Cataract surgery is the most commonly performed outpatient procedure and a major revenue stream for most ophthalmology practices. Unfortunately, physician reimbursement for cataract surgery has fallen to a value of about one-third the amount paid a couple of decades ago. And this year will see even more cuts in payment from the Centers for Medicare and Medicaid Services (CMS).
The bottom line
Reimbursement for non-complicated cataract surgery will decrease from $654 to $557 and complex cataract surgery will drop from $813 to $766. Rates are based on the recommendations of the AMA’s Relative Value Update Committee (RUC), who determine the effort and resources necessary to perform a procedure.
If there’s a silver lining, it’s that technology has reduced operating and recovery time, as well as the number of post-operative visits most patients need. It’s also good to remember that minute-for-minute cataract surgery reimbursement is still estimated to be higher than reimbursement for major operations such as coronary artery bypasses.
While those comparisons might make us feel a little better, they don’t help balance the ledger sheet. To help mitigate the pain of the 2020 cuts, here are a few ways practices can help offset the decrease in reimbursements.
Give patients high-value options
Offer premium services. The Ziemer femtosecond laser platform offers incisions that can be made with greater precision and predictability, and the potential to correct lower levels of astigmatism through limbal relaxing incisions.
Intraoperative aberrometry can be utilized in post-refractive surgery eyes to provide additional accuracy in IOL selection in these patients. Offering non-covered services, such as presbyopia- and astigmatism-correcting IOL technology can also provide additional revenue streams.
Look for other areas in the practice to increase profitability. Rather than just trying to increase the number of cataract surgeries, explore other ways to improve the bottom line of the practice like decreasing no-show rates and using EMR to make sure patients are being seen regularly.
Advanced preparation including ensuring IOL selections have been made and are ready, equipment is set up, the staff is properly briefed and aware of any additional devices that may be needed and are prepped. Every effort should be made to minimize cancellations and procedures developed so that transitions between procedures are smooth and efficient.
Check out this whitepaper by Surgiorithm, a cataract surgery workflow system, for more details on improving profitability at your practice.