How do you order, buy and use intraocular lenses? Outpatient Surgery Magazine surveyed 68 facility managers on their IOL purchasing and inventory practices as well as their advice on improving those practices. Here's what they told us.

Advantages of advance planning
Preparing for successful cataract cases means having the right IOLs on hand. The key to making this happen? "Keep stock current and up to date with par levels, [and] get lens picks ASAP," writes Chandler R. Shirer, ASC administrator for the Indiana Eye Clinic in Greenwood, Ind. Most respondents say they stock 2 to 4 lenses of each strength, though some describe bell-curve par levels with 6 or 8 lenses each in the most frequently used strengths.

Timely notification from your surgeons of the lenses they'll need for upcoming surgeries is critical, since ordering the types or strengths you don't have in stock will have to take vendor turnaround and shipping time into account. About one-half of respondents (50.8%) say they place their IOL orders a week in advance of surgery. Another 27.1% say they order less than a week ahead, and 22% say they give it more than a week.

Always check your lens orders against your surgery schedule in order to confirm that your surgeons have ordered lenses for all the patients they've scheduled, recommends Carol Stadnyk, RN, BSN, administrator of Doctors Outpatient Surgery Center in Naples, Fla.

After you receive a shipment, keep your stock organized. One way to do this is to pull the lens from the right and stock on the left, so that you're always using a first-in, first-out procedure, says a Topeka, Kans., eye center administrator.

Consider consignment
More than three-fourths (77.6%) of respondents reported that their IOLs are provided on consignment by vendors. Only 6% purchase their inventory outright.

Those who participate in consignment arrangements describe compelling advantages. To have a wide selection of lenses based on surgeons' preferences and past order histories, without charge until they're used, means "we have them readily available, and do not have to worry about late shipments, back orders and the possibility of canceled surgeries," says an administrator.

Given the cost of purchasing and maintaining an adequate IOL inventory, that convenience can benefit the budgets of smaller facilities with less-busy cataract practices. "We don't do enough volume to stock the amount of IOLs required to make it cost-effective," says Kie McNabb, MS, RN, director of surgical services for Doctors Hospital at Deer Creek in Leesville, La. As a result, consignment represents less money sitting on supply shelves and, since many vendors allow the charge-free exchange of lenses before their expiration dates, less waste.

For facilities seeking to stay on the cutting edge, consignment arrangements that allow such exchanges enable them "to be flexible with changes in technology, physician preference and patient needs," says Loris D. Cook, RN, surgical services manager at Columbia Memorial Hospital in Astoria, Ore.

IOLs on consignment can also simplify inventory management, says a Lompoc, Calif., administrator who has one less supply to keep track of. "The vendor makes sure we have them, and that they are not expired." Tiffany Monk, RN, administrative director of St. Dominic Ambulatory Surgery Center in Jackson, Miss., points out that consignment arrangements can help keep you from overstocking the types of lenses you don't often use.

About 12% of respondents obtain lenses, along with equipment and technical support, when a cataract outsourcing company visits — an option that can likewise save your materials manager, staff nurse or scrub tech time that they'd otherwise have to spend placing IOL orders, checking inventory and otherwise managing inventory.

Standardize for eyes?
Some survey respondents admit that consignment has freed them from even knowing how many IOLs they have on their supply room shelves. Most, however, say they have about 100 or fewer lenses on hand. Some high-volume centers count as many as 1,500 to 2,000.

At most facilities, the lowest strength lens in stock is 6 diopters, though many respondents reported 10 diopters or zero on the low end. In terms of the highest strength lens, the majority of facilities stock 30 diopter lenses.

That's a broad inventory to manage. Add to it the fact that more than half of the survey's respondents (52.5%) say they buy and stock IOLs from more than 1 manufacturer. If your storage shelves and your supply budget might benefit from simplifying your purchasing habits, consider standardizing your IOLs.

You can start the process by speaking with your physicians. While price and healthcare system contracts with vendors determine IOL choice at a few surgical facilities, physician preference is the guiding factor for 84.4% of respondents.

"Having surgeons agree on a single brand of IOL decreases inventory needs and makes inventory management easier," says Mary C. Wilson, RN, BSN, CNOR, clinical preceptor for Ruby Day Surgery Center at West Virginia University Hospitals in Morgantown. "Surgeon awareness of models and sizes available also ensures that any patient that needs an IOL outside of those in stock will have a lens special-ordered in time to arrive for the surgical procedure."

"Keep it simple," concurs Becky Netzer, RN, CNOR, the PACU director for Dosher Memorial Hospital in Southport, N.C. "Stock the most common sizes and order any odd size in advance of surgery."

Covering the cost of specialty lenses
Medicare allocates $150 per standard monofocal lens, but sometimes the situation calls for a specialty IOL, either a toric lens for astigmatism or a multifocal lens for presbyopia. These specialty lenses are more expensive than standard IOLs, and while not every facility stocks them on consignment (according to the survey, about half do and half don't), they've become commonly used.

The question facing surgical facilities is, how much should patients be charged for the use of the specialty IOLs? While they typically pay the difference between a lens's cost and an insurer's reimbursement — hardly any respondents said their facilities bridge that financial gap themselves — are other factors calculated into the charge?

At many facilities, the answer is no. "We use the actual difference between cost and reimbursement," says Karen Maloney, RN, BSN, CASC, administrator of Tri-State Surgery Center in Washington, Pa. Says Barbara Marco, RN, BSN, MS, "It was a board decision to pass through the cost, with no markup."

A slightly smaller number of facilities add a small markup, often based on the costs associated with ordering the non-consignment lenses. "It's a minimal fee, to cover shipping, handling and restocking costs," says one administrator, usually totaling under $15 per lens. A Palm Springs, Calif., eye clinic administrator reports, "You are limited to what you can charge, so it's usually cost plus a small fee."

The decision to charge is often a pragmatic one. "Usually the amount is the same as competitors'," says Judy Bailey, LVN, assistant administrator of surgery at DeHaven Surgical Center in Tyler, Texas. "The sales reps make the suggestion and the facilities tend to go with what they put out there. Of course, you can make your own charges, but ASCs are very competitive with costs."