Image by PublicDomainPictures from PixabayOphthalmology is a growing specialty in the ambulatory surgery center (ASC) space.
In part, that growth is fueled by operators using advanced technology that increases patient satisfaction and generates more demand. Rising case rates and ownership opportunities for younger physicians are also giving ophthalmology momentum in the ASC industry.
Ophthalmology is so hot, in fact, there may be a looming supply-demand imbalance for ASCs to contend with down the line.
“In ophthalmology, I think we’re going to be upside down in the number of providers in the future,” Scott Kulstad, CEO of St. Paul Eye Clinic, told ASC News. “And so when we have more and more patients coming in, and we’re going to wrestle with the Medicare Advantage issues, we’re going to have fewer and fewer surgeons to take care of the patients that really need the care.”
St. Paul Eye Clinic is a full-service eye care clinic with eight locations across the Midwest.
Joint ventures have gained significant traction in the ophthalmology space, particularly among private equity backed ASCs, William Hoffman, shareholder at Polsinelli, told ASC News.
“What we’re seeing now is two things,” Hoffman said. “We’re seeing it become more common for private equity funds to offer direct ownership to their ophthalmologists into the joint venture ASC.”
In these scenarios, doctors can sometimes feel disaffected or like they’ve lost their practice, Hoffman said. Younger doctors are especially affected.
“What happens on most PE ophthalmology transactions is there’s always going to be some associates who don’t receive any material purchase price, because they didn’t own the practice,” he said.
To address this, private backed ASCs are increasingly offering ownership opportunities to younger physicians, to align with generational shifts that prioritize immediate investment and equity over the traditional “work-your-way-up” approach.
“If [physicians] receive a direct ownership interest in ASC, they feel more like they have skin in the game, like they’re part of it,” Hoffman said.
In terms of reimbursement, the 2024 average net revenue per ophthalmology case was $1,732, according to HST Pathways data.
Upping case volumes
Joseph D’Agostino, administrator at the multi-speciality ASC Gwinnett Advanced Surgery Center in Georgia, told ASC News his facilities have seen significant growth in ophthalmology case volumes.
“When I started, we had one operating room committed to … our ophthalmology service line, and then we looked at a capital purchase of then outfitting a second operating room with the same equipment, which would allow that efficiency and kind of flipping rooms for those busy surgeons,” D’Agostino said.
“Flipping” rooms directly impacted surgeon productivity, D’Agostino said.
“Each day a surgeon would come and use one OR for eye surgery, we were then able to flip rooms, which was allowing them to … almost double their volume as an individual,” he said. “Our busiest eye surgeon could do up to 26 to 28 cases in one day, flipping rooms.”
Building strong relationships with surgeons and staff are key to driving success, he added.
“Reaching out to [our busiest eye surgeon], he told me his biggest challenge was just keeping up with that surgical volume and just not having enough surgery time,” D’Agostino said. “So, taking that conversation and then reaching out to all the other ophthalmologists we had on our medical staff, it seemed to be our best bet for kind of a great [growth strategy].”
Despite staffing challenges, ophthalmology’s low-acuity procedures and the efficiency of the ASC setting make it a natural fit for outpatient care, D’Agostino said.
“A lot of our patients are typically otherwise perfectly healthy, other than low acuity with their vision,” he said.
Generally, ophthalmology requires the least amount of time to turn over an OR of all specialities. In 2024, the average OR turnover time for ophthalmology was 11.9 minutes, according to HST Pathways data. In comparison, the turnover time for orthopedic and cardiovascular procedures was 21.1 minutes and 18.4 minutes, respectively.
The average OR duration for ophthalmology in 2024 was 24.6 minutes, according to HST Pathways’ data.
Patient recovery time for ophthalmology procedures is also typically much lower compared to other specialties.
Technology and growth
Advancing technology is also enhancing patient outcomes in ophthalmology, Michael Klein, administrator at the Retinal Ambulatory Surgery Center of New York, told ASC News.
Klein’s facility’s procedure room is equipped with the CATALYS Precision Laser System, a femtosecond laser developed by Johnson & Johnson Vision. This technology, introduced in 2012, assists surgeons by performing critical steps in cataract surgery, such as anterior capsulotomy and lens fragmentation.
“I think it adds time to cases, to cataract surgeons, but I do think that patients really are happy with the outcomes,” he said.
The Retinal Ambulatory Surgery Center of New York began in 2007 as a boutique, two-operating-room facility primarily handling out-of-network cases two days a week, Klein said. Over time, center leadership opted to network with major health insurers, which attracted more cataract surgeons and increased the volume of cases, eventually turning it into a full-time operation.
The growing demand and insufficient block time for new doctors prompted an expansion, on the third floor of the same building.
“We see this trend where hospitals are moving all elective surgeries to outpatient facilities,” Klein said. “I think that was one of the reasons why we were trying to open the new ASC.”
And patients often feel more comfortable in ASCs due to their controlled environment and efficiency, Klein said.
“I see a lot more elective surgeries moving out of hospitals into ASCs,” he said. “I think payers want their patients to use ASCs because hospitals have higher infection rates.”
