Same-Day Bilateral Cataract Surgery: Providing More Value to Members and to Kaiser Permanente

Abstracts from the Kaiser Permanente2018 National Quality Conference


Robin Cisneros; Neal Shorstein, MD; Alan Moreno

From Colorado, Hawaii, Mid-Atlantic States, Northern California, Northwest, Southern California, Program Offices

Background: Same-day bilateral cataract surgery (SDBCS) is patient-centered, translates evidence to practice, and improves value to members and Kaiser Permanente (KP). Value includes safety, health outcomes, quality, access, cost, convenience, or satisfaction. This project demonstrates results for patients undergoing cataract surgery and benefits from facilitating interregional clinical collaboration and interentity analysis. Work products include clinical and business cases that ease implementation burden and optimize SDBCS. Southern California Permanente Medical Group (SCPMG) Chiefs of Ophthalmology and Interregional Ophthalmology Practice Leaders established a 2018 goal to increase SDBCS.
Methods: Population: Approximately 90,000 members/y have cataract surgery. Intervention: The common cataract surgery in the US is performed on each eye, on separate days (delayed, sequential bilateral). Comparison: SDBCS is rare in the US because of Centers for Medicare and Medicaid Services reimbursement and fear of rare, bilateral complications. Worldwide rates of Same Day Bilateral Cataract Surgery (SDBCS) are rising. In 2015, KP’s SDBCS regional rates varied from 0.3% (SCPMG) to 43.1% (Colorado Permanente Medical Group). Outcome measures: Refractive error, best-corrected visual acuity, and endophthalmitis. Evidence, including a large, published KP study, shows that SDBCS is safe and effective for appropriate patients and that risk of bilateral endophthalmitis is not supported in the literature.
Results: During the course of this 1-year project, cataract surgeons studied the evidence and compared available tools, process flows, and member and provider education. The Interregional New Technologies Committee reviewed the published evidence on health outcomes. Members who had both procedures were interviewed about their experiences. Decision Support analyzed surgery, visit, operative time, and pre- and postoperative times. Finance facilitated monthly meetings, documented work, and created deliverables such as the business and clinical cases. Though complete datasets are not yet available for 2017, SDBCS rates continue to increase whereas endophthalmitis rates hold steady, as shown in the Northern California study. Conservative estimates of time savings from the member perspective because of SDBCS are approximately 3 hours, including visits, and 90 minutes of preoperative and postoperative time.
Discussion: Start with sound evidence of increased value to patients. Value was defined as what patients feel or care about. Member interviews demonstrated SDBCS added meaningful conveniences and savings; physicians not yet offering SDBCS listened. Patients’ opinions and internal and external outcome data were packaged with implementation tools to reduce barriers to change. Clinicians received needed guidance from similarly motivated, interregional colleagues. The Health and Value Creation Initiative (HAVC)-accessed data, rallied administrative resources, facilitated monthly discussions, and provided business tools for physicians to work with their operational leaders. Regional work continues to translate this work into practice, monitor outcomes and utilization, and measure member satisfaction.

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