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Cost Analysis of Outpatient Ophthalmic Procedures
Emily F Moon1, Leo Lt Meller1, Bobby S Korn2
1From the Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, UC San Diego Shiley Eye Institute, La Jolla, California, USA (E.F.M., L.L.M., B.S.K., D.O.K.).
American Journal of Ophthalmology
|June 15, 2026
Summary
Ambulatory surgical centers (ASCs) are financially viable for most ophthalmic procedures, with a maximum intraoperative time to maintain financial neutrality exceeding 30 minutes. Medicare reimbursement and material costs significantly influence financial neutrality for ASCs and hospital outpatient departments (HOPDs).
Area of Science:
- Ophthalmology
- Health Economics
- Healthcare Management
Background:
- Evaluating the financial feasibility of ophthalmic procedures in outpatient settings is crucial for healthcare providers and policymakers.
- Ambulatory surgical centers (ASCs) and hospital outpatient departments (HOPDs) offer distinct financial models for surgical care.
- Understanding Medicare reimbursement rates is essential for assessing the economic viability of surgical services.
Purpose of the Study:
- To assess the financial feasibility of common ophthalmic procedures performed in ASCs and HOPDs.
- To compare the financial performance of ASCs and HOPDs relative to Medicare facility reimbursement rates for 2025 and beyond.
- To develop a framework for analyzing the cost-efficiency of ophthalmic procedures based on maximum intraoperative time.
Main Methods:
- A cost-efficiency analysis was conducted using data from outpatient facilities in San Diego, California.
- A novel framework was developed to determine maximum intraoperative time for financial neutrality.
- Data sources included insurance claims, internal financial records, operational frameworks, and publicly available data.
Main Results:
- Maximum intraoperative time to maintain financial neutrality for ASCs varied from 11.9 to 117.2 minutes across nine common ophthalmic procedures.
- For HOPDs, maximum intraoperative times were approximately double those of ASCs, ranging from 54.5 to 160.8 minutes.
- Medicare reimbursement and direct material costs were primary drivers of financial neutrality, influencing maximum intraoperative times.
Conclusions:
- The majority of ophthalmic procedures analyzed in ASCs demonstrated a maximum intraoperative time to maintain financial neutrality greater than 30 minutes.
- ASCs are well-positioned for financially efficient delivery of common ophthalmic surgical procedures.
- The study highlights the importance of Medicare reimbursement and facility fees in the financial considerations for ASCs and HOPDs, impacting equitable healthcare access.
