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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.).
Objective Or Purpose:
To evaluate the financial feasibility of various ophthalmic procedures performed at outpatient facilities, including ambulatory surgical centers (ASCs) and hospital outpatient departments (HOPDs), relative to Medicare facility reimbursement in 2025 and beyond.
Design:
Cost-efficiency analysis.
Subjects, Participants, And/Or Controls:
Outpatient facilities in San Diego, California.
Methods, Intervention, Or Testing:
In this study, we propose a novel framework to analyze ASCs and HOPDs based on the maximum intraoperative time to maintain financial neutrality. Common ophthalmic procedures were selected using insurance claims data. Total costs for each procedure were determined using a combination of internal financial records, defined operational frameworks, and publicly available data. These inputs were used to calculate the maximum intraoperative time for each procedure relative to the publicly available Medicare facility reimbursement rates.
Main Outcome Measures:
The primary outcome was the total intraoperative time required to maintain financial neutrality for 9 common ophthalmic surgical procedures.
Results:
Common ophthalmic procedures included the following: cataract removal with insertion of intraocular lens, aqueous shunt to extraocular plate reservoir, upper eyelid blepharoplasty, dacryocystorhinostomy, trabeculectomy, penetrating keratoplasty, repair of blepharoptosis, strabismus repair, and mechanical pars plana vitrectomy. The maximum intraoperative time to maintain financial neutrality for ASCs ranged from 117.2 (aqueous shunt to extraocular equatorial plate reservoir) to 11.9 (vitrectomy) minutes and was driven by Medicare facility reimbursement and direct material cost per procedure. For HOPDs, the maximum intraoperative times were approximately twice as high for most procedures and ranged from 160.8 (aqueous shunt to extraocular equatorial plate reservoir; CPT 66180) to 54.5 (blepharoplasty, upper eyelid; CPT 15823) minutes.
Conclusions:
In this analysis, most ophthalmic procedures performed at the ASCs analyzed had a maximum intraoperative time to maintain financial neutrality of >30 minutes, indicating that ASCs are well positioned to offer common ophthalmic surgical procedures in a financially efficient manner. Our model finds that Medicare reimbursement relative to the direct material cost per procedure was the main driver of maximum intraoperative time, highlighting the unique financial considerations ASCs may face due to limitations on reimbursement and lower Medicare facility fees compared with HOPDs. These findings support the utility of this framework in evaluating the cost-efficiency of ASCs to inform future decisions on procedures to adopt. Furthermore, our findings identify areas of discussion regarding the feasibility and utility of performing ophthalmic procedures at ASCs rather than in traditional hospital-based operating rooms to promote equitable access to health care.
