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The July 2024 Eversight Academy webinar featured Parag Majmudar, MD, of Chicago Cornea Consultants covering the topic of office-based surgery (OBS). Dr. Majmudar implemented OBS in his practice and shares his opinions and experience in this webinar.
He introduces the topic and defines a current issue in ophthalmology: the number of cataract surgeries may double in the next 10 or so years and surgical facilities are trending towards a preference for more lucrative procedures. OBS may be a solution to this issue trend.
Many surgical procedures performed by ophthalmologists can be done safely and effectively in an out-patient environment. Dr. Majumdar highlights the lack of OBS in private practice in the US and outlines the primary barriers to adoption: contentment with status quo, fear, physical space, decision-making ability, regulatory hurdles and operational challenges.
Making the case for OBS
Office-based surgery can have a lower cost of startup, the ability to capture facility fees, and the growth of cash-paying services such as ICL or RLE. Importantly, it is also noted that patients tend to prefer it, and surgeons gain more voice in purchasing equipment for surgery.
Literature demonstrates that OBS is very safe and effective, and outcomes are very comparable to procedures performed at an ambulatory surgery center (ASC). As in an ASC, complication rates are predicated on good patient selection. All patients may not be candidates for OBS, but those patients can still be cared for at an ASC or hospital.
Dr. Majumdar digs deeper into OBS patient satisfaction, citing that patients do not have to deal with the additional hassle of a hospital or ASC and can be treated by familiar staff at the clinic. Additionally, scheduling surgeries at an OBS is more convenient for both the physician and patient.
In addition to these benefits for patients and surgeons, he also cites a financial incentive. Profit margins for the practice can also be increased by operating OBS. He estimates the breakeven point for OBS is about 250-400 cases depending on what type of cases are being done. He then begins to go into the details of the regulatory situation related to starting and operating an OBS. These regulations vary by state and Medicare continues to evaluate payments for OBS cases.
Things to consider
Consider decreasing anesthesia in an ASC setting to get used to it and start to think about patient characteristics, such as anxious personality, that may be contraindications for OBS procedures.
He also discusses who might not benefit from opening an OBS suite, like those who mostly see patients with significant comorbidities or those who do mostly complex cases. Disadvantages of OBS include that not all patients are good candidates, and that start-up costs can be sizable and strategic planning is paramount.
He closes the talk with a discussion of how to get started when venturing into OBS and really stresses the importance of consulting with someone who has experience with OBS. Finally, he reiterates his personal experience with increased surgeon satisfaction, stating that OBS has been a real boon for his own personal well-being. The webinar closes with Q&A.
Key takeaways include:
- Introduction, problem and solution
- Barriers to OBS
- The case for OBS
- Safety and efficacy
- Patient satisfaction
- Financial benefits
- Regulatory considerations
- Transitioning to OBS
- Who should not have OBS & disadvantages
- Where to begin?
- Conclusion and Q&A
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About the author
Michael Szkarlat
Partner Development Director
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Michael has been with Eversight since 2016 and has recently worked to develop Eversight's educational wet lab programs for EK surgery and a standardized protocol for DALK practice in a wet lab setting. His eye banking experience is rooted in the preparation of corneal grafts and spent nearly five years as Eversight’s Medical Director designee in charge of training clinical team members to prepare corneal tissue for DMEK and DSAEK surgery. In his time at Eversight, Michael has presented at scientific conferences, been involved in clinical research and developed innovations in tissue processing. He was named an IAPB Eye Heath Hero in the innovations category. Michael is passionate about community-based eye banking and honoring the precious gift that is donation. When not at work, he enjoys traveling with his wife and baking artisan sourdough bread.