Quick Hits

Study: Ambulatory surgery center use growing in popularity
TearLab submits new Discovery platform for FDA clearance

Lowered costs for Medicare, patients factor into growth.

A study examining trends in the use of ambulatory surgery centers has found that such facilities have only grown in popularity since 2001.

Published in JAMA Ophthalmology, “Trends in use of ambulatory surgery centers for cataract surgery in the United States, 2001-2014,” found the proportion of cataract surgeries performed at ASCs, as opposed to hospital outpatient departments (HOPDs), increased from 43.6% in 2001 to 73% in 2014. The study used data from a large managed care network to examine 369,320 individuals, who underwent 531,325 surgeries. All individuals included were 40 years or older at the time of their surgery. Data were analyzed between February 2016 and February 2017.

The study authors noted that further research was needed to assess how this change affects care, efficacy and outcomes.


Albert Castillo, members services consultant for the Outpatient Ophthalmic Surgery Society, states that the total number of ASCs in the United States has gone from 400 in 1983, to 5,584 in 2017; of that number, 1,107 are specifically ophthalmic ASCs.

There are many reasons for that rising number, Mr. Castillo says, and two of the biggest are that ASCs are more affordable for patients and more efficient for surgeons.

While the cost differences for patients between ASCs and HOPDs varies from state to state, says Mr. Castillo, costs tend to be cheaper at ASCs since they do not have the same overhead as hospitals. Surgeons also typically find ASCs more efficient because they own the facilities and can design and run them as they wish, adds Mr. Castillo.


The study findings reinforce Mr. Castillo’s view, with the authors writing that surgeries at ASCs cost insurers less than those performed at HOPDs. In 2014, according to the study, the national average Medicare facility payment rate for cataract removal was $976 at an ASC and $1,766 at a HOPD; one analyst estimated that cataract surgeries performed at ASCs, rather than HOPDs, saved Medicare $829 million in 2011.

Lower copayments from patients were also recorded by the study; $190 was the average cataract surgery copayment in 2014 at an ASC and $350 was the averge at a HOPD. While the study noted that surgeries are reimbursed at a lower rate at ASCs, the cost difference is made up in an ASC’s greater efficiency and shorter turnover time, resulting in increased surgical volume. Across all types of surgeries, average surgical time was reduced by at least 30 minutes when performed in an ASC, the investigators found.


Geographical location also played a large part in a patient’s choice to use an ASC; for instance, in Pueblo, Colo., 98.8% of cataract surgeries performed between 2012 and 2014 took place in an ASC. Meanwhile, during the same period in La Crosse, Wis., only 1.6% of cataract surgeries occurred in an ASC. Other locations analyzed in the study included Green Bay, Wis.; St. Paul, Minn.; Salem, Ore.; and Hudson, Fla. Younger patients were also more likely to use an ASC than older patients.

While ASCs are widespread throughout the country, some states require an ASC to receive a Certificate Need before construction, says Mr. Castillo.

The cost of constructing an ASC, including equipment, is about $2 million per operating room, he adds. OM

TearLab submits new Discovery platform for FDA clearance

The device can display multiple indicators on single test

TearLab has passed the FDA’s acceptance review phase for clearance of its new platform, Discovery.

TearLab’s Discovery platform, unlike its existing osmolarity test, will be able to test for biomarkers beyond tear osmolarity. Currently, it can test for both osmolarity and the inflammatory biomarker MMP-9, but TearLab CEO Seph Jensen states that the Discovery system will be able to support a variety of other biomarkers in the future without the need for additional hardware. TearLab reported on the FDA’s decision in mid-February. A single test will be able to measure multiple markers, continues Mr. Jensen. This presents a distinct advantage to a clinic if it has been interested in using other point-of-care tests, he says. Discovery uses the same workflow for all its tests, producing test results in two minutes. TearLab believes that offering these different tests can help identify conditions earlier and improve patient outcomes.

While TearLab will remain focused on dry eye and the ocular surface for the near future, Mr. Jensen says the company plans to expand beyond those tests with Discovery. "The tear has the same information as the blood, for the most part," he explains. "We’re not limited to the ocular surface for sure, and we’ll go wherever the greatest unmet need is."

The FDA has started the substantive review of the Discovery filing, according to TearLab. Because Discovery is based on predicative technology previously cleared by the FDA, Mr. Jensen says the company is confident in the package it submitted.

TearLab is also planning to appeal a February ruling from the Federal Court of Canada related to a patent dispute TearLab has with I-MED Pharma Inc., over that company’s I-PEN Osmolarity system. Mr. Jensen says that the Canadian ruling will not affect its plans for TearLab Discovery. In January, OCuSOFT announced a partnering with I-MED Pharma to bring the I-PEN to the United States. OM


On last month’s cover, the generic name for Rhopressa (netarsudil ophthalmic solution) 0.02% was misspelled. OM sincerely regrets the error.