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