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3 by Matt Jensen Integrating ReLACS into today's practice "Of the 35,821 laser cataract procedures performed between January 2013 and December 2013, 57% were conventional IOLs, 24% were presbyopic IOLs, and 19% were toric IOLs." R efractive laser-assisted cataract surgery (ReLACS) is a simple procedure that is performed with a femtosecond laser— technology that our industry has known and loved for quite a while. The distinction between ReLACS and LACS is important because even the nomenclature is a cue that helps determine how the procedure is charged for and reimbursed. The first femtosecond laser used for ReLACS was labeled by the FDA for four uses: the incision, the capsulorhexis, the breaking up of the lens, and arcuate incisions. This is important because three of these four items are already covered cataract services by payers. Because of the heavy capital expense associated with using a femtosecond laser for cataract surgery, surgeons need to be aware of what they can actually charge payers for. In 2005, there was a marquee event in the advanced implant world for cataract surgery— practices were now able to charge for refractive diagnostics that, when combined with advanced IOLs, could reduce refractive errors, such as presbyopia and/or astigmatism. This was an important event in ophthalmology because it unbun- dled the combined portions of the cataract surgery package that were previously locked down. Now, there are the traditional or medical components of cataract surgery, and there are the elective portions of surgery that patients might pay for additionally. There have always been many regulations overseeing the tradi- tional or medical components of cataract surgery. Today, practices need to understand what they can bill for and what will be reimbursed regarding the elective components of the procedure. Things that might be included in the refractive portion of the consultation are refraction, OCT, and wavefront that might be used for laser vision correction. True, many of these diagnostics may be covered with a chief complaint, but many refractive cataract surgeons feel they benefit from the informa- tion these test provide. For the astigmatic or presbyopic lenses, the patient pays an additional fee. After surgery, there could be a laser fine-tune performed. By navigating reimbursement appropriately for those services, practices can align the work they're performing with the reimbursement and can find ways to add new tech- nology, like femtosecond lasers, to their premium IOL program. This is how practices can bring this to market and set up their billing. According to a recent survey conducted by Spectacle in associa- tion with SM2 Strategic, practices with femtosecond cataract lasers are ramping up quickly to an average of 30% laser penetration of their cataract practices. Additionally, most lasers are exceeding the volumes needed for a positive return on investment. In fact, most single- surgeon centers are achieving at least near breakeven volumes, and nearly all multi-surgeon centers are doing so. This survey included 330 lasers that were installed by the end of 2013. Data collected cover the 35,821 ReLACS cases from January 2013 to December 2013. Surgeons averaged 741 cataracts per year, with 21% of their implants being premium IOLs (10% toric and 11% presbyopic lenses). Practices were asked whether the adoption of the laser affected the volume of cataract procedures performed by the practice. Sixty- seven percent of practices reported their volume increased, 30% said there was no change, and 3% re- ported that their volume decreased. Of the 35,821 laser cataract procedures performed between January 2013 and December 2013, 57% were conventional IOLs, 24% were presbyopic IOLs, and 19% were toric IOLs. According to the survey results, 3% of surgeons felt the laser had already paid for itself, 79% felt the volume had surpassed the breakeven point, and 18% had a positive out- look but had not yet broken even. Given their experience, 84% said they were likely to recommend that their peers get involved and begin performing laser cataract surgery. Mr. Jensen is CEO of Vance Thompson Vision and a member of Spectacle. He can be contacted at matt.jensen@vancethompsonvision.com. After incorporating laser cataract surgery, most practices say that the number of patients choosing an elective lens package has increased. Matt Jensen Laser-assisted cataract surgery

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