Once considered high-cost, low-volume cases, retina procedures have slowly but successfully been moving to the outpatient arena. Over the past couple of years, I have helped four facilities fully integrate retina, and I am now helping several other facilities through the process. While most of these facilities are single-specialty ophthalmic facilities, a few are multi-specialty centers offering a variety of surgical specialties.

In this article, I'll share some of the secrets of success to adding retina procedures, including how to credential surgeons, how to train staff and how to keep supply costs down.

Retina basics
There are a number of different types of retinal procedures that are appropriate for the outpatient setting, ranging from macular hole repair to retinal detachment repair (see "Retina Procedures" on page 62). Because eye disease is strongly correlated with age, most patients are seniors and/or diabetics. Other patients suffer from degenerative eye diseases that predispose them to the development of a retinal detachment. Provided that they don't have advanced disease states, high comorbidities, or require silicone oil or other expensive supplies, most patients are good candidates for outpatient procedures.

One of the reasons it's now possible to do these types of cases on an outpatient basis is because surgeons are using local anesthesia (typically a retrobulbar or peribulbar block) and, in some very rare cases, topical anesthesia. Previously, general anesthesia was the status quo.

Equipment advancements and surgeons' techniques are also helping to make retina cases less time consuming. They may have taken up to two hours only a few years ago, but these cases now run from 30 to 90 minutes, depending on the patient, the procedure and the surgeon.

Credentialing your surgeons
The credentialing process for your retina surgeons is the same as credentialing other ophthalmic surgeons. You will want to check for proof of licensure and proper training. Most commonly, retina surgeons do a three-year ophthalmology residency, followed by a one-year fellowship in retina surgery. Also, verify their professional liability coverage as well as their hospital staff privileges.

Surgical skill is just one part of the equation, however. Because these cases can be expensive and time-intensive, you'll need to find surgeons who are willing to standardize to keep costs down. You'll also need to find surgeons who can bring in enough cases