Cataract Surgery's New Normal

ADD ON Treating astigmatism and presbyopia are non-covered services, so facilities can charge patients additional fees for improved vision outcomes.

The reimbursement reality of cataract surgery is all too familiar to James Dawes, MHA, CMPE, COE, chief administrative officer at the Center for Sight in Sarasota, Fla. This year, his physicians received a 13% cut in professional fees for simple cataracts and a 21% slashing of payments for complex cataracts. On the facility side, his payments have stayed relatively flat, which means they're essentially decreasing. "From the surgery center perspective, we're not making any headway," he says. "In fact, we're going backward. On the professional side, we're going backward fast."

Rather than sit back and accept the declining reimbursements, the Center for Sight decided to get innovative, offering patients "cataract upgrade packages." In exchange for improved vision outcomes — defined as reducing their dependence on glasses by treating astigmatism or presbyopia — the center upcharges patients and bills them directly for the improved outcomes. Two examples:

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• Advanced Vision ($3,295 per eye). Involves laser cataract surgery, implantation of presbyopia-correcting IOLs, treatment of astigmatism and post-op LASIK enhancement if patients aren't satisfied with the vision outcomes. This package offers patients the best chance to get out of glasses, although it's not guaranteed. Mr. Dawes says 95% of patients don't wear glasses after surgery.
• Custom Vision ($1,695 per eye). Involves laser cataract surgery, implantation of standard IOLs, treatment of astigmatism and post-op LASIK enhancement. Because a non-presbyopia-correcting IOL is used, patients will deal with presbyopia following surgery. Surgeons set focal points so patients will be out of glasses for distance vision, but they'll still need glasses for reading.

Yes, cataract surgeons are being successful in raising per-case revenue by adding non-covered services, delivering better refractive outcomes to satisfy a savvy patient population willing to pay thousands of dollars in order to see without glasses. "How much you charge depends on whatever your local market will absorb and your value proposition to patients," says Mr. Dawes, who has seen some centers charge as much as $5,000 to $6,000 per eye. "How much value do they place on being out of glasses after surgery?"