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Anthem doesn't want to pay for anesthesia during cataract surgery?

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fakin' the funk

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Our involvement in cataracts done under topical is quite silly. The goal is to give as little as possible. It's ridiculous even doing the preop. "You'll be awake so you can look straight ahead." 1mg midaz, 25-50mcg fentanyl is more than enough.

If the surgeon does blocks either blanket or selectively, I find it usually takes 0.75-1 mg/kg propofol for adequate depth. By the time they wake up the case is started. Your biggest problem is the "reachers." God knows what the ophthos are doing in there but their patients seem to like them.

Does anyone else think it's hilarious that there are all these subspecialties of ophtho when the different parts are like 1cm from each other. "Oh I'm a retina guy"
 
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gasdoc77

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Nope. Not worth it. We're not talking about GI here.
"first they came for the cataracts and I did not speak out, because......"
 
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nimbus

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Our involvement in cataracts done under topical is quite silly. The goal is to give as little as possible. It's ridiculous even doing the preop. "You'll be awake so you can look straight ahead." 1mg midaz, 25-50mcg fentanyl is more than enough.

If the surgeon does blocks either blanket or selectively, I find it usually takes 0.75-1 mg/kg propofol for adequate depth. By the time they wake up the case is started. Your biggest problem is the "reachers." God knows what the ophthos are doing in there but their patients seem to like them.

Does anyone else think it's hilarious that there are all these subspecialties of ophtho when the different parts are like 1cm from each other. "Oh I'm a retina guy"


The most important question for a cataract preop is, “Can you lie flat for 10min without moving?” If the answer is yes, then the case is a go.
 
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deleted162650

The most important question for a cataract preop is, “Can you lie flat for 10min without moving?” If the answer is yes, then the case is a go.

I was taught that a cataract preop actually involves 2 questions. The first is “can you lie flat” and second is “are they gonna die in the parking lot walking in from their car”. If the answers are “yes” and “no” then it’s a go.
 
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Arch Guillotti

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I was taught that a cataract preop actually involves 2 questions. The first is “can you lie flat” and second is “are they gonna die in the parking lot walking in from their car”. If the answers are “yes” and “no” then it’s a go.
I would add that they need to avoid coughing like crazy and not freak out when stuff goes over or near their eye.
 
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deleted171991

"first they came for the cataracts and I did not speak out, because......"
I disagree, Dr. Niemöller. Anesthesia for modern cataract surgery should come close to anesthesia for a bigger tooth filling. Is it fun? No. But should it need anything more than local and handholding? No.

P.S. Does it pay peanuts, and are there many more productive ways of spending our worktime, especially in this day and age when every dollar matters in healthcare? You bet.
 
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narcusprince

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I know many crna only groups that will take a big pay cut due to this ruling. These cases were their bread and butter.
 
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deleted162650

I know many crna only groups that will take a big pay cut due to this ruling. These cases were their bread and butter.

Keep in mind this was Aetna not MC. The vast majority of cataracts are MC.
 
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Ezekiel2517

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Does anyone else think it's hilarious that there are all these subspecialties of ophtho when the different parts are like 1cm from each other. "Oh I'm a retina guy"
Was in the OR the other day and the plastic surgeon asks the RN what her husband does and she says he's an anesthesiologist. He asks her if he did a fellowship and she says "yah, he did an acute pain fellowship". Plastic surgeon goes, "Wait, isn't that just anesthesiology? So he did a fellowship in anesthesia?"
 
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Ezekiel2517

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I disagree, Dr. Niemöller. Anesthesia for modern cataract surgery should come close to anesthesia for a bigger tooth filling. Is it fun? No. But should it need anything more than local and handholding? No.

P.S. Does it pay peanuts, and are there many more productive ways of spending our worktime, especially in this day and age when every dollar matters in healthcare? You bet.
lol you think we get peanuts for cataracts? Most PP ophthos are very very fast and can bust out a ton of these cases. Room turnover is also very rapid for these cases. It can be quite lucrative dude.
 
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deleted162650

lol you think we get peanuts for cataracts? Most PP ophthos are very very fast and can bust out a ton of these cases. Room turnover is also very rapid for these cases. It can be quite lucrative dude.

If you’ve got a lot of private insurance cataracts you’re right, but that’s very rare. Even an efficient lineup of MC phaco’s ain’t that great.
 

Ezekiel2517

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If you’ve got a lot of private insurance cataracts you’re right, but that’s very rare. Even an efficient lineup of MC phaco’s ain’t that great.
Well, if you're in a solo MD practice with a unit of 50 and the ophtho has a lineup of 15 eyeballs and you're home by noon, I consider that a decent day.
 
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Well, if you're in a solo MD practice with a unit of 50 and the ophtho has a lineup of 15 eyeballs and you're home by noon, I consider that a decent day.

Meanwhile at academic medical center, 4 cataracts on the list means you're there until 7 pm
 
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Southpaw

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Well, if you're in a solo MD practice with a unit of 50 and the ophtho has a lineup of 15 eyeballs and you're home by noon, I consider that a decent day.

I assume you’re talking mixed unit rate of 50? The cataract room is almost always all Medicare, and from a ($ to group)/room perspective, it is almost always the worst room of the day. You personally may like it bc it does produce good units if you can get 15/day in a timely manner, but your group as a whole gets very little.
 
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deleted162650

Well, if you're in a solo MD practice with a unit of 50 and the ophtho has a lineup of 15 eyeballs and you're home by noon, I consider that a decent day.

OK, so that's a bit of a superficial way to look at it. Let's beak down what @Southpaw was saying:

Let's say your lucky, and out of your 15 phase's 3 happen to have private insurance that pay at $65/unit. The other 12 are MC at essentially $20/unit. You've got a solid optho, and can crank out 3 cases per hour at 6 units each (remember, MC isn't gonna pay you for the modifiers like ASA level or age, but to be fair I'll throw in 4 bonus units for modifiers on the private insurance cases). So, total revenue for the lineup is $2870.00. You got paid at the blended unit rate and collected $4700.00. So, at the end of the day, the group is $1830.00 in the hole covering that cataract lineup. The group quite literally would have been better off not covering that room in the first place.
 

Ezekiel2517

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OK, so that's a bit of a superficial way to look at it. Let's beak down what @Southpaw was saying:

Let's say your lucky, and out of your 15 phase's 3 happen to have private insurance that pay at $65/unit. The other 12 are MC at essentially $20/unit. You've got a solid optho, and can crank out 3 cases per hour at 6 units each (remember, MC isn't gonna pay you for the modifiers like ASA level or age, but to be fair I'll throw in 4 bonus units for modifiers on the private insurance cases). So, total revenue for the lineup is $2870.00. You got paid at the blended unit rate and collected $4700.00. So, at the end of the day, the group is $1830.00 in the hole covering that cataract lineup. The group quite literally would have been better off not covering that room in the first place.
Yah, I know how to do basic math dude. There's probably quite a bit of other **** we literally would be better off not covering as well. Doesn't mean we just say "F*ck off, you're on your own". But I guess I'm just too superficial to understand
 
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deleted162650

Yah, I know how to do basic math dude. There's probably quite a bit of other **** we literally would be better off not covering as well. Doesn't mean we just say "F*ck off, you're on your own". But I guess I'm just too superficial to understand

Oh chill out. This thread is about potentially losing cataracts as a revenue stream, and you said a day of phacos was good money. I was just illustrating (especially for the youngsters out there) that losing cataracts isn’t a hit financially, and in the example you provided would actually improve the group’s bottom line.

Didn’t mean to offend. In an effort to lighten the mood I’ll go ahead and close out this post with a dancing monkey. :zip:
 
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Planktonmd

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Here is the bottom line:
Between us, the majority of cataracts done with topical drops can be done safely without anesthesiology involvement. ;)
But, anesthesiology providers make money when they sit in the eye room and watch the patient, so is it really wise to admit publicly that anesthesiology services are not needed in these cases?
Why do we continue to be our own worst enemies in this specialty is beyond comprehension!
 
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jwk

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As long as the eye docs want us and we're getting paid for them, we'll continue to do them. The moment we don't get paid, we're done. We work with a couple dozen cataract guys. All but two are topical all the way. We refuse to do eye blocks. Period. We don't get paid extra for it, so why incur the liability? We give a little propofol ONLY while they do the block.
 
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2Fast2Des

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Here is the bottom line:
Between us, the majority of cataracts done with topical drops can be done safely without anesthesiology involvement. ;)
But, anesthesiology providers make money when they sit in the eye room and watch the patient, so is it really wise to admit publicly that anesthesiology services are not needed in these cases?
Why do we continue to be our own worst enemies in this specialty is beyond comprehension!

Lol seriously! If there is an opportunity to keep a revenue stream why kick the gift horse?
 

Hawaiian Bruin

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I could put a swan in every heart I do, and my practice would make more money. Insurance would probably pay for it.

But swans aren't indicated for every heart, so I don't put them in.

Same thing.

I'm all for putting food on the table, but much like the horse and buggy driver of bygone days, it's time to look elsewhere for revenue IMO.

I don't fault anyone for milking it while they can, just to be clear.
 

Planktonmd

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I could put a swan in every heart I do, and my practice would make more money. Insurance would probably pay for it.

But swans aren't indicated for every heart, so I don't put them in.

Same thing.

I'm all for putting food on the table, but much like the horse and buggy driver of bygone days, it's time to look elsewhere for revenue IMO.

I don't fault anyone for milking it while they can, just to be clear.
But Swans have complications and risks, having an anesthesia provider in the cataract room is not harmful and occasionally beneficial, that's the idea.
 
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Hawaiian Bruin

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To play reductio ad absurdum with that idea, it would also not be harmful and potentially occasionally beneficial to have a cardiologist also in the room.

But definitely not cost effective.

Cataracts can be done with topical anesthesia, and when done that way, we don't add a damn thing except cost to the process. That's my story and I'm sticking to it.
 
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Mman

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Why do we continue to be our own worst enemies in this specialty is beyond comprehension!

In an era of cost containment, I'd argue that we should be happily not doing unnecessary anesthetics and should be proving our worth on the cases where we are needed and do make a difference. Pigs get slaughtered and the cataract hill is not the one I'm dying on.
 

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In an era of cost containment, I'd argue that we should be happily not doing unnecessary anesthetics and should be proving our worth on the cases where we are needed and do make a difference. Pigs get slaughtered and the cataract hill is not the one I'm dying on.

We should decide where we would be best used. Why should we allow an insurance company to dictate our role?
 

Planktonmd

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In an era of cost containment, I'd argue that we should be happily not doing unnecessary anesthetics and should be proving our worth on the cases where we are needed and do make a difference. Pigs get slaughtered and the cataract hill is not the one I'm dying on.
You my friend are obviously in the category of the fat cats of anesthesiology practice.
Nothing wrong with that, but there are others out there who are more hungry than you and don't mind being less idealistic for a few more bucks.
Disclaimer: I am not not in that hungry category.
 
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Mman

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We should decide where we would be best used. Why should we allow an insurance company to dictate our role?

So are you going to argue you should get paid to provide anesthesia for skin biopsies in the dermatologist office? I mean nobody else is really going to say sure you guys should get paid for whatever you want to do as long as you think it's important.
 

Mman

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You my friend are obviously in the category of the fat cats of anesthesiology practice.
Nothing wrong with that, but there are others out there who are more hungry than you and don't mind being less idealistic for a few more bucks.
Disclaimer: I am not not in that hungry category.

I don't think "being hungry" has anything to do with providing an unnecessary service.
 

nimbus

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If you think about it, it makes more sense for us to be present for something like wisdom tooth extraction than a topical cataract. But we are not because of tradition more than any rational reason.
 
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