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With hospitals already feeling the pinch of reduced cataract reimbursements, and ASCs set to feel the effects of a seven-percent drop in Medicare reimbursements next spring, more and more surgical facilities are going to need to find a way to cut case costs. A prime opportunity for many centers may rest in intraocular lens buying.
A recent analysis of cataract case costs at one outpatient surgery network shows why. The analysis revealed that one of the centers was doing cataracts for $150 to $175 less than the others. The key reason? The center had reduced the number of lens choices and was subsequently getting a much better price on IOLs.
We asked a number of facility managers and owners how they make sure they stock the lenses their surgeons prefer, at prices they can afford. Here's what they had to say:
 Bring Your Physicians Up to Date
Before you take any IOL economization measures, you will need maximum cooperation and flexibility from the surgeons who use your facility. Yvonne Bley, RN and director of clinical operations at Wills Surgical Network, says the coming reimbursement cuts have convinced the Wills administrators to meet with the physicians who do surgery there. "We plan to show them how difficult it is in today's market to make a profit," says Ms. Bley, adding that most doctors are unfamiliar with both reimbursements and costs.
Be aware that in doing so, you will be fighting some powerful influences to the contrary. Vendors may want to "wine and dine" your doctors, warns Darlene Johnson, administrator at Surgery Center of Cleveland in Cleveland Tenn., Don't give in; chances are you are much better equipped to make the buying decisions. Says George Violin, MD, a Boston ophthalmologist, "Doctors are culturally unaccustomed [to the buying side of running a surgery facility]."
 Consolidate
Your Inventory
Once you have persuaded your physicians to go along, "simplify, simplify, simplify," says Dr. Violin. He believes that step one toward saving money on IOLs is getting your surgeons to agree on one or two lens types for the "bread and butter" cataract cases. Consolidating your choices in this way will offer two benefits. First, when it's time to make a deal, ordering lots of one or two lenses will give you more clout. Second, selecting just a few lenses will cut down on the number of knives, folders and manipulation devices you must keep at your facility. "You only need to stock one type of lens for most cases," Dr. Violin says.
Veronica Melendes, RN and administrator at ASCOA's Specialty Surgery and Pain Center in San Antonio, Texas, agrees, saying that IOLs are "pretty much the same." Her lens inventory typically includes a silicone three-piece lens, a plate-haptic lens, and an acrylic lens, which the surgeons there use for diabetic patients.
Just a few notes:
- Although it's wise to consolidate the standard-fare lenses, you will need to have other IOLs on hand. Gina Stancel, administrator at Eye Centers of Florida's Surgicare, says you may need a few PMMA lenses at the very high and low powers. Dr. Violin recommends stocking anterior chamber lenses for use after the rare vitrectomy. And at his center, he also stocks the Allergan Array multifocal lens for patients and physicians who want it. The lens costs much more than standard lenses, even with the $50 "high technology" reimbursement that is tacked onto the APC code (see sidebar). However, it's possible to partially make it up in volume, because the Array requires bilateral implantation.
- Consolidation does not mean closing the door on new ideas. Ms. Stancel says her center also does the biggest volume in standard silicone three-piece and plate-haptic lenses. She points out, though, that her facility has done well by getting involved in new-IOL trials. She says the center worked with the Staar's Collamer lens in a six-year study. As a result, five of the center's surgeons now use this lens as one of their lens of choice; they like the high refractive index and its performance compared with other lenses. She says that although using this lens may not have been the absolute best for the center's bottom line, she believes that it positively affected surgeon and patient satisfaction, "If you make your patients happy, then you're not going to have to go looking for more patients," she says.
Hold a Dutch auction
Once you have determined how much consolidation you can live with, Dr. Violin suggests that you employ the "Dutch auction" method every year or whenever your contract comes up. (The practice is named for the method retailers used to get the best price arrangements with wholesalers in Dutch flower markets.) Approach the gamut of manufacturers and offer a contract to the one manufacturer who will give you the best price for your lens or lenses.
Two other notes:
- If cash flow is an issue, you may want to bring up the concept of consignment with vendors. Most facilities should expect to pay more per lens for this privilege, however. Ms. Stancel says you can win this concession at a low per-lens price, but only if you are a high-volume facility that is established with the vendor. "You have to move the lenses" for consignment to work, she says.
- Whatever deal you make, see that next-day delivery is built into the agreement, suggests Dr. Violin.
 Stay vigilant
Even if you think you may have a great deal, it pays to do an annual review of what's available. Says Ms. Johnson, "We used to buy silicone lenses from one company, which charged us $88 for a silicone lens; $85 if we bought ophthalmic solutions from them for another $20." After some searching, Ms. Johnson was able to cut her costs by more than half by going with another company, which charges around $40 for a comparable lens, with no bundling requirement. The lesson: even if you think you've got a great deal, it may pay to look for a better one.
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