In-office surgery (also referred to as office-based surgery), is surgery typically performed in an office surgery suite instead of an ASC (Ambulatory Surgery Center) or hospital.

An In-office Surgery Center is typically an accredited in-office surgery suite, usually located in a surgeon’s office or in a free-standing office. It often consists of an operating/procedure room, clean and dirty room(s) for cleaning and sterilizing instruments, preop/postop area(s), and a scrub area.

This varies by specialty, but the most common specialties performing in-office surgery are ophthalmology, plastic surgery, dentistry and oral maxillofacial surgery, dermatology, cardiology, gastroenterology, urology, ob-gyn, and otolaryngology.

Ophthalmologists are the largest specialty group joining the in-office surgery movement over the last few years mainly due to interest in in-office cataract surgery. The most common in-office surgeries they are performing include the procedures that our company has special agreements for:

Standard cataract surgery

  • Complex cataract surgery
  • MIGS procedures
  • IOL exchange
  • Secondary (piggyback) IOLs
  • IOL repositioning
  • Removal of retained lens material
  • Eyelid procedures (blepharoplasty, ptosis repair, brow ptosis repair, etc)
  • Pterygium removal
  • Vitrectomy

ASC

(Ambulatory Surgery Center)

 

In-Office Surgery Center

Free-standing building

In a surgeon’s office (but could also be in a free-standing office)

Medicare-certified outpatient surgery facility

Not certified with Medicare, but is accredited for in-office surgery

Provides all classes of anesthesia (local, monitored-care, general)

Provides for either local (with minimal sedation) or IV (moderate sedation) anesthesia

May be either single or multi-specialty

Single specialty

Has its own staff separate from the surgeon’s office

May or may not be staffed separately from the surgeon’s office

Charges Medicare and other insurance companies a facility fee

Cannot charge a facility fee to Medicare or other insurance companies (but special insurance agreements are possible – which is what we have arranged for your participation)

Is its own business entity with a unique NPI, Tax ID, business governing documents, board and officers, and staff employment agreements

May or not be its own business entity with its own unique NPI, Tax ID, business governing documents, board and officers, and staff employment agreements.

Has its own insurance policies

May or may not have its own insurance policies

We will help our clients work through all options to meet their needs and goals.

Multiple studies have shown that In-office Surgery Centers are not only safe, but are efficient, convenient, and preferred by patients:

  • A 2016 Ophthalmology article describes a Kaiser Study of >21K cataract procedures’ outcomes performed in an office-based surgical setting showed Office-based efficacy outcomes were consistently excellent, with a safety profile expected of minimally invasive cataract procedures performed in ASCs and Hospital Outpatient Departments (HOPDs).
    • Source: Ianchulev T et al. Office-Based Cataract Surgery: Population Health Outcomes Study of More than 21 000 Cases in the United States. Ophthalmology. 2016;123(4):723-728.
  • A 2017 article entitled, Is Office-Based Surgery Safe? compared outcomes of over 183K procedures in accredited In-office Surgery Centers, ASCs and hospitals with the conclusion, “There was a lower risk of developing a complication in an office-based surgery suite compared to an ASC or a hospital…Accredited office-based surgery suites appear to be a safe alternative to ASCs and hospitals.
    • Source: Gupta V et al. Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities. Aesthet Surg J. 2017; Feb(2):226-235

In a pilot practice of ours, 250 consecutive surgeries had the outcomes below:

  • 3-week post-operative best-corrected visual activity:
    • Mean 20/20-1 and Median 20/20 (excluding 2 patients where visual improvement was not expected as surgeries’ purpose was to prevent or treat phacomorphic glaucoma).
    • 20/25 or better in 98% of total patients and 20/20 or better in 85% of patients.
  • Zero complications with 0 infections and 0 preoperative (preoperative holding area), and 0 intraoperative and 0 postoperative complications.

Patients from this same practice were surveyed regarding their experience.

  • 100 consecutive patients who had surgery in the ASC or hospital (due to lack of insurance coverage for in-office surgery) were asked if they would have preferred to have their surgery in-office.
    • 100% of the participants indicated that they strongly agree that they would prefer to have surgery in office rather than in the ASC or hospital.
    • Write-in reasons included:
      • Convenience
      • Familiarity
      • Ease of navigation through the facility
      • Comfort
      • Less anxiety/scary/stressful
      • Belief there was a lower risk of contracting COVID
      • Belief it is easier to deal with one-entity billing.
  • Additionally, in the first group of 250 patients since the practice began in-office cataract surgery:
    • 8 patients have opted to pay out-of-pocket to have surgery in-office rather than use their insurance for surgery in the ASC or hospital.
    • 4 patients changed insurance plans to a different plan that covered in-office surgery.
    • They have a list of patients whose insurance plan currently does not cover in-office surgery, but have elected to wait and see if we are able to arrange an agreement with their plan for in-office surgery rather than proceeding with surgery in the ASC or hospital.
    • No patient who had their first eye in-office has elected to have their second eye at the ASC or hospital
  • Convenience and comfort for both patients and doctors
  • Improved efficiency
  • Elevates the practice in the eyes of both patients and the community
  • Creates staff excitement
  • Brings opportunity for potential additional service lines (RLE, ICL)
  • Produces financial savings by eliminating the outside surgery center

All while offering a safe and equal or better experience when compared to an outside facility.