{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T15:45:56Z","timestamp":1794239156616,"version":"4.9.0"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of VitreoRetinal Diseases"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the time-adjusted economics of retinal and cataract surgery in order to clarify how the dynamics of ambulatory surgery centers influence access to urgent care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A time-driven activity-based costing model integrating Centers for Medicare &amp; Medicaid Services ambulatory surgery center reimbursement, intraservice times, and cost data from a provider was applied to 18 421 retinal and 880 448 cataract procedures (2021\u20132024). Reimbursement, cost, and profit were converted to per-minute values, and a financial efficiency coefficient was used to quantify time-adjusted profitability. Variation in time and overhead allocation was assessed with sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Retinal procedures required 76.1 minutes vs 20.8 minutes for cataract surgery (ratio, 3.65). Time-normalized metrics favored cataract surgery, with reimbursement, cost, and profits per minute of $52.63, $29.28, and $23.35, compared with retinal procedures\u2019 $24.61, $16.22, and $8.40. The profit per minute for retinal procedures was 36% of the cataract profit. The financial efficiency coefficient was 0.098, indicating retinal surgery was less than 10% efficient after adjusting for operative duration. Parity would require reducing operative time to 7.5 minutes or increasing reimbursement by $61.05 per minute (~71%). No retinal Current Procedural Terminology code achieved a financial efficiency coefficient \u22651. Block modeling showed adding 2 retinal cases to a cataract block converted a margin to a loss, with retinal blocks generating losses approaching $5,908.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Although ambulatory surgery center reimbursement was higher for retinal than cataract surgery and the cost per minute was lower for retinal surgery, cataract surgery was more profitable per minute. These findings underscore the need for reform of time-based reimbursement that reflects the complexity of retinal surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24741264261469011","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:46:46Z","timestamp":1785134806000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["A Comparative Time-Based Profit Analysis of Retinal and Cataract Surgery in Ambulatory Surgery Centers"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9522-8486","authenticated-orcid":false,"given":"Miguel A.","family":"Busquets","sequence":"first","affiliation":[{"name":"Retina Associates of Kentucky\/EyeCare Partners, Lexington, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6114-0996","authenticated-orcid":false,"given":"Hasenin","family":"Al-khersan","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Bellaire, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avni","family":"Finn","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Vanderbilt University, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Folgar","sequence":"additional","affiliation":[{"name":"Carolina Eyecare Physicians, Mt. Pleasant, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6640-6869","authenticated-orcid":false,"given":"Ghassan","family":"Ghorayeb","sequence":"additional","affiliation":[{"name":"West Virginia University School of Medicine, Morgantown, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0144-3319","authenticated-orcid":false,"given":"Michael","family":"Javaheri","sequence":"additional","affiliation":[{"name":"Retina Specialists of Beverly Hills, Beverly Hills, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Kolomeyer","sequence":"additional","affiliation":[{"name":"New Jersey Retina, Vineland, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Niles","sequence":"additional","affiliation":[{"name":"Buffalo Niagara Retina, Williamsville, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6681-6104","authenticated-orcid":false,"given":"Nimesh","family":"Patel","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear Infirmary, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lai","sequence":"additional","affiliation":[{"name":"Retina Group of Washington, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3690-2965","authenticated-orcid":false,"given":"Calvin","family":"Lutz","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Blim","sequence":"additional","affiliation":[{"name":"American Society of Retina Specialists, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4874-2471","authenticated-orcid":false,"given":"Ella","family":"Leung","sequence":"additional","affiliation":[{"name":"Georgia Retina, Marietta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"American Society of Retina Specialists (ASRS). Preferences and Trends (PAT) Survey 2025: Summary Report. ASRS; 2025."},{"issue":"4","key":"e_1_3_2_3_2","first-page":"212","article-title":"Long-term reimbursement trends for vitreoretinal surgery under Medicare Part B, 2000\u20132021","volume":"7","author":"Li ES","year":"2023","unstructured":"Li ES, Greenlee TE, Thompson JT, et al. Long-term reimbursement trends for vitreoretinal surgery under Medicare Part B, 2000\u20132021. J Vitreoretin Dis. 2023;7(4):212-220.","journal-title":"J Vitreoretin Dis"},{"issue":"1","key":"e_1_3_2_4_2","first-page":"22","article-title":"Cost drivers for pars plana vitrectomy for rhegmatogenous retinal detachment: a time-driven activity-based costing analysis","volume":"8","author":"Haliyur R","year":"2024","unstructured":"Haliyur R, Jalali S, Blanch RJ, et al. Cost drivers for pars plana vitrectomy for rhegmatogenous retinal detachment: a time-driven activity-based costing analysis. J Vitreoretin Dis. 2024;8(1):22-31.","journal-title":"J Vitreoretin Dis"},{"issue":"2","key":"e_1_3_2_5_2","first-page":"73","article-title":"Time-driven activity-based cost analysis of pars plana vitrectomy for rhegmatogenous retinal detachment including 90-day global episode of care","volume":"9","author":"Hwang MW","year":"2025","unstructured":"Hwang MW, Patel N, Sridhar J, et al. Time-driven activity-based cost analysis of pars plana vitrectomy for rhegmatogenous retinal detachment including 90-day global episode of care. J Vitreoretin Dis. 2025;9(2):73-83.","journal-title":"J Vitreoretin Dis"},{"issue":"3","key":"e_1_3_2_6_2","first-page":"165","article-title":"Operative times and cost implications in scleral buckle surgery: a multicenter analysis","volume":"7","author":"Blumenthal J","year":"2023","unstructured":"Blumenthal J, Houston S, Chang JS, et al. Operative times and cost implications in scleral buckle surgery: a multicenter analysis. J Vitreoretin Dis. 2023;7(3):165-172.","journal-title":"J Vitreoretin Dis"},{"issue":"3","key":"e_1_3_2_7_2","first-page":"145","article-title":"The economics of emergency retinal surgery and declining access to care","volume":"9","author":"Thompson JT.","year":"2025","unstructured":"Thompson JT. The economics of emergency retinal surgery and declining access to care. J Vitreoretin Dis. 2025;9(3):145-147.","journal-title":"J Vitreoretin Dis"},{"issue":"2","key":"e_1_3_2_8_2","first-page":"189","article-title":"Impact of reimbursement and resource allocation on access to advanced ophthalmic surgery in the United States","volume":"131","author":"Bressler NM","year":"2024","unstructured":"Bressler NM, Do DV, Parke DWII, et al. Impact of reimbursement and resource allocation on access to advanced ophthalmic surgery in the United States. Ophthalmology. 2024;131(2):189-197.","journal-title":"Ophthalmology"},{"issue":"4","key":"e_1_3_2_9_2","first-page":"22","article-title":"Policy perspectives on sustaining access to vitreoretinal surgery in community ambulatory settings","volume":"40","author":"Wykoff CC","year":"2025","unstructured":"Wykoff CC, Hahn P, Sridhar J, et al. Policy perspectives on sustaining access to vitreoretinal surgery in community ambulatory settings. Retina Today. 2025;40(4):22-30.","journal-title":"Retina Today"},{"issue":"1","key":"e_1_3_2_10_2","first-page":"81","article-title":"Time-driven activity-based costing: from concept to applications in surgical services","volume":"155","author":"Hernandez-Boussard T","year":"2020","unstructured":"Hernandez-Boussard T, Jiang W, Curtin C, et al. Time-driven activity-based costing: from concept to applications in surgical services. JAMA Surg. 2020;155(1):81-89.","journal-title":"JAMA Surg"},{"issue":"9","key":"e_1_3_2_11_2","first-page":"46","article-title":"How to solve the cost crisis in health care","volume":"89","author":"Kaplan RS","year":"2011","unstructured":"Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89(9):46-52.","journal-title":"Harv Bus Rev"},{"issue":"5","key":"e_1_3_2_12_2","first-page":"502","article-title":"Time-based cost analysis of ophthalmic surgery in ambulatory surgery centers: per-minute cost modeling and resource utilization","volume":"131","author":"Berkowitz RL","year":"2024","unstructured":"Berkowitz RL, Thomas BJ, Ding Y, et al. Time-based cost analysis of ophthalmic surgery in ambulatory surgery centers: per-minute cost modeling and resource utilization. Ophthalmology. 2024;131(5):502-511.","journal-title":"Ophthalmology"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2021.09.010"},{"key":"e_1_3_2_14_2","unstructured":"Centers for Medicare & Medicaid Services (CMS). Medicare Physician Fee Schedule and ASC Payment Rates 2021\u20132024. Accessed January 2025. https:\/\/www.cms.gov\/medicare\/medicare-fee-for-service-payment\/ascpayment"},{"key":"e_1_3_2_15_2","first-page":"76","article-title":"Delayed surgery for rhegmatogenous retinal detachment: visual outcomes and prognostic factors","volume":"164","author":"Stevenson W","year":"2016","unstructured":"Stevenson W, Stewart MW, Flynn HWJr. Delayed surgery for rhegmatogenous retinal detachment: visual outcomes and prognostic factors. Am J Ophthalmol. 2016;164:76-84.","journal-title":"Am J Ophthalmol"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(98)91142-3"},{"key":"e_1_3_2_17_2","unstructured":"American Academy of Ophthalmology (AAO). Preferred Practice Pattern\u00ae Guidelines: Retinal Detachment Repair. AAO; 2024."}],"container-title":["Journal of VitreoRetinal Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24741264261469011","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/24741264261469011","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24741264261469011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:24:22Z","timestamp":1790695462000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/24741264261469011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,26]]},"references-count":16,"alternative-id":["10.1177\/24741264261469011"],"URL":"https:\/\/doi.org\/10.1177\/24741264261469011","relation":{},"ISSN":["2474-1264","2474-1272"],"issn-type":[{"value":"2474-1264","type":"print"},{"value":"2474-1272","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,26]]},"article-number":"24741264261469011"}}