OFFICE SURGERY - Key Persons

Kevin J. Nusz, MD, Office Surgery Centers'™ founder, graduated from The Johns Hopkins School of Medicine in 2002 and completed his Ophthalmology residency in surgical eye training at The Mayo Clinic in 2006. During his training, Dr. Nusz was impressed with the innovative design of both hospitals - in particular how operating room suites were attached to clinical patient exam areas. This up-close view of how the two eye care giants successfully married medical eye care with surgical eye care in a single location sparked Dr. Nusz's interest in in-office surgery early on in his career. Dr. Nusz's first professional experience was in Canada where the practice's office space included in-office surgery suites for both out-of-pocket and private insurance-reimbursed in-office cataract surgeries. Though in-office cataract surgery had been successful in Canada for over a decade, starting in 2006 harsher border crossing restrictions limited the practice's ability to perform surgery on US residents. Around this time, Dr. Nusz was recruited to help create and launch an in-office eye surgery suite for a new refractive practice in upstate New York. Dr. Nusz oversaw the successful creation of this surgery suite, and it was here that he began to appreciate the difficulty in obtaining insurance reimbursement for in-office cataract surgery in the United States. Kevin J. Nusz, MD, Office Surgery Centers™ founder, graduated from The Johns Hopkins School of Medicine in 2002 and completed his Ophthalmology residency in surgical eye training at The Mayo Clinic in 2006. During his training, Dr. Nusz was impressed with the innovative design of both hospitals - in particular how operating room suites were attached to clinical patient exam areas. This up-close view of how the two eye care giants successfully married medical eye care with surgical eye care in a single location sparked Dr. Nusz's interest in in-office surgery early on in his career. Dr. Nusz started out by working with an ophthalmologist in Canada, and the space included private in-office surgery suites for both out-of-pocket and private insurance-reimbursed in-office cataract surgeries. Though in-office cataract surgery had been successful in Canada for over a decade, starting in 2006 harsher border crossing restrictions limited the practice's ability to perform surgery on US residents. At this time, Dr. Nusz was recruited to help create and launch an in-office eye surgery suite for a new refractive practice in upstate New York. Dr. Nusz oversaw the successful creation of this surgery suite, and it was here that he began to appreciate the difficulty in obtaining insurance reimbursement for in-office cataract surgery in the United States. The following year, Dr. Nusz relocated to South Carolina and joined his current practice. There, cataract surgery was performed in a local hospital in a converted closet in a remarkably inefficient and understaffed environment. Surgeons were responsible for supplying their own technicians who assisted in surgeries by following proper sterile technique, running the equipment (including the phacoemulsification machine), and cleaning and sterilizing the instruments. He also observed that the hospital's anesthesia staff slowed down an already slow system and added costs to an already expensive surgery - and this was an area that he would later impact. In 2008, that local hospital opened a multi-specialty Ambulatory Surgery Center (ASC) and Dr. Nusz and his partner moved their surgeries from the hospital to that ASC in 2011. They created and developed the eye program at the ASC - supervising staff training, purchasing equipment and instruments, recruiting other eye surgeons, and overseeing billing. This was clinically successful and that success brought in more than 10 additional ophthalmologists from other practices. But as the number of surgeons increased, more profitable surgeries were often prioritized, leading to difficulty in securing time for cataract surgeries. At the same time in the ASC, Dr. Nusz and his partners' surgeon administered oral anesthesia techniques (without the help of anesthesia professionals) were examined, trialed, and ultimately implemented by other surgeons. This change led to eye surgeries in the ASC moving to procedure rooms rather than operating rooms. By 2018, Dr. Nusz had helped create a system at the ASC where thousands of eye surgeries a year by multiple surgeons were successfully and safely performed in procedure rooms without professional anesthesia staff. Though patients, surgeons, and staff were all thrilled with the ASC surgical experience, the vast majority (96%) of patients in Dr. Nusz's practice lived outside of the closest ASC's zip code. And since his eye practice was the only one in the region, many patients already had substantial drives to his office - and the additional 27-mile drive to the ASC was significantly burdensome for his patients. In-office cataract surgery was the solution, but Dr, Nusz knew that the challenge would be in the reimbursement from insurance companies. He knew that his patients wouldn't want to pay out-of-pocket for in-office cataract surgery, but Dr. Nusz's prior experience in New York had shown him that obtaining insurance reimbursement for in-office cataract surgery was nearly impossible. And he didn't want to repeat the New York experience of building a state-of-the art surgery suite only to have it unusable because insurance reimbursement was unattainable.