5 Ways to Save on Viscoelastics

If you are looking for ways to compensate for dropping cataract surgery fees, consider your buying strategies for viscoelastic, the slick substance that helps protect the eye during cataract surgery. If you have a reasonable volume, you can save at least $10 per case by following the advice below, our experts say.

1. Narrow it down
The larger the visco order you can place, the better the bargain you can drive. For that reason, it's best to narrow down the viscoelastics you use.

According to all the experts we interviewed, you only need to stock two kinds:
- A dispersive viscoelastic. This type, which generally has shorter molecular chains, is more viscous than cohesive viscoelastic. It does an excellent job of providing working space for the surgeon. It also does a good job of coating and protecting the delicate ocular structures. The downside is that it is harder to remove. Leftover viscoelastic can temporarily clog the eye's drainage system and lead to a rise in intraocular pressure. For this reason, most surgeons use this type only for difficult cases.
- A cohesive viscoelastic. This type, which has long molecular chains, is very easy to remove and so is less likely to result in a pressure spike. For this reason, surgeons use this type for routine cases. Unfortunately, it's not as viscous as the dispersive variety, and not as good at deepening the chamber. It also gets sucked out of the eye more quickly, leaving the eye unprotected.

The brand or brands you choose should matter little to good surgeons, at least according to our experts. "The variations are minute. Managers needn't worry that economic considerations will clash too terribly with surgeon brand preferences," opines David Nelson, MD, a Long Island, N.Y. ophthalmologist. George Violin, MD, a Massachusetts ophthalmologist and principal of Ambulatory Surgery Centers of America, agrees, "You absolutely do not need more than one type of cohesive and one type of dispersive."

If your surgeons squawk, work to persuade them to test drive the product. Today, all surgeons must understand that they will have to occasionally use alternative, less expensive products.

2. Consider unbundling
Many vendors prefer to "bundle" viscoelastics along with IOLs, tubing, spears, blades, drapes and other disposables for one package price. More than one offer a deal where you can pay off your phaco machine by using the manufacturer's packs.

Before agreeing to such a deal, always carefully consider your alternatives, our experts advise.

Bundles can help with cash flow, allowing you to acquire a phaco machine for no or very little money down. They can even save you money. John Dunne, CRNA, Chief Operations Manager for several Ambulatory Surgery Centers of America locations, says he has done so. "By promising 70 percent compliance for 12 months, I obtained a 0.8 ml viscoelastic and a foldable silicone IOL for only $80 per case," saving $10-15 per procedure, he says.

However, saving is the exception, not the rule, says Tucson ophthalmologist Robert Kershner. Not only that, but bundling locks you into using just one company's products. He recommends negotiating the very best deal you can on each item and comparing that to the cost of a bundle. Significant savings usually result.

If you do choose a bundle, do not commit for more than a year, Gina Stancel, HCRM, Surgicenter Administrator for Eye Centers of Florida, advises.

3. Reconsider Consignment
If you do a high volume, consider purchasing viscoelastics outright rather than using consignment, recommends Santa Maria, Calif. ophthalmologist Dennis Shepard. Consignment always costs more, since the vendor provides the financing. Dr. Shepard keeps a three-month supply on hand. Ms. Stancel commits her center to purchasing a certain volume at a discounted rate, and gets additional discounts for anything above that.

However, if you do a low volume, you may actually do better with consignment, particularly if you often do not use all the products before they reach their expiration date.

4. Supersize it
If the manufacturer you choose offers two different vial sizes, study your usage to see which size is best, advises Dr. Nelson. For instance, say you pay $40 for a 0.5 ml syringe of viscoelastic, and $60 for a 0.8 ml syringe. If your surgeons routinely need more than 0.5 ml but less than 0.8 ml, you can save $20 per case by buying the larger size.

5. Use Instant Replay
Take a lesson from professional athletes, Dr. Shepard advises, and videotape your surgeons during procedures. Have them review the footage, looking for ways to waste less time and product.