Cataract extraction study looks at costs, efficiency

Lens costs, patient attire practices compared

High volume of one type of surgery equals low supply costs and improved efficiency. This is a common belief among day-surgery program staff, but a recent study shows that programs with lower volumes can still be efficient and cost-effective.

Twenty-two same-day surgery programs that perform cataract extraction with lens insertion participated in a benchmarking study sponsored by the Accreditation Association for Ambulatory Health Care’s Institute for Quality Improvement (IQI) in Wilmette, IL. The participants were chosen randomly from facilities accredited by Accreditation Association for Ambulatory Health Care. The numbers of procedures performed by each program ranged from 160 cases per year to 3,000 per year.

"The most significant finding is that there is no correlation between the volume of cases and low supply costs," says Girard F. Senn, consultant with Clinical Benchmarking in Glen Ellyn, IL, and project manager for the IQI study. The participant with the lowest average intraocular lens cost performs less than 500 cataract extractions with lens insertions per year, he points out. At the same time, a facility that performs 1,500 procedures per year had an average lens cost of $80 more per lens than the top performer in this category. Costs for lens ranged from $40 to more than $140, with the average reported cost at $85,1 he says.

The study also shows eye-drape costs that range from just more than $2 per case to $14 per case. Eight of the participants purchase their eye drapes as a part of a custom pack for all cases, so their charges were not included in the eye-drape costs data, says Senn.

Participants measured different periods of time for the study that included pre-procedure time, procedure time, discharge time, and overall facility time. Surprisingly, the best performer in the overall facility time category, which is defined as the time the patient arrives in the facility to the time of discharge, was not the best performer in the other three time categories.

"We were not surprised to see that we have the lowest overall facility time because we’ve worked hard to be as efficient as possible," says Kathy Donigan, RN, administrator of Fraser (MI) Eye Care Center.

The staff at Fraser were surprised to see other facilities with better time in the pre-procedure, procedure, and discharge times, she adds. "Fortunately, the report gives specific information about the practices of the best performers in each category, so we had an opportunity to review our own practices in comparison to the best practices. We implemented a number of changes as a result of this study." (See story on making changes, p. 78.)

The best overall average facility time — less than 100 minutes — was posted by Fraser Eye Care Center. The best average pre-procedure time, which is the time the patient arrives to the time a patients enters the operating room, was 40 minutes. The best average procedure time was less than 10 minutes, and the best average discharge time (time from the end of the procedure to the patient’s discharge) was less than 20 minutes.

One practice that greatly affects the overall facility time is the participant’s patient dress attire practice, points out Senn.

"We found that patient attire practices differed greatly among the participants," he says. Forty-two percent of participants required no clothing removal by patients; 22% required clothing from waist up removed; and 27% required all clothing or all clothing except undergarments removed. The other 9% did not respond to the question. Patient attire practices affected average facility times, says Senn. Organizations that do not require clothing removal report average facility time of 131 minutes compared to 210 minutes for facilities that require removal of all clothing, he points out.

Follow-up studies will examine clothing practices as related to the location of the procedure, such as office-based procedure room vs. sterile operating room, says Senn.

Same-day surgery programs can request a copy of the study from IQI, says Naomi Kuznets, PhD, managing director of the institute. (See source box, at left.)

"Not only do we want to share results of completed studies in an effort to give ambulatory care centers appropriate performance measurement information, but we also want to provide a cost-effective way to participate in future studies," she explains. (See story on other studies, p. 80.)

Benchmarking studies give organizations a chance to gain a greater understanding of the costs and times involved with different procedures, points out Kuznets. "As all ambulatory care facilities face payment issues that result in lower reimbursement, it is critical that each manager gain a better understanding of how his or her program is performing and how performances may be improved."


1. Accreditation Association for Ambulatory Health Care. Cataract Extraction with Lens Insertion. Wilmette, IL; 1999.

For more information about the cataract extraction study, contact:

Girard F. Senn, Consultant, Clinical Bench-marking, 799 E. Roosevelt Road, Suite 4-317, Glen Ellyn, IL 60137. Telephone: (800) 808-3076 or (630) 790-1264. Fax: (630) 790-2696. Web site:

Kathy Donigan, RN, Administrator, Fraser Eye Care Center, 33080 Utica Road, Fraser, MI 48026. Telephone: (810) 296-7250. Fax: (810) 296-0276. Web site:

Naomi Kuznets, PhD, Managing Director, Accreditation Association for Ambulatory Health Care’s Institute for Quality Improvement, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091. Telephone: (847) 853-6079. Fax: (847) 853-9028. E-mail:

To order a copy of the Cataract Extraction with Lens Insertion study, contact:

Accreditation Association for Ambulatory Health Care, Institute for Quality Improvement, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091. Telephone: (847) 853-6079. Fax: (847) 853-9028. Web site: