Your intention for balanced discussion is noted, but both the moderator and guest favor OBS, lacking balance. Most medical societies, including AAO, ASCRS, ASRS, and ASCA, oppose OBS. Selecting healthy patients for OBS could harm ASC viability. Anesthesia services may cease if OBS draws private patients away. Criteria for ASC vs. OBS selection are unclear, raising safety concerns. The Kaiser study cited didn't reflect OBS conditions. Valium's irreversible sedation in OBS contrasts with titration in ASC. ASC nurses' experience surpasses that of office nurses. Quad A accreditation varies, with Medicare-deemed being more stringent. ASC competition is threatened by OBS proliferation, risking ASC survival. Lower reimbursement rates for OBS could undermine its viability. Advocating for safer ASCs and cautious OBS reimbursement is suggested.

Reply

Dr. Kaldawy, thank you so much for your comments and for your passion. We need more of our colleagues to speak up and also challenge each other in a respectful way in order for us to grow and move forward. As the moderator of this podcast, my role is to foster discussion and allow for exchange of ideas in a fair and balanced way. I do not own shares or make any profits on iOR or their centers. I do own an OBS suite and like you, am also an owner of an ASC. Therefore I do believe strongly in ASCs and their crucial role in outpatient cataract surgery. By no means do I believe that we have to choose between OBS and ASCs. I do think they can coexist and both offer benefits to patients and surgeons. You are absolutely correct, the patients who I schedule in the OBS are generally healthy people. Those who have significant co morbidities and are at a higher risk end up going to the ASC where we have monitored IV anesthesia. There have been other studies showing the high safety of in office cataract surgery. In fact Kaiser published a study that included all types of cataract patients, even those with comorbidities, and found safety was maintained. There were no life- or vision-threatening intraoperative or perioperative AEs and no endophthamitis cases reported. (Published in Ophthalmology 2016). For those healthy patients in the office setting, oral sedation (5mg Valium) tends to be a great option since the patients are calm but yet cooperative. They are not disinhibited like we experience with even 1 mg of Versed. Patients are more calm going into surgery in the office since they are familiar with staff and the environment, there is no IV, and are not NPO. Historically, surgeons have performed surgery with oral sedation in the office, ie refractive surgery, eyelid surgery, conjunctival surgery, etc… with the same risk for cardiac events as in office based cataract surgery. In terms of training, our staff is well trained and went through vigorous training before we opened our center. In fact our head surgical technician was the head of the OR in the hospital across the street where I used to take my cases to. In terms of the space, we are not doing these cases in an “old waiting room,” our OBS OR has been built from scratch to specs similar to an ASC, with similar flooring, walls, air filtration, and top surgical equipment as in the ASC. By no means are we trivializing cataract surgery. In fact, the technology and the skill set needed to do surgery in the office has to be at the highest level and therefore should command reimbursement to reflect that skill and technology. We are also quad A accredited and have to meet those standards and are inspected as well. I wish all states could just “build more ASCs” but many states require a CON which makes it difficult to open another center. Some rural areas may not have the infrastructure to build an ASC as well. Love the discussion, would love to continue offline if you would like. Thank you again for your comments. Warmest regards!

Reply

The guest and the interviewer are IMO misleading the viewers and the regulatory bodies. The studies they picked to show safety were cherry-picked to reflect safety. In those studies the co-morbidity does not match the comorbidity of patients presenting in an ASC which is much higher. This was either intentional but may have been unintentional, as those patients picked to go to office by definition are healthier. If this is approved by Medicare financial bias will lead those owners to take more patients to the office and this is when incidents will happen and when those centers will close. Legal exposure is huge in OBS: No anesthesia and staff not-well trained, as they are at ASC. The only MD in the room is an ophthalmologist and he/ she is busy doing surgery! Furthermore, trivializing cataract surgery this way will lead to lower reimbursement and optometrists will also want to do it. "If they can do it in their old waiting room, so can I in my office at he mall!". If you need to do surgery take your patients to an ASC: Anesthesia presence is best for your patients in case of an emergency, and it takes one adverse event to be sued. There is no need for OBS and if ASC's are full, build more. Also, Dr Durrie does not tell you he has finacial interst in thhis company andmakes money each time a new OBS cente ris built, thretening patient safety at teh expense of profit. Just imagine your patient has a cardiac arrest and all what you can do is call 911 and wait for them...hoping they will arrive soon! Wouldn't you as a patient request an anesthesiologist to be rpesence so you should wish the same fo ryour patients.

Reply