to do things “our way” or take options out of their hands.
However, by modeling utilization through product champions, proactively communicating product features and clinical data, and helping to minimize reimbursement issues, the center has been successful in improving the standard of care that all of the surgeons who operate in the facility are able to deliver and that they have come to expect.
This commitment to innovation benefits the patients through improved surgical outcomes and the center by increasing patient flow, cost savings, and patient satisfaction scores. â