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O P H T H A L M O L O G Y
IOP," says Dr. Vold, "and that adding the inserts meant even more
reduction."
Safely and efficiently performed by practiced hands, the micro-incisional technology and techniques of some glaucoma treatments are
ideal additions to cataract cases, says Dr. Dewey. "We're going to be in
the eye anyway, why revisit the risk of infection with a second procedure?" he asks.
The reimbursement picture
There's a catch, though. "Under Medicare, when you combine procedures, you're impacted by the multi-procedure discount rule," which
pays 100% of the rate for the higher-valued procedure but only 50% of
others, says Steve Sheppard, CPA, COE, managing principal of the
Medical Consulting Group in Springfield, Mo. "You're not going to lose
money, but you're not going to make as much as if you'd done 1 procedure this week and the other next week."
Especially, he notes, if you're dealing with ASCs' lower rates and if
your surgeons are doing cases that require pricey supplies. For example, a tube shunt surgery for glaucoma reimbursed at $1,610.43 and
requiring a $900 to $1,000 implant will adversely impact the profit margin of a cataract surgery half-reimbursed at $470, minus $250 to $300
for an intraoperative lens. Additionally, any facility considering the capital expense of a $40,000 trabectome micro-cautery unit for $947.46
cases had better book a busy schedule, says Dr. Vold.
To ensure the fiscal health of your facility, forecast how many dualprocedure Medicare patients your surgeons expect to bring to your
ORs. "If they're overestimating your revenues, you need to know,"
says Mr. Sheppard.
You might have more flexibility with commercial payors on combined procedures, however. "If you anticipate this will be a large num1 0 8
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2013
