Advances in retina surgery have attracted the attention of many ophthalmic ASC owners in recent years, and rightly so. Sophisticated new instruments and equipment have enabled us to refine our techniques and develop new procedures, making for more efficient surgeries with consistently favorable outcomes. Reimbursement is relatively high — although often offset by overhead (See “Have You Heard the One About…”) — and the need for retina care is increasing with our aging population and the rising prevalence of diabetes.

I’m often asked for advice by ASC owners and administrators who are considering expanding their offerings to include retina. While each situation is unique, I’ve found some common threads among surgery centers that have added retina successfully.

1. Research your market thoroughly.

Step 1 is the most time-consuming and important one: Do your research extremely carefully. Make sure you examine characteristics that are unique to you and your location, taking into account the personality and culture of the region, as well as its economy and demographics. What may work for an ASC in Georgia may be a disaster in Alaska, or vice versa.

Although not a comprehensive list, some key questions to answer include:

• How many cases will I need?
• Are there surgeons willing to operate in my ASC?
• Do I have access to skilled staff to support retina?
• Will my referral pattern allow me to do this?
• Does one insurer dominate the region and dictate where surgeries must be performed?

The answers to these questions may encourage you to go forward, or they may reveal all kinds of reasons why you should never venture beyond step 1.

2. Talk to people who’ve gone down this road already.

ASC owners often ask if I can recommend any professional resources — individuals or organizations — to help them decide if retina is right for them. To me, the best resources are the people who have either succeeded or failed at integrating retina.

Once you’ve done your due diligence and decided to press on, visit one or two successful centers where retina surgeries are performed. Have some of your key personnel accompany you, so all of you can observe how the center functions from various perspectives. Talk to the surgeons, the administrators, and the staff. I think you’ll find most people are willing to share information and insights.

3. Make sure your new retina surgeons really want to operate in an ASC.

The success of an ASC is extremely surgeon-dependent, particularly in retina, which requires such a huge capital investment. Thoroughly interview the surgeons you recruit; explore not only their skill level, but also their motivation and adaptability.

It’s not a matter of good or bad surgeons. There are some fantastic surgeons who simply do not like and do not want to operate in ASCs, and I certainly understand that. Make sure you bring in surgeons who recognize the economical and efficiency pressures, as well as the requirements, of working in an ASC and are willing to embrace them.

4. Be prepared to hire and train specialized staff.

This highly specialized surgery, which is so different from anterior segment surgery, requires highly specialized staff. Clinical staff must be totally dedicated to retina surgery, and this will require extra training. Is it a challenge to find personnel with a skill set suited to retina? Yes, but that challenge is not insurmountable. It requires some effort, but it can be done.

5. Ensure the person who manages your ASC is enthusiastically on board.

Your administrator doesn’t necessarily need to know everything about retina right away, but that person needs to be enthusiastic about retina and convey that enthusiasm to staff. He or she needs to learn about retina quickly and be willing to make adjustments to accommodate some of the issues that are unique to retina surgeries. For instance, cases may run later than planned, patients may be sicker than those you are accustomed to seeing, and emergencies happen. Your administrator must be totally committed to this new venture and proactive in adapting some of the center’s protocols to maintain efficiency, ensure safety, and provide positive outcomes.

One more thing: Be prepared to just say “no”

Retina surgery requires a huge capital investment and, as such, is a big risk. Your due diligence requires the most time and has to be done properly, regionally, and exactingly. The wrong decision can result in a huge loss of money and, possibly, time, patients, and referrals.

If, during your research, you find you won’t have the number of cases you need, the right surgeons, or access to skilled staff, or if you learn your referral network simply won’t allow this to work, then retina may not be right for your ASC.

If, on the other hand, you’re confident your community will benefit from — and support — retina, you will find delivering this specialized care in your ASC to be extremely rewarding. ■