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CMS ruling brings new opportunity for growing patient population
In this report from the OSN IOL Economic Summit, Elizabeth A. Davis, MD, FACS, discusses the impact the CMS ruling has had on her practice.
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We have seen how LASIK has made significant penetration in the United States. I am finding, although I am still removing cataracts, that my cataract patients are having surgery earlier. They are not waiting until they are severely impacted by their visually impairing cataracts.
Patients are also living longer and leading active lives for many more years. I would have to say that I have about 20 90-year-old patients in my patient population who have all undergone either cataract surgery or cornea surgery recently. Many cataract patients desire the same outcomes as LASIK. They have heard a lot about it, but they are confused by it. They want good, uncorrected acuity, and they ask about their options. In some cases they may want it for both distance and near vision.
New opportunities
Prior to the CMS ruling, we had the FDA approved, crystalens available. Unfortunately, I could not offer it to the majority of my patients because they were on Medicare. Additionally, we have seen declining reimbursement for Medicare procedures. In May 2005, CMS allowed us to bill patients for the reasonable costs of services and supplies associated with inserting presbyopia-correcting IOLs. This ruling provides our practice with a financial opportunity, without some of the risks and burdens of third-party insurance. It also allows me to offer added value to my patients, as well as more options for individualized care.
Equally important is the future, because we are going to see more options for patients in terms of IOL technology and advances in vision correction. There is also going to be an increase in the aging population. Baby Boomers are going to be reaching retirement age between 2011 and 2029. This is going to increase the segment of the population age 65 and older from 36 million today to 70.7 million in 25 years. Therefore, for patients 45 years and older, this is going to be the largest segment of that population, reaching about 61 million by 2024.
Vision care trends
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We are also going to see some differences in vision care trends. Cataract is the leading cause of vision impairment in older patients, and 37% of all eye care visits are made by patients 65 years of age and older. According to the National Eye Institute, over 50% of Americans aged 65 and older suffer from cataracts. Today, that number is about 20 million Americans, but that is going to grow an additional 50% to 30 million in 20 years. Cataract surgery accounts for more than 60% of all vision-related Medicare costs, and you can guarantee that the government is going to pay special attention to this. Further growth is going to have substantial effects on health care spending in the United States.
What is this going to do to cataract surgery volume? Currently, about 2.8 million cataract surgery procedures are performed per year. This is estimated to grow to 4.8 million procedures by 2030.
With LASIK volumes we saw an exponential increase up to the year 2000, which was the peak, then a decline with the economy, followed by another increase to about the same level in 2005. It is going to plateau around this level unless we get another improvement in LASIK surgery, such as what we witnessed with the introduction of wavefront procedures. If we look at the penetration rate of LASIK, which is defined as the eligible population who have LASIK surgery, it has hit a steady rate.
In contrast, the number of refractive cataract procedures has not yet reached a steady rate. Currently, it has a growth rate of about 1.6% in cataract surgery, and this is going to grow by about 1.6%. Consider the conversion of traditional cataract surgery to refractive cataract surgery, with conservative conversion rate, a moderate conversion rate and an aggressive conversion rate. A conservative conversion rate is one that, for example, is about a 2% conversion in 2006 with a 1% increase for every year thereafter. A moderate rate starts out with a 4% conversion and increases 2% every year, and an aggressive rate starts at 6% and increases by about 3%. There are significant differences in these projections in the amounts of refractive cataract surgery being performed even by 2010.
One practice’s experiences
I think in our practice we will see a growth rate over the next five years to a conversion rate of at least 10% to 15%. However, this is difficult to predict and will be determined by the IOLs and other surgical procedures available and their success rates. The chair time with these patients has probably doubled or tripled. There is a lot of chair time spent preoperatively explaining the patient’s options, the risks and benefits of all of these options and the monetary component. Therefore, what we have started to do in our practice is to begin the education process before the clinic visit. We actually mail out a pamphlet to patients who have scheduled a cataract evaluation that informs them that they have various choices for their implants and the benefits and side effects of each option. Then we spend a fair amount of time in the clinic elaborating in further detail and allowing them to make a decision. We have also started holding some courses for referring optometrists to educate them about the options for the patients so they can also discuss this with their patients.
Because we also do LASIK in our practice, our staff is used to discussing elective vision correcting procedures and monetary issues. Yet this may present a difficult scenario for those ophthalmologists who do not already do this. However, even for our practice, because of the increasing variety of implants that are available, this creates challenges in training our counselors and technicians. Oftentimes patients call back to ask, “Well, what about this lens versus that lens?” They will talk to our staff because they may not have an opportunity to speak with the surgeon through multiple phone calls.
As more penetration occurs, patients are going to be coming in to ask about the presbyopia-correcting IOLs. They will have friends who have had these procedures. They are going to get on the Internet and learn more about the various IOLs. They are well educated and more affluent. They are certainly more active, and they definitely have higher expectations. What our practice intends to do is focus on continued patient and referring doctor education and marketing to provide added value to our patients and take advantage of what I view as an exciting opportunity.
A note from the editors:
Dr. Davis would like to thank Bruce Maller for some of the data provided in this article.
For more information:
- Elizabeth A. Davis, MD, FACS, can be reached at Minnesota Eye Consultants, 710 E. 24th St., Minneapolis, MN 55404; 952-885-2467; fax: 952-885-9942; e-mail: eadavis@mneye.com. Dr. Davis is a consultant for Advanced Medical Optics, STAAR Surgical, Bausch & Lomb and IntraLase.