We have reached an inflection point in ophthalmology as two converging pressures reshape how we practice. The first is a workforce shortage, which continues to worsen year after year. The second is declining reimbursement.
For the first time in more than a decade, we ophthalmologists face proposed cuts to ambulatory surgery center facility fees.1 We often celebrate when proposed double-digit decreases are negotiated down to only a 2% or 3% loss on the physician side, but that is hardly a win. It is simply less painful than anticipated.
This year’s proposed facility fee cut is deeply worrisome. Ambulatory surgery centers have long been attractive to private equity and consolidation models precisely because of their reliable, steadily increasing reimbursement. That reliability is now at risk.
Historically, facility reimbursement has increased annually—3.1% in 2024 and 2.9% in 2025. In 2026, however, the proposed rule introduces a 4.7% decrease for cataract surgery, dropping from $1,214 to $1,157. ASCRS has estimated that cataract reimbursement may fall 5% from the 2025 rate of $1,371.2
At the same time, staffing costs have risen significantly since the COVID-19 pandemic. Compensation demands are higher, and recruiting and retaining skilled staff are more challenging than ever. Efficiency, therefore, is no longer optional. It is a survival strategy.
In my practice, this has meant rethinking workflows, streamlining processes, and leveraging technology. Efficiency allows us to do more with fewer staff, preserve quality of care, and remain financially viable while still supporting our teams with competitive compensation and benefits.
Some practices are experimenting with alternative models, such as cash-pay or concierge ophthalmology. Others are seeking tighter control of costs within their own office-based surgery settings. For most, however, the balance comes from accepting lower reimbursement but offsetting the impact with greater efficiency and increased cash-pay service lines and options for patients.
Technology is central to this transition. Efficiency gains must never come at the expense of patient outcomes. The right technology elevates both simultaneously.
AI surgical planning platforms are a prime example. These systems manage and analyze massive data sets in ways that were previously impossible without enormous manual effort. They can rank and interpret data, recommend treatment plans, track outcomes, and then refine nomograms based on results. This iterative process closes the loop between planning, execution, and outcome measurement. It allows us to deliver more uniform and optimized results across a broader range of patients, facilities, and surgeons independent of the variability inherent in individual clinical inputs.
As we navigate shrinking margins and rising costs, efficiency is the lever that allows us to preserve patient safety, optimize outcomes, and sustain our practices. The financial pressures are real and worsening, but they also create an impetus for innovation.
By embracing AI and other technologies, we can create new capacity, improve care delivery, and ensure our surgical practices remain both clinically excellent and economically viable.
Cathleen M. McCabe, MD
Chief Medical Editor
1. Federal Register. Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals; Medicare Provider Enrollment; and Physician Self-Referral Updates. Fed Regist. 2025;90(138):51126-51482. July 17, 2025. Accessed September 6, 2025. https://www.federalregister.gov/documents/2025/07/17/2025-13360/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical
2. American Society of Cataract and Refractive Surgery. 2026 ASC proposed rule released. July 17, 2025. Accessed September 6, 2025. https://www.ascrs.org/news/ascrs-news/2026-asc-proposed-rule-released
