Keys to running a profitable cataract surgery service? Increase your volume — or at least sustain it. And attack costs continuously. That's the formula they follow at Heritage Eye Surgicenter in Oklahoma City, Okla. "But it's becoming more difficult by the year," says James Elledge, RN, BSN, the director of surgical services.

About 1 in 5 (22.1%) of the 96 facilities that participated in Outpatient Surgery's 2011 Cataract Surgery Benchmarking Survey are hosting more cases today compared to this time last year. Another 15.8% are hosting fewer, and 62.1% are hosting about the same. To the right is a breakdown of how many cases the facilities we surveyed host per month.

Here's a breakdown of what the facilities spend on supplies per case:

• IOLs. $130.92
• Visco. $54.89 (viscoelastic is included in many respondents' phako packs)
• Phako pack. $108.34
• All other cataract supplies. $90.51 (including such supplies as tips and blades, tubing and BSS)

The many stages of cataracts
Cataract surgery is a great logistical challenge: How do you shuttle slow-moving, elderly patients from pre-op to the OR to post-op as quickly, as safely and as efficiently as possible?

Many obstacles can get in the way of "treating "?em and streeting "?em," including these that our respondents cited: patients (and surgeons) showing up on time, room turnover, elderly patients taking longer to complete paperwork, the ease with which you can start an IV and the time it takes to instill dilating drops. One respondent reports that her facility's recent switch to a compounded eye drop has significantly reduced pre-op time (see "Is Custom Compounding Right for You?" in April's Manager's Guide to Medication Management and Delivery).

As you can see in the tables below, it's common for pre-procedure times (defined as patient check-in to start of the procedure) and discharge times (defined as end of the procedure until patient meets discharge criteria) to be as long or longer than the actual procedure times (defined as incision to removal of drape). Given this, perhaps it pays to focus your efficiency efforts on pre-op and PACU.

Certainly, pre-op, procedure and discharge times are key benchmarks, but you should also compare your facility's common practices in these areas.

• Street clothes. It's long been thought that you could save valuable time by letting your cataract patients remain in their street clothes during surgery. Nearly 3 in 4 (73.9%) of our facilities let their patients stay in their street clothes in the OR.
• Wheel or walk in? More than 4 in 5 (86%) of our facilities wheel or roll their cataract patients into the OR. The other 14% let patients walk in, even though this is a notoriously slow-moving patient population.
• Turnover time. Nearly 9 out of 10 (88%) respondents turn rooms over in less than 10 minutes, with 40.2% doing so in less than 5 minutes and 47.8% doing so in 5 to 10 minutes. Another 8.7% need 10 to 15 minutes, and 3.3% take 15 to 20 minutes.
• Drops at home. About 1 in 4 (23.7%) of our facilities have patients administer pre-op eye drops at home.

The delicate profit picture
The margin for error when it comes to turning a profit with cataract surgery is razor-thin — just like the profit margin itself. While 84.8% of the facilities we surveyed say that cataract surgery is profitable ("Not very — just barely," says Lisa York, RN, nursing director of the Hunterdon Center for Surgery in Flemington, N.J.), many stressed that all it takes for the equation to go from good to bad is one slip-up, something as seemingly inconsequential as "one extra item being opened or needed," says the administrator of a New York ASC.

That's why the Bethesda Outpatient Surgery Center in Boynton Beach, Fla., streamlined its procedure packs to eliminate waste and negotiated a good price for its IOLs, says Center Director Maddie Linder, RN, CASC. "Cataracts are good if you watch your expenses and it brings in more surgeries," says Deena Lee, RN, director of surgical services at Mercy River Valley Outpatient Surgery in Fort Smith, Ark.

"While cataract surgery is still a profitable procedure, profitability has become more of an issue in the last 2 years with single-use supplies, single-dose medications and decreased reimbursement," says Jennifer Teeter, administrator of the Fry Eye Surgery Center in Garden City, Kan.

Sharon Sjulstad, RN, CNOR, CRNO, CASC, administrator of the Phoenix (Ariz.) Eye Surgical Center, agrees. "As reimbursement keeps decreasing, you need to be more efficient and cost-effective to make this profitable," she says. "Surgeons need to collaborate on equipment and supplies."

Tempering this lukewarm commentary is this indisputable fact: Nothing moves like cataracts. "At 4 to 5 procedures per hour, [cataracts] are by far the fastest moving and most profitable surgery in an ASC," says Patrick Garman, MHA, administrator of the Spartan Health Surgicenter in Monongahela, Pa.

"Our profitability is based on our volume," says Emily Duncan, RN, BS, CASC, executive director of the Lakeland (Fla.) Surgical & Diagnostic Center. "Without the volume, we would not be profitable."

Cataract cases keep "the doors open" due to fast turnover and relatively low supply cost, says L. Evelyn Buensuceso, RN, BSN, director of nursing at the Scripps Mercy Surgery Pavilion in San Diego, Calif. Finally, the manager of an ASC in Waco, Texas, cut right to the chase: "We're able to do an average of 3 cases an hour with a profit between $350 and $400 per case."