Disclosure: The following content is based on a sponsored webinar presented by iOR Partners and does not reflect the editorial positions of Eyes On Eyecare. The views, claims, and business models discussed represent those of the sponsor and participating practitioners.
Co-management has long been central to optometrists facilitating surgical care. When effective, patients transition seamlessly between primary eye care providers and specialists, with clear communication and coordinated care.
But some optometrists have encountered friction in the fragmented process. Chris Browning, OD, of VisionQuest Eyecare, recalls an early-career case involving a patient with substantial strabismus and cataracts. After Dr. Browning made a specialist referral, the patient underwent vision therapy and received multifocal implants — but was ultimately dissatisfied with the outcome.
“The patient was under the impression he’d no longer need glasses, but post-op he still had 4 prism diopters of exotropia and needed glasses with prism,” explains Dr. Browning. While the patient's expectations were likely unrealistic, communication gaps between providers meant those expectations were never fully addressed.
Experiences like these aren't universal, but they highlight a challenge that can arise when multiple providers are involved in a care pathway. As Nick Garn, OD, of Zionsville Eyecare, puts it, “The first thing patients always ask regarding surgery is, ‘Are you doing it?’ They’re very much interested in continuity of care wherever possible, but healthcare often gets fractured now.”
Tony Burns, CEO of iOR Partners, frames it as a system design issue rather than blame. “It's nobody's fault, but when you're referring out any type of care, especially when it's a step removed, there’ll always be communication errors. Patients benefit tremendously from having primary eye care providers and surgeons in constant communication.” For some practitioners, this has led to exploring ways to be more active in the process. Office-based surgery (OBS) provides the infrastructure to follow patients through their surgical journey
Introducing OBS
OBS refers to ‘any surgical or invasive procedure performed by a licensed physician in a location other than a hospital or ambulatory surgery center (ASC).’ It means developing a dedicated surgical space within or near an optometric practice.
Several approaches exist for incorporating OBS. iOR Partners, which has developed and managed over 180 OBS suites, describes a "hub-and-spoke" framework as one model. In this framework, a "hub" is a standalone surgical suite—owned independently or co-owned with peer practitioners—while a "spoke" arrangement lets nearby practices share the suite on available days, offering access to OBS without the overhead of a dedicated suite.
The specifics vary. Some practitioners opt for shared-equity arrangements to reduce capital investment. Others develop single-use suites tailored to their patient volume. Aaron King, OD, of Timp Vision Clinic, is developing a co-owned suite with Collin Gray, OD, of Eyecare of Lehi, and notes that the model doesn't require high surgical volume to be viable. "You don't have to be a huge practice or have a massive volume of referrals," Dr. King says. "It's really a good model for any practice, which was huge for us because while we don't send out a million patients every month, we send out enough that it makes sense to get a few of us together."
Regardless of the model, OBS still requires a qualified surgeon. Organizations such as iOR Partners, can help connect optometrists with their network of OBS surgeons.
What Practitioners Hope to Gain
Drs. Browning and Garn intend to launch their OBS suites this fall, while Drs. Gray and King anticipate an early 2027 launch. All are citing several expected benefits.
Continuity of care. “We've always thought that if we take care of patients, everything else will take care of itself,” Dr. Browning says. “By providing a level of continuity for patients that takes into account their history, proclivities, and all the nuances of their prescriptions, we’ll have better patient retention, happier staff, and ultimately a practice that’s worth more. It's a win-win for everybody.”
Earlier patient engagement. Dr. Garn sees an opportunity to begin surgical conversations sooner. “I’m hoping to have more communication with patients earlier in the discussion process leading up to surgery, perhaps 1–3 years prior, and then hopefully make sure the transition into surgery and the implant technology discussion seems seamless instead of being hemmed into the tight window between consultation and surgery.”
Patient enthusiasm. All four practitioners report that patients have responded positively to the idea of OBS, with some electing to wait for the suites to open rather than pursue an external referral. “My patients are really excited about the practice being a place where everything is kept together in-house, including the comprehensive patient care and now surgery,” says Dr. King.
Revenue potential. Dr. Gray points to his historical referral data as a reason for optimism. “Looking at my historical referral patterns, I was already sitting at around a 50% premium cash upgrade rate, but I’m expecting that to rise post-OBS implementation,” highlights Dr. Gray. While individual results will vary based on patient demographics, procedure mix, and market dynamics, OBS proponents generally view in-house surgical capability as a revenue diversification opportunity.
Important Considerations
OBS is not a fit for every practice, and practitioners considering this model should evaluate several factors, including:
- Regulatory landscape: State office-based surgery regulations and facility licensing requirements differ greatly and can influence whether, and how, OBS is implemented in a specific market.
- Capital investment: Even with shared-equity or spoke setups, build-out, equipment, staffing, and compliance costs could still apply. Conducting a detailed financial analysis is crucial.
- Legal consultation: Practitioners should consult legal and insurance counsel early in the consideration process, prior to implementation.
- Patient volume: Although supporters argue that OBS can suit smaller practices, financial viability depends on maintaining enough surgical volume to justify the investment.
- Surgeon partnership: The strength of the optometrist-surgeon relationship is fundamental to the model. Identifying the ideal partner, someone whose clinical philosophy and communication style match the practice, requires time and careful effort.
Looking Ahead
So, what’s the advice for practitioners intrigued by the possibility of implementing OBS within their practices? “Start looking now,” Dr. King says, and Dr. Gray agrees. “I wish I’d started sooner. At the very least, get in contact with iOR and have them evaluate your numbers because they can help and guide you on which option might be the best for you.”
Dr. Browning sees broader potential. “I feel like this is the future of surgical care.” Regardless of whether OBS achieves the widespread use its advocates predict, these practitioners clearly see it as an opportunity to strengthen the patient relationship—a goal most optometrists share.
