Pearls for adding femtosecond laser to practice

Aug 07, 2013

Ophthalmologists are nearing a crossroads with the replacement of phacoemulsification by femtosecond laser technology. New femtosecond laser technology is costly, and surgeons must decide if this technology is right for their practices, explained John Vukich, MD.

Madison, WI-Ophthalmologists are nearing a crossroads with the replacement of phacoemulsification by femtosecond laser technology. New femtosecond laser technology is costly, and surgeons must decide if this technology is right for their practices, explained John Vukich, MD.

Among the issues with adoption of femtosecond laser technology are cost, charges to patients, acceptance of the technology by other practices, and outcomes, said Dr. Vukich, surgical director, Davis Duehr Dean Center for Refractive Surgery, Madison, WI.

The laser costs from $400,000 to $550,000; service fees annually are about 10% of the purchase price; and each surgery has a per-use fee of $350 to $450.

The fee passed along to the patient must be economically viable to both the patient and the practice. The recently determined guidelines for the patient fees are that the facilities and physicians can charge patients for the portion of a fee that is not covered by insurance and the services that are part of a conventional cataract surgery cannot be charged separately. Importantly, when a premium procedure provides another service, such as imaging, the patient can be charged and performance of the other services on a limited and non-routine basis in conventional cataract surgery would not disqualify those services as non-covered services, Dr. Vukich explained.

A survey of physicians who perform femtosecond laser cataract surgery included 65 of 134 eligible femtosecond laser centers in the United States and 205 surgeons who performed more than 278,000 cataract cases; of these surgeries, 23% and 22% were premium procedures in 2012 and 2013, respectively (a total of 37,600 surgeries).

Twenty percent of conventional IOL implantations were performed using the femtosecond laser, Dr. Vukich noted.

“This was a surprise, because many expected the use of the femtosecond laser to be tied to premium IOLs,” he said. “Another surprise was that 55% of toric IOLs were implanted using the femtosecond laser; and 74% of presbyopic IOLs were implanted using the femtosecond laser.”

The survey found that the mean acquisition cost was about $438,000; the services fees were about $165,000; and the 5-year cost was more than $600,000. The average increase in the cost per case was $859 with a per-case cost of $327, which resulted in a per-case margin of $532.

“Surgeons must perform about 1,100 femtosecond laser cases to break even, which means they must perform about 227 cases annually and 19 to 20 cases monthly,” he said.

With these numbers, one-third of the practice is involved with the femtosecond laser in order to break even, he explained.

The actual trend in utilization of the femtosecond laser indicated that most practices were at about 25% to 30% penetration within the first year of use of the laser, and most were at 25% within 3 months. Of the practices that initially purchased a femtosecond laser, about 71% were breaking even and 8% were near the break-even point. Multisurgeon centers fared much better in recouping the initial costs of the laser compared with single-surgeon centers.

In addition to the initial start-up costs, Dr. Vukich underscored the importance of understanding the practice’s patient population.

“The laser has to be affordable for the patients and surgeons must discuss conversion to the femtosecond laser with patients,” he commented, noting that surgeons will have to document carefully how they bill for refractive services.

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