Jared Younger's blog focuses on laser cataract surgery. He discusses successfully implementing laser technology into practice and his own precess for patient discussion and education.

BLOG: How low will reimbursement go?

Prior laser blogs have talked about how I believe the technical capabilities of a femtosecond cataract laser can add to your tool set in different surgery cases. Specifically, I discussed how the Catalys laser from Johnson & Johnson Vision, with its impressive OCT imaging and super precise delivery of cornea and lens treatments, can decrease surgeon stress and help avoid complications. Case examples have included capsulotomy speed benefits, safety in white and exfoliation cataracts, use in post-radial keratotomy corneas, and benefits of intrastromal marks and arcuate incisions.

But wait, it is 2020, and thanks to the recent cost analysis of cataract surgery by “big brother,” significant reimbursement cuts for standard cataract surgery have been made. The rate has been lowered to an amount close to some minor office procedures. Let us take that into consideration, plus the fact that patients deserve — and expect — an elevated cataract surgery experience.

Refractive management package

Adding refractive management to your practice includes a package of additional office testing, astigmatism correction and premium postoperative care; this is the solution to these unfair insurance “adjustments.”

Offer patients the best in technology, and then additional laser costs become less of a talking point; instead, it simply makes sense to most patients. For example, patients have 32 teeth, and when one tooth needs repair, there are significant out-of-pocket costs associated with that, which can exceed a typical laser/refractive cataract fee for one eye. Or look at an even more common scenario: Patients pay the cost of a high-end iPhone — nearly $1,000 — which then gets used for 2 years and replaced. So, giving cataract patients a laser refractive cataract surgery option should not include any apologies for cost; it makes sense for a better surgical experience for them and the surgeon.

But what about LRIs?

An argument that some would make to this suggestion may be the cost-effectiveness of a manual limbal relaxing incision (LRI) package; it costs less, and it is low risk with overcorrection unlikely. I offered this as a low-cost add-on to cataract surgery for 8 years prior to having a Catalys laser. Conversion was 30%, and using a diamond knife was straightforward. Adding a Catalys option, however, increased my conversion to 80%, and in my hands, the arcuates are beautifully precise and more accurate. Patients understand the difference between an OCT imaging-based laser incision vs. a hand-held manual LRI. Plus, patients can watch a laser cataract surgery animated video while dilating, after which there is a usually minimal surgeon discussion needed to clarify the benefits of the laser. Remember, many patients walk into a cataract consultation assuming our surgery is done with laser; I am sure glad I don’t have explain why I don’t need the help of a laser.

Disclosure: Younger reports he is a consultant to Johnson & Johnson Vision.