"It's an easy case to make in terms of dollars and cents," says Stephen C. Sheppard, CPA, COE, managing principal at the Medical Consulting Group in Springfield, Mo.

Let's work off a few assumptions before taking a closer look at the numbers to find out why:

• Surgeon-owners are operating. It makes sense to add laser procedures if surgeons have ownership stakes in your facility because they'll get a share of the facility's reimbursements and pocket the physicians' fees, points out Ralph Paylor, MD, managing partner at Florida Eye Associates/ASC of Brevard.

Physician fees are also slightly lower for laser procedures performed in surgery centers instead of offices. The per-case decreases might not seem like a lot — surgeons earn about $19 less per YAG capsulotomy, for example — but they add up with these high-volume procedures. If surgeons don't have ownership shares in an ophthalmic-only surgery center or have only a minority share in a multi-specialty center, it probably makes more financial sense for them to collect higher physician fees in their offices.

• It's convenient. Surgeons are more likely to bring laser cases to your facility if their clinic is physically attached or very close by, says James Dawes, MHA, CMPE, COE, president and founder of the J. Dawes Group, a consulting firm based in Sarasota, Fla.

That's why YAG capsulotomies might be the easiest to add — high-volume cataract surgeons are already in your facility and can take care of laser patients before or after performing surgery. Dr. Paylor performs YAG capsulotomies on the same day he performs cataract surgeries. "The procedures take about 2 minutes to perform," he says. "Patients are in and out of the facility in 2 hours."

Mr. Sheppard says investing in laser platforms might also attract surgeons from a practice with offices in several locations who prefer to bring cases to a facility in a centralized location or surgeons from low-volume practices who don't have the budget or interest to invest in their own unit.

• Start-up costs aren't significant. YAG lasers cost between $20,000 and $25,000, a combination YAG-SLT platform can be had for about $50,000 and a refurbished 523nm laser needed to perform retina procedures costs between $12,000 and $20,000, according to Mr. Sheppard. Per-case costs are essentially a nonfactor because there are few, if any, consumables needed and there are no per-click fees to worry about. Plus, laser platforms take up very little real estate in your facility.

• Demand is high. Mr. Sheppard says 10% to 30% of cataract patients require YAG capsulotomy after having IOLs implanted. More patients are undergoing glaucoma laser procedures, in line with the growing number of people with diabetes, which has been associated with increases in intraocular pressure.

"Many surgeons are opting to use laser treatments as a first-line treatment before resorting to more invasive procedures or even a multi-drop daily regimen of eye drops," adds Mr. Dawes.

Do the math

OK, now for the numbers.

• YAG capsulotomy (CPT code 66821). Cell growth that occurs in the eye after cataract surgery can cloud the posterior capsule, giving patients the sensation that their cataract is growing back. Surgeons use a YAG laser to ablate the tissue in the posterior capsule, behind the intraocular lens, in order to reopen up the visual pathway.

The average Medicare facility reimbursement for the procedure is $250, according to Mr. Sheppard. That means your facility would have to perform between 90 and 100 cases to pay off a YAG laser.

"If 20% of patients in a facility that performs 1,000 cataract cases a year undergo laser capsulotomy, the facility would pay for the YAG in about 6 months," he explains. "The payback period is fairly short."

• Selective laser trabeculoplasty (CPT code 65855). Surgeons perform selective laser trabeculoplasty (SLT) on glaucoma patients to open up the trabecular meshwork in order to increase fluid outflow. The average facility reimbursement is $133 so it takes longer to pay for the SLT laser needed to perform these procedures, but the cases are still profitable, says Mr. Sheppard.

• Laser peripheral iridotomy (CPT code 66761). Surgeons perform peripheral iridotomy (LPI) on glaucoma patients to create a hole in the iris. That lowers intraocular pressure by letting fluid flow out from the back the eye. The average facility reimbursement is $186. Mr. Sheppard says this procedure is performed less often than SLT.

• Focal photocoagulation (CPT code 67210). Retina surgeons perform this procedure to treat diabetic retinopathy and macular edema. They use a 520nm laser to destroy damaged eye tissue and eliminate scarring that contributes to blind spots and vision loss. ?The average facility fee is $250.

• Pan-retinal photocoagulation (CPT code 67228). This procedure is often used to treat patients with diabetic neuropathy and related tissue bleeding in the retinal tissue that can cause retinal detachment. The facility fee is only $178, even though it's a more invasive procedure than focal photocoagulation. However, patients with this level of eye disease need to be treated more than once and often in a relatively short period of time. While the other laser procedures have a 90-day global period — you don't get paid if you repeat procedures within 90 days of each other — pan-retinal photocoagulation has a 10-day global period to allow for sequential treatments.

Mr. Dawes always includes a dedicated laser room in the layouts of the new ophthalmic surgery centers his clients are building because the square footage might end up being the facilities' most valuable real estate. "There are so many positives to including laser procedures in your case mix," he says. "Why wouldn't you add them?" OSM