Efficient surgery, available in the office

Surgical results, reimbursements have led to an increase in office-based medical suites.

In our years of experience developing office-based surgery suites, these facilities have become more common within ophthalmology as practices discover their benefits, including increased revenue and outcomes equal to ASCs.

Office-based surgical procedures, which require minimal to moderate anesthetics, include surgery performed by a licensed physician in a location other than a hospital or ASC, usually within the physician’s office. Examples of ophthalmic office-based surgeries are cataract surgery, refractive lens exchange (RLE) and various other intraocular procedures.

While some practices have utilized office-based surgery suites for more than a decade, the number of new office-based suites iOR Partners has developed has rapidly grown during the past several years based on an increase of elective procedures and efficiency and convenience for the surgeon and patients.

Office-based suites are typically accredited by a third-party agency to ensure they meet industry-wide best practice standards. The level of anesthesia administered during a surgical procedure usually determines the classification of a surgery suite, either Class A or Class B level anesthesia. Class A covers minimal, non-dissociative anesthetics, including oral, topical and local medications such as lorazepam (Ativan), diazepam (Valium) and intracameral lidocaine. Class B accreditation covers moderate IV anesthetics, including midazolam (Versed) and fentanyl and excluding propofol (Diprivan).


The efficacy of office-based procedures is supported by a number of studies, including the 2016 Kaiser Permanente study. The results from this large multicenter study, published in Ophthalmology, include data from 21,501 cataract cases (13,507 patients) performed between 2011-2014. It was the largest U.S. study to investigate the safety and effectiveness of cataract surgery in a Class A office-based surgery suite environment. Kaiser Permanente Colorado has utilized Class A surgery suites since 2006. By 2015, more than 95% of Kaiser’s cataract procedures were performed in office-based surgery suites.

The Kaiser study’s retrospective review found the “overall vision outcomes were excellent, with mean postoperative best-corrected visual acuity of 20/28 Snellen. Surgical reintervention was required in only 0.6% and 0.7% of patients at three and six months postoperatively, respectively,” the authors wrote. There were no cases of endophthalmitis and no intraoperative complications requiring hospitalization. The study also found that less than 1% of procedures need to be performed in a setting where IV sedation is required.


Office-based surgery seamlessly integrates clinic and surgery in one location, providing patients a familiar and personalized premium surgical experience. The surgeon realizes time savings and efficiencies when employing the same staff for clinic and surgery while eliminating segregated clinical and surgery schedules. This allows movement back and forth between the operating room and exam rooms. As a result, doctors can see more patients during the day and increase their flexibility in responding to changes in patient flow and improving practice productivity.

Providing an optimal patient experience while safely performing appropriate surgical procedures within the office space delivers a higher level of patient satisfaction while reducing patient stress and anxiety associated with a surgery center.


Office-based surgery is ideal for premium cataract surgery. Medicare already allows surgeons to bill a “reasonable” amount for implantation of premium IOLs. In addition to reimbursing an average of $700 for standard cataract procedures, Medicare rules permit practices to bill “additional services” for patients choosing premium cataract surgery. Medicare already reimburses the professional fee for cataracts performed in an office-based suite, with no reimbursement for the facility fee.

“Medicare had a comment period for office-based surgery,” says ophthalmologist Daniel Durrie, MD, based in Kansas City, Kan. “Commercial insurers are already covering cataract procedures today, so now is the time for Medicare to make the move to an in-office facility.”

In addition to Medicare, commercial insurance coverage provides another incentive for office-based cataract procedures. Commercial insurance providers have been early adopters in providing the surgeon with an “enhanced professional fee,” with recent agreements reimbursing $2,375 per eye for an office-based cataract procedure.

Practices shifting to office-based surgery suites have developed lucrative new revenue streams. According to the Kaiser Family Foundation, more than half of all cataract surgery-eligible Medicare Part B recipients are covered by a Medicare Advantage Plan, with potential reimbursement for office-based cataract procedures. In order to accept Medicare Advantage or commercial insurance, the office-based suite must be accredited by one of the nationally recognized accreditation organizations.

Kugler Vision in Omaha has seen its office-based surgical volume increase 50% since opening its suite.

“Patients are much more comfortable with the idea of surgery in an environment they already know, and our staff is more comfortable recommending it as well,” says Lance Kugler, MD. “Patients can sense that the entire organization is dedicated to a first-class experience, which translates into higher satisfaction and higher conversion rates across the board.”

The U.S. market for cataract surgery is 3.6 million procedures yearly, not including the rapid growth in patients seeking RLE and phakic IOL surgery. Higher surgery reimbursements from commercial insurers and the fast-growing segment of private pay patients are key drivers of growth and acceptance of office-based surgery.


Providing an optimal patient experience while safely performing appropriate surgical procedures within the office space can deliver a higher level of patient satisfaction and simultaneously reduce the patient’s anxiety associated with a surgery center. In our experience, the cost of an office-based surgery suite can range from $20,000 to $200,000. A “typical” cataract practice would break even on a Class A office-based suite investment by performing four premium procedures per month for three years.

Each project has unique factors such as the current office set-up (a completely new buildout or conversion of an existing LASIK suite or procedure room) and the choice of new or used equipment. Laser suites within an office often can serve as Class A office-based suites, and no dedicated preop or postop area is required, while Class B office-based suites require a dedicated pre-op and postop area. It is important to build an office-based suite that meets or exceeds accreditation standards. Most practices work with a partner to perform insurance contracting services, surgeon credentialing, surgery staff training, mock accreditation review and quality assurance and performance improvement programs.


The efficiency and convenience of an office-based surgery suite offers solid growth potential for ophthalmic practices. Combining proven technology and improved reimbursements provides new opportunities for surgeons.

Practices that invest in office-based surgery suites are well-positioned for a rapid return on investment and a rapid increase in profitability. OM

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