What is In-Office Surgery?

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.

What is an In-Office Surgery Center?

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.

What procedures are done in an In-Office Surgery Center?

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 have been the largest specialty group joining the in-office surgery movement over the last few years. The most common in-office surgeries include those 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

What is the difference between an ASC and an In-Office Surgery Center?

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
Maybe 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.

Are In-Office surgeries safe?

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 performed in an office-based surgical setting that 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

Are In-Office surgeries safe? (continued)

In our pilot practice, 250 (consecutive) surgeries had the below outcomes:

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.

150 consecutive patients who had in-office surgery were asked these questions after surgery with the following results:

Do you feel surgery is less intimidating (scary) in-office?

  • 80% Strongly agree, 19% Agree, 1% Neutral

Do you feel surgery in-office is more convenient?

  • 87% Strongly agree, 12% Agree, 1% Disagree

Was surgery in-office comfortable?

  • 95% Strongly agree, 5% Agree

Did you have a good surgery experience in-office?

  • 93% Strongly agree, 7% Agree

If you had surgery again, would you prefer in-office?

  • 97% Strongly agree, 3% Agree

Would you recommend cataract surgery in-office?

  • 95% Strongly agree, 5% Agree

    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.

    What are the benefits of an In-Office Surgery Center?

    • 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.