Are ophthalmologists anywhere, doing cataract surgery under just local with oral sedation, no IV placed, without a CRNA or anesthesiologist involved?
I actually wonder how many nonacademic places still have a CRNA or anesthesiologist routinely involved in the care of cataract patients. It can't be that many. I had LASIK and getting the flap cut isn't even uncomfortable. Can't imagine a cataract hurts after the topical anesthetic soaks in.
that's interesting - at our surgicenter, our eye docs probably do 30-40 cataracts / week in total. I would guess about 75-80% of them are done under MAC.
we probably do about 100 per week at our surgicenter of which about 5 are MAC, the rest with no anesthesiologist or CRNA involvement and only oral sedation. Other hospitals/surgicenters around us are very similar except for 1 notable outlier that has 100% under MAC. It's basically just ophthalmologist preference, though seeing how well they do without us I question why we are ever involved except in patients with severe anxiety or developmental issues (the occasional Down's patient).
I think I have only seen one OCR in hundreds of cataract surgeries, and even that one resolved fast. I am also pretty sure that cataracts are (close to) a money loser for anesthesia. So I too have been wondering what the heck I was doing there.I often wonder why I'm in the eye room.
Well let's take a look at some numbers. On a typical cataract day, we will do 12 cataracts. Start at 7 am and be done by 2 pm. Typically 10 will be Medicare or Medicaid. 2 will have commercial insurance. At 6 units per case that's 72 units. I guesstimate one eye unit is worth $27. Revenue of $1950 from one operating room is not great, but it's not bad either. If you have 3 eye days a week, that brings in $300 K a year. Just from cataracts. In a tight market and falling reimbursements, it's pretty good revenue. I wouldn't call it a money loser.
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That sucks. How do you deal with it? Mid levels and supervision? Still a money loser I guess, unless you have the MD supervise two other rooms to average out the revenue.Most good cataract surgeons around me demand 2 operating rooms, it is a money loser for us, unless you get a high number of patients with commercial insurance.
We give them 2 rooms, but one of us. I see the patient 2 ahead between cases after looking at chart on EMR during current case. Patient who is 1 ahead is in room with eye being prepped while we finish current case. Works fine if speed is 20 minute range.
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I am always shocked by some people's greed and the malpractice risks they are willing to take for a few dollars more.
I would never provide anesthesia for an elective procedure if I cannot have a uninterrupted unlimited preop discussion with the patient in a quiet non-distracting private environment.
I was referring to dA pilot's setup. A patient who's in the room, with the eye being prepped, is way too anxious to provide an ideal preop encounter, including informed consent. Plus it's just not the place to do a preop for an elective surgery.