Article 110. Daily Plan For Cataract Surgery Clinics

Daily Plan For Cataract Surgery Clinics 

This is an example created by Lawrence Rosier based on his experiences of having cataract surgery. Ref: Articles: 109, 107

This is a design for a Cataract Surgery Clinic to be built in each major city of a State and operated by the State.  This is done to reduce health care costs in the State and the Federal Government.  The Clinic will reduce the costs expended by as much as 90%. The design of the Daily Plans necessary for the Cataract Clinic also provides examples of how Daily Plans are constructed. Ref: Article 107

The Cataract Surgery Clinic is designed to efficiently process 40 patients per day and meets the required criteria for the implementation of Enterprise Lean and Balanced processes.


Eye Examination Facility Daily Plan
Patients:
40 Patients with appointments each day for eye examinations or for post surgery glasses and
40 Patients with appointments the same day for post surgery exam by Surgeon from the day before.

Facilities               Staffing   Time/Patient      Duties         
Waiting Room     Receptionist       All day   Signs Patients in
Exam Room A    Optometrist #1   20 min    Exam Eyes for Cataracts or Glasses
Exam Room B    Optometrist #2   20 min    Exam Eyes for Cataracts or Glasses
Post Surgery C    Surgeon #1       10 min    Exam Eyes of surgery Patients

Surgeon #1 Trades off Surgery every other day with Surgeon #2.                           

 

Cataract Surgery Facility Daily Plan

Patients: 40 Patients with appointments for Cataract Surgery

Facilities                    Staffing      Time/Patient     Duties         
Waiting Room            Receptionist   All day  Signs Patients in         
Prep Patient Room A Nurse #1         20 min  Preps Patients for surgery, eye drops
Prep Patient Room B Nurse #2         20 min  Preps Patients for surgery, eye drops
                                   Anesthetist     10 min  Anesthetizes Patients
Surgery two Rooms   Surgeon #2     10 min  Performs Cataract Surgery 
Surgery two Rooms   Surgery Nurse10 min  Supports Surgeon during operations
Recovery Room A     Nurse #3         10 min  Move Patients,Surgery to Recovery
Recovery Room B     Nurse #4         10 min  Move Patients,Surgery to Recovery 

Ophthalmologist Surgeon does Cataract Surgery in Operating Room #1 while patients are moved from  Operating Room #2 and another patient is brought in. With the completion of surgery in operating Room #1 the surgeon returns to Operating Room #2 to perform surgery on the next patient.


 Cost Analysis:
             Medicare Reimbursement                  
1. Exam of both Eyes for Cataracts   $  320       
2. Cataract Surgery for eye #1            2,400                         
3. Cataract Surgery for eye #2            2,400        
4. Exam of both Eyes for Glasses          320
Annual Medicare Reimbursement $5,440 x 20/day x 200/days per year
                                                           = $21,760,000 

 Annual Estimated Clinic Salary Expenses         $1,130,000
 Annual Estimated Clinic Operation Costs           1,500,000
                        Total Estimated Clinic Costs    $2,630,000
                       
 Annual Estimated Savings = $21,760,000 -$2,630,000 = $19 million 
                                                            90% reduction in costs

Note: 1. Manager of the Clinic is an Ophthalmologist and fills in               when needed for absenteeism or vacations
          2. Office personnel are also nurses and fill in when needed
          3. Secretaries fill in for Waiting Room Receptionist  
          4. There is no other supervision required
          5. Supplies are ordered automatically
Once the process has been setup it will run automatically as long as it has sufficient backlog of Medicaid and Medicare Patients.  The only difference a patient should see between this cataract surgery and that normally done is that there are more people in the waiting room.

Since the Federal Government is unlikely to do anything about the high cost of Cataract Surgery in the near term I recommend that States establish an Eye Clinic in each of their major cities using the Medicare payments to fund the Clinics.

Examples of Major Savings in Cataract Surgery
Cataract Surgery in Burma (CBS 60 minute segment "Out of Darkness" by two eye surgeons).  Drs Geoffrey Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure (both eyes) caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors.  The two Surgeons were doing about 200 eye surgeries per day.  I give you this example of how little a cataract surgery actually costs in Burma $25 (only for the Lenses) in the US $4800 both eyes.

Second Example:
Cataract Surgery in Missouri Dr. Jones, Jones Eye Center West Plains Mo.   Dr. Jones reaches out to small communities 50 to 100 miles from his practice in West Plains to do Cataract surgery, when there are enough patients to make it worth while about 17 to 20 patients.  In a week he can perform 40 eye surgeries paid for by Medicare at $2400 each eye. The surgeon is grossing nearly $4 million annually from Medicare.  These examples prove that certain health care operations can be reduced significantly in cost.