Barriers to efficient supply utilization in cataract surgery

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Barriers to efficient supply utilization in cataract surgery Abstract The US spends $6.8 billion a year on cataract extraction, with the surgery consuming 12% of Medicare's budget. Unfortunately, much of this spending is wasted on unused surgical supplies and pharmaceuticals, adding to healthcare costs with no increase in value. Over 90% of surveyed cataract surgeons find operating room waste excessive. A study of pharmaceutical waste in cataract surgeries found that across four facilities, an average of 45% of drugs (by volume) were unused and discarded after every case. Two of the facilities each discarded over $190,000 worth of drugs every year, equivalent to 50 market-rate surgeries. This unnecessarily high resource use translates to higher overall costs for providers, which are in turn passed to insurers and patients. Cataract surgery and other ophthalmic procedures do not need to be so wasteful and costly. Studies of cataract surgery in lower income countries find comparable surgical outcomes with vastly different resource utilization. These “resource optimized” settings reuse surgical supplies and do not waste multi-dose drugs, reducing costs, waste, and environmental footprint while maintaining high quality outcomes, suggesting that US cataract surgery could be conducted much more efficiently. However, there are many barriers to effectively implementing these strategies. In a recent survey, US ophthalmologists cited regulatory requirements (93% of respondents) and manufacturers mandating single use of products due to liability and other motives (91%) as the primary factors preventing them from safely reusing or multi-dosing surgical supplies and drugs. Furthermore, any interventions toward resource efficiency should not sacrifice safety. Building on this body of research, our proposed study aims to systematically identify the perceived barriers to implementing more resource efficient practices in cataract surgery, from a variety of stakeholder perspectives. We will then scientifically study two specific barriers – policy and safety – to facilitate safe and effective transitions to higher-value ophthalmic care. First, we will identify perceived wasteful practices and barriers to change through interviews with surgeons, nurses, surgical technologists, administrators, and pharmacists from a variety of cataract surgical facilities (Aim 1). The national survey and anecdotal evidence suggest that regulations and accrediting bodies present a major obstacle, as well as concerns over infectious risk. Thus, we will research existing regulations and policies at federal and state levels to identify exactly which wasteful practices can be immediately modified in a safe manner and which will require alteration of existing policies (Aim 2). Finally, we will evaluate potential safety risks from supply and drug reuse by testing a variety of single use products for microbial growth after surgery (Aim 3).