A Comparative Time-Based Profit Analysis of Retinal and Cataract Surgery in Ambulatory Surgery Centers

To evaluate the time-adjusted economics of retinal and cataract surgery in order to clarify how the dynamics of ambulatory surgery centers influence access to urgent care.

A time-driven activity-based costing model integrating Centers for Medicare & Medicaid Services ambulatory surgery center reimbursement, intraservice times, and cost data from a provider was applied to 18 421 retinal and 880 448 cataract procedures (2021-2024). Reimbursement, cost, and profit were converted to per-minute values, and a financial efficiency coefficient was used to quantify time-adjusted profitability. Variation in time and overhead allocation was assessed with sensitivity analyses.

Retinal procedures required 76.1 minutes vs 20.8 minutes for cataract surgery (ratio, 3.65). Time-normalized metrics favored cataract surgery, with reimbursement, cost, and profits per minute of $52.63, $29.28, and $23.35, compared with retinal procedures' $24.61, $16.22, and $8.40. The profit per minute for retinal procedures was 36% of the cataract profit. The financial efficiency coefficient was 0.098, indicating retinal surgery was less than 10% efficient after adjusting for operative duration. Parity would require reducing operative time to 7.5 minutes or increasing reimbursement by $61.05 per minute (~71%). No retinal Current Procedural Terminology code achieved a financial efficiency coefficient ≥1. Block modeling showed adding 2 retinal cases to a cataract block converted a margin to a loss, with retinal blocks generating losses approaching $5,908.

Although ambulatory surgery center reimbursement was higher for retinal than cataract surgery and the cost per minute was lower for retinal surgery, cataract surgery was more profitable per minute. These findings underscore the need for reform of time-based reimbursement that reflects the complexity of retinal surgery.