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Long-term implications of health care reform may affect physician revenue streams in future
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VANCOUVER, British Columbia — Health care reform measures passed earlier this year will have little immediate impact on the practice of retinal specialists, but as scheduled initiatives are implemented, all ophthalmologists can expect dramatic changes.
 William L. Rich III |
In 2015, the Centers for Medicare and Medicaid Services will implement a modifier that will adjust reimbursement based on individual practice expenses compared with the aggregate mean, William L. Rich III, MD, said at the American Society of Retina Specialists annual meeting.
As it is currently understood, the modifier will, for example, allow CMS to reduce nonaffiliated reimbursement streams to physicians who treat age-related macular degeneration with Lucentis (ranibizumab, Genentech) because their practice expenses will be higher than those of physicians treating with the less costly Avastin (bevacizumab, Genentech).
Reforms will also shuffle new patients into coverage. Mandated universal access will expand coverage rights to some 25 million Americans, and it is expected that a large portion will be minorities. According to Dr. Rich, health statistics indicate that this will result in a greater need for services for diabetic retinopathy, open-angle glaucoma and other pathologies that disproportionately affect minority populations.
The reforms will ultimately result in a pay-for-performance model that will necessitate physicians finding ways to practice more efficiently and, most likely, in larger, hospital-based systems, Dr. Rich said.