Low costs are not dependent on volume

Cataract study pinpoints factors that do matter

(Editor’s note: This is the second part of a two-part series on the second study of Cataract Extraction with Lens Insertion conducted by the Accreditation Association for Ambulatory Health Care Institute’s for Quality Improvement. Last month, we looked at pre-procedure time, procedure time, and discharge time. This month, we look at costs.)

The good news identified in the 2000 Cataract Extraction Study is that there is not a high correlation between volume and supply costs, says Naomi Kuznets, PhD, managing director of the Wilmette, IL-based Accreditation Association for Ambulatory Health Care’s Institute for Quality Improvement, which conducted the study.

"The annual number of cataract extractions for our participants ranged from 150 to 2,500," says Kuznets. The facilities that reported the best prices for lenses as well as narcotics and sedatives were not always the high-volume facilities that might be eligible for volume discounts, she says. In fact, negotiations, relationships with vendors, and standardization played more important roles in containing costs than volume, she adds.

Eighteen same-day surgery programs participated in the study. Same-day surgery managers can use benchmark studies such as this one to perform a quality analysis by comparing practice patterns, cost of supplies, and time per case, experts advise. In the intraocular lens category, costs ranged from fewer than $40 to almost $160.

"Our lens costs for the study were very high [$120] because the study was conducted during a time period that we were evaluating a number of new lenses, including acrylic lenses that cost $80," says Grace Niedmann, RN, director of nursing at Opticare Eye Health Center in Waterbury, CT. Now that they are completing their evaluations, Niedmann’s physicians will be standardizing their lenses as much as possible to negotiate the best prices, she says.

"We are always tough negotiators," says Niedmann. "We are always open to switching vendors to obtain the best price as long as they offer the lens we want."

Multidose vs. single dose eye drops

The study also looks at the use of multidose vs. single dose eye drops. Traditional hospital practice calls for single dose eye drops, but 94% of the participants use multidose drops, Kuznets says. "Studies show that infection rates do not rise as a result of multidose eye drops,"1 she says.

The nurses use a no-touch method to administer eye drops, says Niedmann. "They pull the lower lid down and drop the medication from a least one inch from the eye, then they recap the bottle between uses," she explains. "If an infection is reported one to three days after surgery, we look for something that happened on the day of the surgery that might have caused the infection. But if the infection occurs more than three days after surgery, the cause is usually the patient or family member improperly administering drops."

Patients and their family members are given verbal and written instructions on how to administer drops, she says.


1. Brudieu E, Duc DL, Masella JJ, et al. Bacterial contamination of multi-dose ocular solutions. A prospective study at the Grenoble Teaching Hospital. Pathol Biol (Paris) 1999. 47:1,065-1,070.


A copy of the 2000 Cataract Extraction Study is $40. To order, 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.