Eyeworld Daily News

EW SHOW DAILY 56 Sunday, May 8, 2016 Meeting Reporter open access model. Advantages of this approach are that costs are limited to per-use charges. Challeng- es to it include travel distance and a lack of familiarity with different surgical instruments. "It's a good way to put your toes in the water," Dr. Raviv said. Two companies also offer the roll-on, roll-off option for practices that allow them to have femtosec- ond lasers brought to their practice on a regular schedule. This approach eliminates the need to employ and train a techni- cian to maintain the machine. The technician also can help train the surgeons. In addition to the reduced commitment, this approach allows practices to profit from their first procedure. Disadvantages include increas- ing costs once volumes increase and the need for patients to wait for availability. "The patients have to wait in between times they come but that is a small price for the option," Dr. Raviv said. The economics generally indi- cate that practices are better off with either roll-on, roll-off or open access if they expect 10–20 cases each month. However, if their volume is 25 or more monthly cases, then purchase may be financially better. In the ASCRS Clinical Survey, 52% of U.S. surgeons performing LACS were either full or part owners of a femtosecond laser at a primary surgical site. Only 5% utilized a roll- on, roll-off femtosecond system. Among attendees at the EyeWorld symposium, the data appeared to sway them toward a roll-on, roll-off option. Specifically, 41% of surgeons initially said they were planning to incorporate femto through outright purchase with fi- nancing. That dropped to 15% after the presentation. Conversely, those favoring roll-on, roll-off increased from 14% to 42%. EW Editors' note: This event was support- ed by educational grants from Abbott Medical Optics (Abbott Park, Illinois) and Alcon (Fort Worth, Texas). by Rich Daly EyeWorld Contributing Writer an annual maintenance cost of $50,000, and a per-use $350 fee. Additionally, there is the costs of a technician's salary, additional prop- erty insurance, and square footage costs. "So there is an investment to make, and it's a big investment," Dr. Raviv said. The most common purchase option is typically a 5-year capital lease from a bank. Dr. Raviv encouraged surgeons considering a femtosecond laser to try a no-obligation 3- to 6-month rental, which is a trial offered by the manufacturers. "You have to have a laser before you are able to see if your practice, your patient flow, and everyone is able to meet the volume demands," Dr. Raviv said. If a surgeon opts to purchase, manufacturers will apply those rent- al fees toward a purchase. Another option, and 1 which Dr. Raviv initially utilized, was the primary reason for not doing so was concern about the lack of adequate reimbursement for the surgeon's time. But such ongoing financial con- cerns do not need to keep practices interested in the technology away from it, according to Tal Raviv, MD, New York. The 3 primary models surgeons use to add laser-assisted cataract surgery (LACS) to their practice are purchases, open access, and so-called roll-on, roll-off options. Close to 50% of ophthalmic sur- geons are using femtosecond lasers, according to the latest Market Scope report. And 9% of all cataract cases are being done with LACS. "That creeps up every time we look at these numbers," Dr. Raviv said. However, Dr. Raviv noted that femtosecond lasers carry significant upfront costs. Specifically, femtosecond lasers cost an estimated $425,000, with C oncerns about the lack of financial support for the use of laser-assisted cata- ract surgery—among both users and non-users—con- tinue to nag at the procedure. In the 2015 ASCRS Clinical Survey, more than 70% of respon- dents said performing femtosecond laser-assisted cataract surgery was not a viable economic model for their practice. Additionally, 52% of respondents said they were not confident that there is an adequate reimbursement solution to support laser-assisted cataract surgery. Similarly, 72% of current users of femtosecond laser-assisted cata- ract surgery polled at this EyeWorld CME Educational Symposium said the ability to cover the costs of the technology was the greatest challenge in incorporating a fem- tosecond laser into their practice. Additionally, among surgeons not performing femtosecond laser-assist- ed cataract surgery, 32% said their Financial concerns linger for femtosecond laser-assisted cataract surgery Dr. Raviv discusses the relative advantages of 3 options ophthalmic surgeons use to access femtosecond laser systems for their patients.

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