Patrick McGraw, MD, and Harvey J. Reiser, MD
Ophthalmologists who work in a group practice enjoy many advantages, but they also have a number of challenges when making practice management decisions. While a doctor in an individual practice has only himself to consult before making a major investment or decision, those who share ownership and responsibility for a group practice must demonstrate to others that any proposed change will be beneficial for the entire practice.
Our practice, Eye Care Specialists, consists of 10 ophthalmologists and 15 optometrists working among 13 offices in northeastern Pennsylvania. In a setting like this, the partners are interested in services that increase efficiency and minimize the practice’s risk. As the only two doctors in the practice who perform refractive surgery, we hold the responsibility for making sure this segment is managed in the best possible way.
Approximately 9 years ago, we began to reconsider the way we were running our refractive surgery practice. Up to that point, we had been performing refractive surgeries off-site at a hospital-owned facility near our practice, paying for the service on a per-case basis and supplying our own technicians and personnel. However, we performed most other surgeries within the practice, and we began to consider ways to bring refractive capabilities in-house, as well, to streamline our service as much as possible.
Reviewing the options
The cost for a refractive laser at the time was more than $500,000. Purchasing a laser at that point would have been a substantial risk, especially considering the relatively low number of refractive surgeries we were performing. In an exploration of alternatives, we began to consider utilizing a mobile outsourcing service to bring the laser and other equipment directly to our facility. We were familiar with a mobile service due to its use in a small hospital in an outlying community where we performed cataract surgery, so we began to research the possibility of utilizing the service for refractive procedures.
After some research, it became clear that using the outsource provider, as opposed to purchasing our own equipment, was a dramatically better option. Doing this would allow us to continue paying for use of the laser on a per-case basis and also would give us the ability to upgrade the equipment as necessary. We would not be responsible for performing maintenance and software upgrades to the laser, and we could market our use of the latest and greatest equipment. The six partners in the practice readily agreed that this was an appropriately conservative and low-risk option.
The service provider we contracted with, Sightpath Medical, consulted with the practice to determine our needs and make the appropriate recommendations. With the agreement currently in place, Sightpath Medical supplies all equipment while the practice provides the disposables and ensures the site is appropriate for the surgery. We have a selection of state-of-the-art equipment to choose from and currently schedule the laser to be brought in twice per month to meet the level of demand from patients. The equipment is transported in a patented “roll-on-roll-off” system that is specially designed to protect the laser, which gives us confidence that it will continue to work effectively for all our patients, even after transport.
An additional advantage of utilizing an outsourcing service is that the company provides the engineers and technicians to operate the equipment. This is helpful for several reasons. First, these individuals are experts at using the equipment. It can sometimes be difficult for in-house staff members to become proficient with high-tech equipment, particularly when it is not utilized every day. But because the outsourced technicians travel with the equipment and operate it full time, they are able to run it in the most efficient and effective way.
The engineers are also manufacturer-certified and trained to calibrate, maintain and repair the laser. Surgery schedules are rarely thrown off course due to malfunctioning equipment, and in the event that any repairs are necessary, they are performed as soon as possible. The technicians and engineers are also an important source of encouragement and advice to our practice. Because they travel to so many different facilities, they often have tips they have learned at other sites, and they are helpful to have in the room during challenging cases.
Upon implementing the Sightpath Medical service, our operating efficiency improved almost immediately, as we went from performing two surgeries per hour to three. This was possible thanks to the technicians turning the machine over more quickly between procedures. They have the system down to a science and are instrumental in helping us achieve the maximum efficiency. On a typical refractive surgery day, we perform between 10 and 20 procedures. Prior to the recession, we were performing even more.
According to the American Society of Cataract and Refractive Surgery, the volume of laser vision correction has declined 30% during the last 4 years. While we are optimistic that the volume will pick up as the economy continues to improve, this softening is another reason we feel it is wise to continue utilizing an outsourced equipment provider. Our practice does not have to make a capital expenditure or worry about the cost of upgrades or equipment becoming obsolete. We are spared the pressure to perform a minimum number of surgeries to simply cover the cost of carrying the equipment.
Marketing our capabilities
Utilizing the outsourcing service has actually become an important part of the way we position our surgical services to patients. We constructed a LASIK suite in the office, which is a separate area from the rest of the practice, with more modern amenities and a sophisticated setting. The ability to maintain consistency in our patients’ experience with the practice setting, as opposed to continuing to perform the procedure in the hospital facility, was an important factor in our decision to bring the refractive surgery in-house.
Other local offices perform refractive surgeries with fixed-site lasers, but we are able to use our mobile service as an advantage by explaining to patients that our lasers are transported and maintained by professionals who have been trained by the manufacturer and work with the lasers full time. The equipment is calibrated before each surgery day, so it is always running at an optimum level. Fixed-site lasers, on the other hand, may not be serviced as frequently. Patients are often more comfortable with the mobile laser once they understand the ongoing optimization it receives.
Refractive surgeons who are exploring ways to increase their operating efficiencies would be wise to consider their options for outsourcing equipment. As we have seen, the experienced technicians and engineers can help even well-seasoned doctors work more efficiently. We are able to assure our patients that we are treating them with state-of-the-art equipment that is maintained according to strict standards. Most importantly, our practice can save the significant costs associated with purchasing and maintaining a piece of equipment in a constantly evolving field of technology. This arrangement has allowed us to weather the recent recession comfortably while continuing to provide top-of-the-line refractive capabilities to patients. As the economy improves, we look forward to growing this segment of our practice even more.
Patrick McGraw, MD, and Harvey J. Reiser, MD, can be reached at 703 Rutter Ave., Kingston, PA 18704; 570-288-7405; fax: 570-287-2434.
Disclosures: Dr. McGraw has no relevant financial disclosures. Dr. Reiser is a consultant for Alcon and is on the speakers bureaus for Alcon, Ista Pharmaceuticals and Inspire Pharmaceuticals.