When complex surgeries
lose money — and no one notices

At a leading academic eye center, we asked a simple question: how much does surgery really cost? Not based on guesswork, RVUs, or reimbursements — but on real-time staff involvement, room usage, and material costs.

This was harder to do than you might think. Most health systems do not have a reliable way of calculating costs, even for a resource as expensive and strategically important as the operating room. To answer the question, we pioneered a series of studies using Time-Driven Activity-Based Costing (TDABC).

What we found

Across multiple procedure types, a consistent pattern emerged — one that many surgeons understand intuitively but had never been quantified: the more complex the surgery, the greater the hidden financial loss.

In cataract surgery — the most commonly performed surgery in the world — complex cases account for 10–15% of volume. Our analysis found that complex cataract surgery costs on average $877 more than standard cases. Medicare reimbursement, however, pays only an estimated $231 more for that complexity, leaving a relative loss of nearly $650 per complex case.

The same pattern held in retinal surgery. Complex vitrectomy — used for most retinal detachments — cost over $2,700 more per case than standard vitrectomy. Reimbursement difference: approximately $500.

Why this matters for healthcare organizations

These aren't niche procedures. Cataract removal and retinal detachment repair are foundational to modern ophthalmology — they happen every day, in nearly every setting. But across the country, health systems are operating without a clear picture of what these procedures actually cost.

This is not just an accounting problem — it's a strategic blind spot. When complex cases consume more time, tools, and expertise but generate only marginally higher reimbursement, hospitals and providers absorb those costs without realizing it. The result is a distorted system that quietly disincentivizes high-quality care for the patients who need it most.

How EyeQ can help

EyeQ Consulting helps health systems close the gap between clinical effort and financial understanding. Our TDABC methodology is built for real-world practice — not just research. It captures what actually happens in the OR, not what's on paper. That means identifying where resources are overused, where complexity is underpaid, and where change is possible.

We work with academic hospitals, private ASCs, and group practices alike to uncover their true cost structure. Armed with those insights, leaders can advocate for reimbursement reform, redesign OR workflows, and make smarter decisions about patient mix and procedural strategy.