Cataract surgery with no anesthesiologist

[Wiscoblue]

Are ophthalmologists anywhere, doing cataract surgery under just local with oral sedation, no IV placed, without a CRNA or anesthesiologist involved?

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[Direct Laryngoscopy]

Maybe they missed the weekend course on OCR. Some of them can be slow when I tell them to stop.


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[Mman]

Are ophthalmologists anywhere, doing cataract surgery under just local with oral sedation, no IV placed, without a CRNA or anesthesiologist involved?

Yes. I'd venture a guess that 90+% of cataracts done within 100 miles of me are done with oral sedation and topical anesthesia. I'm not sure if they have an IV started or not, but they are not receiving any IV sedation. There are 1 or 2 that still require our services, but most have moved on which is fine by me.

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.

 

[leaverus]

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.

 

[Mman]

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).

 

[nimbus]

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 often wonder why I'm in the eye room.

 

[Wiscoblue]

I often wonder why I'm in the eye room.

To make money, of course!


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[pjl]

To make money, of course!


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So that the patients see a real doctor? 🙂


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[deleted171991]

I often wonder why I'm in the eye room.

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.

Posterior chamber surgery is a different story.

 

[Wiscoblue]

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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[dA pilot]

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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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.

 

[soorg]

My colleagues work in a hospital where the opthal. demands GENERAL for friggin' cataracts. It blows my mind.

 

[Wiscoblue]

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.

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.


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[pjl]

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.

For our guy who can do them in 7 minutes, I supervise a CRNA. We make up for it by doing 30-36 in a morning.


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[deleted59964]

We do peribulbar or sub tenons for every cataract

 

[deleted171991]

We do peribulbar or sub tenons for every cataract

That's the mark of a surgeon practicing last century medicine.

 

[Mman]

We do peribulbar or sub tenons for every cataract

we have one surgeon that does peribulbar blocks for all and needs us to provide some sedation. every other one in town uses topical drops and that's it.

 

[dA pilot]

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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At one eye center, we used to do it this way, except we didn't have an EMR. Instead, we used our employee RN to start our preop and get most of history for next case. At times, they would try to bring the next patient into the other room and start prepping the eye, so you are meeting the patient with the eye being prepped. It was not an ideal patient-physician relationship. The minuscule amount of reimbursement combined with the amount of hustle you needed was not worth it to our group. We dropped this contract.

 

[deleted171991]

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.

 

[deleted59964]

That's the mark of a surgeon practicing last century medicine.

Agreed
Makes eyes lucrative for those that do them privately here though

 

[Mman]

Agreed
Makes eyes lucrative for those that do them privately here though

There are very few non CMS cataract patients.

 

[Consigliere]

Cataract thrills, cataract chills, check out the oil my cataract spills!

 

[pjl]

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.

If you are referring to my set up, please explain the risk. If I need more time, I take it. The patient who is waiting in the room can wait a few minutes. We have pleasant, chatty nurses and techs.
That said, these are cataracts, which have very good literature backing basically no preop testing or workups except in very rare circumstances.

If you are referring to the full on blocks for cataracts...yeah, I agree.


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[deleted171991]

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.

 

[dA pilot]

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.

This did not happen often, but spoke of the production pressure at this eye center, where the circulating nurse thought we saw the patient already and brought the patient in. Our group could not tolerate this and pulled out.