Office Based Cataract Surgery: Questions and Concerns
Lori Baker-Schema, MBA, EdD
Commentary by Regina Boore, MS, BSN, RN, CASC
I am frequently asked about my opinion on cataract surgery moving into an office based environment. This has been a hot topic for a while in our industry, especially since the release of the Kaiser study. I have decades of experience in ASCs. I also have experience with Kaiser. I have managed ASC who were contracted providers to Kaiser for many years. I also have experience with office-based surgery. We have assisted many office based surgery centers with accreditation.
Most office based surgery centers (OBSC) are regulated at the state level, in many states, by the Board of Medicine. Some are accredited, which provides some level of oversight at least every three years. The standard of care is definitely not comparable to an ASC. The accreditation standards vary between the accrediting bodies and are generally broad, allowing latitude in how the center demonstrates compliance. They are nowhere near as prescriptive as the CMS Conditions for Coverage and state ASC licensing regulations. In my experience, this, coupled with a lack of oversight, results in a dramatically different (frequently lesser) standard of care.
I have to say it is frustrating, to say the least, for Medicare to seriously consider promoting this transition at this time. I understand the perceived economic incentives on their part. Yet I cannot ignore the juxtaposition to the ongoing aggressive, onerous expansion of the CMS regulatory burden on ASCs. This dramatic expansion and heavy-handed oversight, in some cases, has been justified in the name of patient safety. I find it “rich” after taking such a resolute position on patient safety, that CMS can reconcile adopting a this new model. I think this article, recently published in EyeNet, is a balanced assessment on the subject.