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In the effort to cut cataract case costs without affecting quality, knives may be one area in which you can save money.
According to Steven Sheppard, CPA, C.O.E., of Medical Consulting Group in Springfield, Mo., it is highly feasible to reduce knife costs to less than $10 per case, and possibly to cut them to less than $5 in the most highly efficient centers. Here are a few tips on how to get closer to that goal while keeping your surgeons happy and your outcomes excellent.
Evaluate material
Changing the material of your blades may be one way to cut costs without cutting quality. To do this, it's important to understand your surgeons' preferences and the characteristics of your facility.
Some surgeons swear that because diamond knives can be made much thinner and sharper than metal varieties, they cause less trauma to the tissue and create better-sealing incisions. One such proponent is Pine Bluff, Ark., surgeon Mike McFarland, MD, who marvels at the "exquisite" incisions he gets with diamond knives and says they've enabled him to increase his volume to 30 cataracts a day (seven per hour).
Although diamond knives range in price from $1,000 to $3,500, they may be worth the investment and actually cut costs, provided that they can help your surgeons be more efficient, and you maintain the knives with the special care and handling they need. Some high-volume centers have attained major savings after they switched from metal to diamonds. At Taylor Hospital in Ridley Park, Pa., OR materials coordinator Traci Graf found that changing to diamonds for two of the three cataract surgeons cut costs by two-thirds. At the Bloomington Eye Institute in Bloomington, Ill., director Karen Magers says that knife costs fell 79 percent after the surgeons switched to diamond knives. "They never get dull," raves Dr. McFarland. "Economically, they're the only way to go."
There are a couple of caveats, however. First, to make the investment pay off, you have to be able to take special care of diamond knives-even seemingly minor missteps in care and handling necessitate repairs. The repairs often cost about $1,000 (the price of 80 or 90 stainless-steel knives) and it's inconvenient to have to send out your knife. At the Hauser-Ross Surgery Center in Sycamore, Ill, "we had a really high diamond knife death rate," says ASC manager Karen Rouse, and the center ended up switching to a combination of diamond and steel. Many experts recommend purchasing diamond knives only if you are able to assign just one technician to handle them.
Another downside of diamonds is that you run the risk of obsolescence?if your surgeon wants to switch to a 3-mm incision and the knife is set to make a 3.2-mm incision, you may have to buy a new knife.
Finally, some surgeons can't work with diamonds because they're actually too sharp. "If you're the least bit careless with a diamond [while making the incision], it's unforgiving," says Robert E. Kellan, MD, of Metheun, Mass. He says that surgeons may feel that they have better control with a metal knife, which offers greater tactile feedback. Obviously, facilities should never try to force diamonds on surgeons who are not comfortable with them.
Stainless steel knives have their own advantages and disadvantages.
Most surgeons still prefer stainless steel, possibly in part because that is what they are used to. Also, manufacturers are now creating metal knives that are sharper and thinner, allowing the knives to produce incisions that are more comparable to those of diamond blades.
Metal knives also don't require expensive upkeep, and although no manufacturer is permitted to recommend reuse, many facilities sterilize and reuse the knives (a recent survey done by the American Society of Cataract and Refractive Surgeons revealed that 27 percent of surgeons reuse their knives). Depending on with whom you speak, metal knives can be reused from 2 to more than 100 times before getting dull. Nearly all disposable knives are made to withstand sterilization.
Finally, because metal knives cost $9 to $18 each, there is significantly less initial investment necessary.
In the end, each individual facility must determine which option offers the best per-use price, depending on its reuse policy for metal and its repair record with diamonds. For example, a facility that pays $12 for each metal knife and reuses it three times on average and a facility that buys a $2,000 knife and makes it last for 670 cases before replacing it both pay about $3 for each use, if you call the cost of care and sterilization equal. Don't forget that another option may be a combination of the two, which is what Ms. Rouse did.
"The bottom line is that if you have a reasonably good volume and you have one scrub tech in charge of the knives and a surgeon who is conscientious, you're going to be better off with diamond knives," says Tennessee cataract surgeon Larry Patterson. "If you're in a facility where there are a lot of different people handling the knives, you may find you're better off with metal blades. When I was in a hospital setting, we had a different scrub tech every day and there wasn't one person who was responsible for making sure the knives were being cared for, and we had a lot greater incidence of knife damage. If you damage a diamond enough, then you would have been better off going with the metal blades to begin with."
A couple of notes about diamonds and steel:
Streamline your trays
Although techniques vary widely, many new knives have the capability to do "double duty," for two separate steps of the incision. If your surgeons are willing, this may present another opportunity for economy.
Surgeons who use the "scleral tunnel" technique start the process by cutting a groove perpendicular to the scleral surface. There are special knives for this, but most surgeons can make do without one, our experts say. They can just flip the disc or crescent knife that they use for tunneling and make the groove that way. There are also special "implant" knives for widening the incision after phaco, but again, some surgeons are able to make do by widening the incision "freehand" with a disc knife.
Surgeons who use the "clear corneal" technique may only need a total of two knives, which is another reason this procedure is so efficient. Many of the trapezoidal blades are designed for both making the initial incision and widening it. If you have such a blade, and the surgeon is comfortable with it, then the only other knife needed is a paracentesis blade.
Make a deal
Once you know your surgeon's preferences, negotiate with your supplier for the best deal. Ms. Graf convinced a knife manufacturer to supply her with five surgical items that one of her surgeons required in a standardized pack. This saved so much that all the cataract surgeons in the Crozer Keystone Health System (the four-hospital network in southeastern Pennsylvania for which she buys supplies) are now using these same standardized packs. She projects an annual savings of $120,000.
Ophthalmologists have almost unlimited choices when choosing surgical knives to accommodate their technique and achieve excellent results. With a little planning and care, you can provide them with the tools they require and keep your costs down at the same time. n
According to Steven Sheppard, CPA, C.O.E., of Medical Consulting Group in Springfield, Mo., it is highly feasible to reduce knife costs to less than $10 per case, and possibly to cut them to less than $5 in the most highly efficient centers. Here are a few tips on how to get closer to that goal while keeping your surgeons happy and your outcomes excellent.
Evaluate material
Changing the material of your blades may be one way to cut costs without cutting quality. To do this, it's important to understand your surgeons' preferences and the characteristics of your facility.
Some surgeons swear that because diamond knives can be made much thinner and sharper than metal varieties, they cause less trauma to the tissue and create better-sealing incisions. One such proponent is Pine Bluff, Ark., surgeon Mike McFarland, MD, who marvels at the "exquisite" incisions he gets with diamond knives and says they've enabled him to increase his volume to 30 cataracts a day (seven per hour).
Although diamond knives range in price from $1,000 to $3,500, they may be worth the investment and actually cut costs, provided that they can help your surgeons be more efficient, and you maintain the knives with the special care and handling they need. Some high-volume centers have attained major savings after they switched from metal to diamonds. At Taylor Hospital in Ridley Park, Pa., OR materials coordinator Traci Graf found that changing to diamonds for two of the three cataract surgeons cut costs by two-thirds. At the Bloomington Eye Institute in Bloomington, Ill., director Karen Magers says that knife costs fell 79 percent after the surgeons switched to diamond knives. "They never get dull," raves Dr. McFarland. "Economically, they're the only way to go."
There are a couple of caveats, however. First, to make the investment pay off, you have to be able to take special care of diamond knives-even seemingly minor missteps in care and handling necessitate repairs. The repairs often cost about $1,000 (the price of 80 or 90 stainless-steel knives) and it's inconvenient to have to send out your knife. At the Hauser-Ross Surgery Center in Sycamore, Ill, "we had a really high diamond knife death rate," says ASC manager Karen Rouse, and the center ended up switching to a combination of diamond and steel. Many experts recommend purchasing diamond knives only if you are able to assign just one technician to handle them.
Another downside of diamonds is that you run the risk of obsolescence?if your surgeon wants to switch to a 3-mm incision and the knife is set to make a 3.2-mm incision, you may have to buy a new knife.
Finally, some surgeons can't work with diamonds because they're actually too sharp. "If you're the least bit careless with a diamond [while making the incision], it's unforgiving," says Robert E. Kellan, MD, of Metheun, Mass. He says that surgeons may feel that they have better control with a metal knife, which offers greater tactile feedback. Obviously, facilities should never try to force diamonds on surgeons who are not comfortable with them.
Stainless steel knives have their own advantages and disadvantages.
Most surgeons still prefer stainless steel, possibly in part because that is what they are used to. Also, manufacturers are now creating metal knives that are sharper and thinner, allowing the knives to produce incisions that are more comparable to those of diamond blades.
Metal knives also don't require expensive upkeep, and although no manufacturer is permitted to recommend reuse, many facilities sterilize and reuse the knives (a recent survey done by the American Society of Cataract and Refractive Surgeons revealed that 27 percent of surgeons reuse their knives). Depending on with whom you speak, metal knives can be reused from 2 to more than 100 times before getting dull. Nearly all disposable knives are made to withstand sterilization.
Finally, because metal knives cost $9 to $18 each, there is significantly less initial investment necessary.
In the end, each individual facility must determine which option offers the best per-use price, depending on its reuse policy for metal and its repair record with diamonds. For example, a facility that pays $12 for each metal knife and reuses it three times on average and a facility that buys a $2,000 knife and makes it last for 670 cases before replacing it both pay about $3 for each use, if you call the cost of care and sterilization equal. Don't forget that another option may be a combination of the two, which is what Ms. Rouse did.
"The bottom line is that if you have a reasonably good volume and you have one scrub tech in charge of the knives and a surgeon who is conscientious, you're going to be better off with diamond knives," says Tennessee cataract surgeon Larry Patterson. "If you're in a facility where there are a lot of different people handling the knives, you may find you're better off with metal blades. When I was in a hospital setting, we had a different scrub tech every day and there wasn't one person who was responsible for making sure the knives were being cared for, and we had a lot greater incidence of knife damage. If you damage a diamond enough, then you would have been better off going with the metal blades to begin with."
A couple of notes about diamonds and steel:
- The number of cases a surgeon performs plays a major role in determining how flexible you should be in his or her choice of knives. If your highest volume surgeon is your most demanding, "the bottom line is you don't want to lose that business," says Dawn Cavanaugh, a Jefferson City, Mo.-based surgery center consultant.
- If you choose diamond blades, ask for help from your manufacturers. At the very least, the company should educate your staff and surgeons on the care of the diamond, including its cleaning, sterilization and general usage. Some allow you to test-drive the knife before you buy. Although none guarantee the diamond, some guarantee the mechanical portion of the knife for life. Some makers will also send you a loaner during repairs.
- Some centers require surgeons to buy the knives themselves. "If my surgeons want to use diamond knives, I require that they purchase them themselves," says Andrea Hyatt, administrator of the Dulaney Eye Institute in Towson, Md. She retains an expert scrub tech to maintain the knives and pays for the upkeep as long as the surgeons use them on site ? if they chip at a different center, repairs are the surgeon's responsibility.
Streamline your trays
Although techniques vary widely, many new knives have the capability to do "double duty," for two separate steps of the incision. If your surgeons are willing, this may present another opportunity for economy.
Surgeons who use the "scleral tunnel" technique start the process by cutting a groove perpendicular to the scleral surface. There are special knives for this, but most surgeons can make do without one, our experts say. They can just flip the disc or crescent knife that they use for tunneling and make the groove that way. There are also special "implant" knives for widening the incision after phaco, but again, some surgeons are able to make do by widening the incision "freehand" with a disc knife.
Surgeons who use the "clear corneal" technique may only need a total of two knives, which is another reason this procedure is so efficient. Many of the trapezoidal blades are designed for both making the initial incision and widening it. If you have such a blade, and the surgeon is comfortable with it, then the only other knife needed is a paracentesis blade.
Make a deal
Once you know your surgeon's preferences, negotiate with your supplier for the best deal. Ms. Graf convinced a knife manufacturer to supply her with five surgical items that one of her surgeons required in a standardized pack. This saved so much that all the cataract surgeons in the Crozer Keystone Health System (the four-hospital network in southeastern Pennsylvania for which she buys supplies) are now using these same standardized packs. She projects an annual savings of $120,000.
Ophthalmologists have almost unlimited choices when choosing surgical knives to accommodate their technique and achieve excellent results. With a little planning and care, you can provide them with the tools they require and keep your costs down at the same time. n
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