Eye care delivery model offers tools to prosper in coming years

Issue: September 10, 2011

ByRichard L. Lindstrom, MD

Richard L. Lindstrom

While we are in a period of great change and turmoil in American medicine, the future is bright for the ophthalmologist who positions his practice properly.

We spend today about $2.2 trillion on health care in America, and eye care is roughly 3% of that number, or $60 billion to $70 billion. That is a big number, and driven by an aging population, it is growing at close to 6% per year. Despite rhetoric to the contrary, I see no way this growth can be curtailed. There will be a progressive shifting of the increased cost of care to the patient, what I call patient-shared responsibility, and that trend is already well under way, but the growth in total dollars spent in eye care will continue to grow at least 6% per year for decades to come.

We 78 million baby boomers will accept increased responsibility for the costs of our care, but we will demand access to the best care available and choice in the provider who delivers it. Our children, the echo boomers or Generation Y, the second most powerful demographic and voting block in America, feel the same, so woe to any politician who ignores these two powerful demographics. That means rationing will not win out and spending on eye care in America will double in the next 12 years.

Despite all of our concerns as ophthalmologists, we are firmly positioned at the top of the eye care food chain, and we are a shrinking, rather than growing, resource. No one else has our education and training, and no one else can do all that we can do, from primary care through the most complex tertiary surgical care. In addition, the typical patient fears vision loss about equivalent to cancer and highly values the eye care practitioner who helps them preserve, restore and enhance their vision. Finally, we are blessed with strong third-party payment for medically indicated treatments and a unique array of direct patient-pay offerings to enhance our income. Our biggest challenge will be to meet the increasing demand generated by our relatively affluent aging population and the increasing demand for new and innovative treatments.

Here are my thoughts on how the prudent ophthalmologist might position himself to prosper in the stormy decades to come.

The most successful and robust practice of the future will use an ophthalmologist-led integrated eye care delivery model. One or more surgeons will practice collegially with medical ophthalmologists and optometrists. Ideally, there will be two to four medical ophthalmologists and/or optometrists per surgeon. These physicians and surgeons will be supported by ophthalmic medical technologists, technicians, assistants, opticians, nurses and, in some busier practices, a physician’s assistant. To orchestrate such a practice, a talented and well-compensated administrator and appropriate consultants are a must. Such a practice also requires a written and at least annually reviewed and modified business plan.

The practice will have an ownership position in an ambulatory surgery center. It is critical to get on the facility side of third-party reimbursement as pressure continues to mount on physician fees. In addition, efficiency will have great value in the future I envision, as will high patient satisfaction with the care delivered, which will become ever more important as patients increasingly share in the cost of their care. Also, the most financially robust lifestyle-enhancing refractive cataract surgery, the major revenue growth opportunity in the foreseeable future for the cataract surgeon, will require ownership in an ASC to be economically viable.

Next, the surgeons must embrace new technology, especially when patients will be paying directly for a lifestyle-enhancing premium outcome. This will include laser and/or bladed refractive cataract surgery, laser corneal refractive surgery, minimally invasive glaucoma surgery and cosmetic plastic surgery. While in some settings this might not be appropriate, ownership of an optical shop and participation of the medical ophthalmologists/optometrists in primary refractive eye care including contact lens wear are ideal. Consideration should be given to other adjunct services including dispensing of over-the-counter medications and nutritional supplements, hearing screening and treatment, and, in the near future, automated dispensing of prescription medications.

At Minnesota Eye Consultants, we live this model, and it works well for our surgeon owners and employees at every level. We have eight surgeons: four cornea fellowship trained, two glaucoma fellowship trained and two fellowship trained in oculoplastic surgery. We have enjoyed the services of as many as four medical ophthalmologists and 12 optometrists in recent years. These doctors are supported by 180 staff members including 30 ophthalmic technologist/technician assistants, a dozen nurses, a physician’s assistant, 10 opticians, an audiologist, a superb administrator and great consultants. I expect that number to grow, as demand on our practice is growing at 8%-plus per year, which means at the current rate we will double in size in less than a decade. We offer quality care close to home with 12 offices in the 50-mile circle around the Minneapolis-St. Paul downtown area, which includes a demographic of 3.5 million people growing at 3% per year. We have three ASCs, four laser corneal refractive surgery centers, eight optical shops and audiology, and we are beginning to provide dispensing of over-the-counter medications and even considering an automated system for prescription medication dispensing.

The ophthalmologist-led integrated eye care delivery model works. Patient satisfaction is extremely high and the model is financially robust.

This is only one of many models of eye care delivery, but I encourage every ophthalmologist to consider its benefits. The scale can be much smaller and still function beautifully. The magic is in the model, not in the scale.