By Arunima Rajan

Insurers now approve cataract claims for two-to-four-hour stays. Dr Vikas Jain of ASG Eye Hospital tells Arunima Rajan what replaces the overnight ward, and which insurer terms hospitals should refuse to sign.

Insurers now approve cataract claims for two-to-four-hour stays. What has ASG changed in pre-op assessment and surgery to make that window safe, not just convenient on paper?

We welcome this shift. Shorter, well-managed stays improve patient experience and hospital efficiency when done safely. At ASG we have therefore tightened both pre-operative assessment and surgical protocols so the two-to-four-hour window is clinically appropriate, not merely administrative.

Pre-operative work that previously happened the night before is now completed earlier on the day of surgery, without omission. Every patient receives a same-day fitness review that includes blood pressure, blood sugar, cardiac history, and a careful check of current medications—particularly anticoagulants. Anyone who needs longer observation is identified and moved out of the short-stay pathway before surgery is scheduled.

Biometry is performed using optical non-contact biometers, which virtually eliminate the risk of infection. When the first two readings do not agree, measurements are repeated on a second independent machine. This dual-check discipline removes the risk of a later lens exchange that would defeat the purpose of a short stay.

On the surgical side, nearly all cataract cases are now performed under topical anaesthesia with phacoemulsification through sub-2.2 mm incisions. These techniques reduce bleeding risk and accelerate recovery, making early discharge safer.

Patient selection remains the final safeguard. Patients with uncontrolled glaucoma, a single seeing eye, or no reliable attendant at home are not placed on the two-to-four-hour pathway simply because an insurer has approved it. Length of stay continues to be determined by clinical need, not by claim rules.

We also recognise that recovery is always better at home in familiar environments. When clinical criteria are met, enabling patients to return home sooner supports both safety and comfort.

In short, we have adapted our processes so that the shorter window is safe for the right patients—and we continue to protect those who need more time.

With less observation time before insurer-approved discharge, what post-op checks catch complications an overnight stay used to catch, and how does ASG confirm they work?

Three structured checks replace the older overnight observation and are designed to catch the same early complications.

First, intraocular pressure is checked before discharge. Pressure spikes are the complication most likely to appear early and the one most easily missed if a patient is sent home too soon.

Second, every patient undergoes a full slit-lamp examination before discharge—not a cursory look—to detect a shallow anterior chamber or early signs of inflammation.

Third, every patient is required to attend a mandatory review at the hospital the next day. Specific questions are asked about pain, glare, and any sudden change in vision, and a clinical examination is performed. In addition, our 24-hour helpline remains available for any emergency, ensuring continuous access to care.

To confirm these checks are effective, we systematically track every unplanned return within the first 48 hours and analyse the reason. This continuous audit tells us whether the protocol is working and where it needs refinement.

In modern cataract surgery there is essentially no clinical need for an overnight stay when these safeguards are in place.

Pre-authorisation delays can derail a full day of cataract surgeries. What workflow does ASG use with insurers and TPAs to cut that friction, and how much has it actually helped?

The traditional model often created friction. Waiting for TPA approval on the day of surgery could delay the entire list.

To reduce this, we now send complete documentation, diagnosis and package details to the insurer or TPA the evening before. Each hospital has a dedicated insurance desk that coordinates this process. For cases falling within pre-agreed packages, approvals are usually secured in advance. For procedures outside standard packages, we still push for same-day clearance.

As a result, turnaround time for pre-agreed cases has reduced from several hours of waiting to a much shorter window, allowing surgery lists to start on time and reducing last-minute cancellations. Faster same-day approval further supports a smooth short-admission pathway by ensuring patients can proceed without unnecessary delay.

Short-stay policies are often built for cost containment, not patient pathways. What would a well-designed short-stay model look like for cataract care, and how close is ASG to it?

A well-designed short-stay model should be driven by clinical recovery milestones, not by the clock or cost alone.

Discharge should be permitted only when vision, eye pressure, pain level and the patient’s ability to mobilise safely have been assessed and found satisfactory. A mandatory next-day review at the hospital, supported by a 24-hour helpline, should be standard. Equally important, the hospital must retain the flexibility to keep a patient longer when clinical need requires it.

ASG already follows this approach. We use milestone-based discharge criteria rather than fixed time slots, insist on next-day review, and do not discharge patients simply because an insurer has approved a short stay. We are therefore close to the ideal model, with continuous refinement based on outcomes.

Has remote monitoring helped ASG track patients after early discharge, and has it caught issues that would otherwise have surfaced only at follow-up?

We rely on a structured follow-up system rather than device-based remote monitoring.

Every patient receives a phone check after discharge, followed by a mandatory next-day in-person review. Patients are clearly counselled on red-flag symptoms—sudden pain, unusual redness, a curtain-like shadow in vision, or a sharp drop in clarity—and are instructed to contact us immediately rather than wait for the scheduled visit. Our 24-hour helpline supports this.

This process has allowed us to bring patients back early when needed. For example, a patient reporting unusual pain can be examined the same day, often revealing raised intraocular pressure that requires prompt treatment. In this way, structured telephonic and next-day follow-up has helped us detect and manage issues that might otherwise have been identified only at a later visit.

What part of ASG’s short-stay insurance model should other hospitals adopt, and what should they resist agreeing to too quickly?

Other hospitals should adopt a dedicated insurance desk that supports patients and families with TPA documentation and ensures there are no authorisation delays on the day of surgery. Sending complete pre-authorisation requests the evening before surgery is another practice worth copying.

What they should resist is agreeing to rigid time-based discharge rules that ignore clinical need. Hospitals must retain the right to keep a patient longer when recovery milestones have not been met, regardless of what the insurer has approved on paper.

Tell me about a time ASG found a gap in the short-stay process, fixed it, and measured the result. What changed, before and after?

We noticed that a small number of patients were returning unplanned within 48 hours, often with raised intraocular pressure or early signs of inflammation that had not been fully stabilised at discharge.

We strengthened the pre-discharge protocol by making both intraocular pressure measurement and a full slit-lamp examination mandatory before the patient leaves. We also made the next-day hospital review compulsory for every case. This next-day follow-up has proved particularly useful in detecting early post-operative inflammations and delayed IOP rise.

After these changes, unplanned returns within the first 48 hours dropped noticeably. Patients who needed further attention were identified earlier usually at the scheduled next-day visit rather than as emergencies.

From what you’ve seen or heard directly from patients, has this shift to shorter, insurance-approved stays actually made things easier or better for them, or has it mostly shifted the burden elsewhere without them realising it?

For patients who have family support and live reasonably close, a shorter stay is clearly beneficial. They spend less time away from work, create less disruption for caregivers, and avoid the cost of an overnight hospital stay. Most of our patients fall into this group, and for them short-stay cataract surgery works well.

However, for patients who live alone or who have to travel several hours to reach us, the shorter stay can make recovery harder, even when nothing goes clinically wrong. In these situations we remain flexible and keep the patient longer when needed. The model succeeds only when clinical judgement, not the insurance approval, decides the actual length of stay.

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