Maryland Surgeon Speaks to Benefits of Ophthalmic Office-Based Surgery

At Kiawah Eye 2024, Jonathan D. Solomon, MD, presented an overview of his transition to office-based ophthalmic surgery. A summary of that talk follows:

I’ve had the pleasure of working alongside my father who’s an ophthalmologist and my mother who’s an anesthesiologist. Both have over 50 years of experience, and both welcomed the transition to OBS. My father remembers the pushback when surgeons were transitioning from the hospital to the ASC, and that same shift is happening today. Office-based surgery has been around for nearly a decade and is widely accepted as a safe, viable alternative to the ASC. My move to ophthalmic office-based surgery took place in 2022 and I haven’t looked back since. It’s given me complete control of my own OR and the surgical experience.

When adopting office-based surgery, important elements to consider are safety and efficacy, efficiency, economics, and the patient experience…

Safety & Efficacy 

It’s simply not an issue in our office-based suite. In fact, I’ve found safety is superior to a hospital or ASC. And the research backs that up. Three separate safety and efficacy studies demonstrate that OBS matches—and in some cases exceeds—that of hospital outpatient departments (HOPDs) and ASCs. Complication rates were also superior in the office-based setting.

Accreditation

Once again, this concern has been alleviated. Office-based surgical suites are bona fide operating rooms that operate under the same safety and accreditation standards and the same national organizations as ASCs and hospitals, including, but not limited to, The Joint Commission (TJC) and Quad A. I have to say our collaboration with iOR Partners ensured that accreditation.

Oral Sedation

I’m routinely asked about anesthesia in the OBS. In my OBS, we started with ten milligrams of Valium, but soon realized we only needed five for most patients. IV sedation was the only choice in the hospital or ASC. Without question, patients are more comfortable and less stressed prior, during, and after surgery with oral sedation.

Reimbursement

We did an extensive review of the process for OBS reimbursement. Working with iOR Partners, we learned about the concept of code set billing to get reimbursed for in-office procedures in our practice. This has been tested with multiple audits and to date, we’ve had zero refunds or deficiencies.

There is a path forward for standardized reimbursements as CMS continues to evaluate office-based procedures. In a recent survey, a third of surgeons said that they would consider the transition to OBS when CMS standardizes reimbursement.

If you’re considering the transition to OBS, I encourage you to talk with me or other surgeons who are doing surgery in the office. It’s been exciting to be at the forefront of medical innovation. With OBS, I own the OR and I own the patient’s experience start to finish. I couldn’t ask for anything more. It’s safe. It’s accredited, and it was a smart choice for my practice. Now you can decide whether it’s a viable option for your practice.

To hear more from Dr. Solomon, view his video on patient outcomes with office-based surgery.

Jonathan D. Solomon, MD

Jonathan D. Solomon, MD is a board-certified ophthalmologist specializing in laser cataract and refractive surgery, and was the first surgeon in the District of Columbia, Maryland, and Virginia (DMV) to implant a Visian® ToricTM ICL. Dr. Solomon has been recognized nationally as one of the “Top Doctors in America” by his peers, and listed as one of Baltimore-Washington’s Super Doctors. Learn more. 

1. Ianchulev T, Litoff D, Ellinger D, Stiverson K, Packer. Office-based cataract surgery: population health outcomes study of more than 21,000 cases in the United States. Ophthalmology. 2016;123(4):723-728.
2. Kugler LJ, Kapeles M, Durrie. Safety of office-based lens surgery: a U.S. multicenter study. J Cataract Refract Surg. 2023. 10.1097/j. jcrs.0000000000001231.
3. iRWD Registry: Real-World Data Collection for Ophthalmic Office-Based Surgery.