This article is more than 5 years old. Information may no longer be current.
Ophthalmologists challenged as they try to deliver best patient care possible
Click Here to Manage Email Alerts
 Richard L. Lindstrom |
I have commented on this topic before but will briefly expand on my previous discussions. We ophthalmologists are definitely at the beginning of an increased demand for our services, and as I do the numbers, we are decreasing slowly in manpower. This may be mitigated some if we baby boomers delay retirement secondary to the “Great Recession,” but long term, there will be more units of care to provide per ophthalmologist available. That is good for us but will require increased efficiency in our care delivery models.
My favorite model, as I have stated before, is Ophthalmologist-led Integrated Eye Care Delivery. This model does not require more than one highly talented ophthalmologist, but it does require a willingness to work with and delegate to other ancillary caregivers, including ophthalmic assistants, technicians, technologists, opticians, nurses, optometrists, administrators and, for larger groups, physician assistants.
In addition, I believe the most financially successful practices will have a large offering of services that are paid for directly by patients. We in ophthalmology are blessed to have many options, including refractive surgery, refractive cataract surgery, plastic surgery, optical and contact lenses, and I predict there will even be elective patient-pay surgery for glaucoma in our future as our glaucoma procedures become minimally invasive. To maximize efficiency and revenue, ownership in an ASC will be a great advantage. Best of all worlds, the ophthalmologist of the future will be no more than 50% dependent on third-party pay, as reimbursement per unit of care surely must decrease over time when paid for by our state and federal government.
We are getting insights into the shape of heath care reform. I see the recent laws passed as initially a ruse to raise taxes, as our federal government desperately needs money. Later, I see a significant increase in Medicaid patients. Basically, the federal government will mandate that the states add 32 million-plus new patients to the Medicaid rolls. Medicaid reimbursement per unit of care is below cost in most states already and, considering the financial status of most states today, likely to go lower. One logical option would be to opt out, but I suspect most states will require Medicaid (and Medicare) participation to retain licensure to practice. They can and will treat us like a utility, and we will be required to provide care for Medicare and Medicaid patients to retain the privilege to practice. These “entitled” patients will be demanding and in many cases difficult. An inefficient care model seeing a large number of these patients is almost certainly on its way to bankruptcy. The solution for me is an integrated eye care delivery model, with significant delegation to other caregivers, especially optometry. This will happen one way or the other, either inside the ophthalmologist practice or outside it, and likely both.
One other likely byproduct of health care reform is a significant negative impact on new technology development and approval compared with past decades. To be direct, third-party payers do not want new expensive treatments, as they usually increase costs significantly. Better is a traditional generic drug or device with a reasonable cost and a well-known safety and efficacy profile. Increasing regulatory barriers will decrease new device and drug approvals to a trickle. In the short run, this will have little impact on ophthalmology and our patients, but in the long run, new advanced treatments will become available outside the U.S. long before we can access them, and some treatments readily available elsewhere will never gain approval here. Our major device and drug companies will suffer a negative impact initially, but they will adapt and increase their investment outside the U.S., which already represents two-thirds of their business and is growing rapidly as countries such as India and China mature. The medical device and drug innovation cycle that has been so valuable to America will atrophy here and progressively move offshore.
We will also see an increasing migration of patients to other countries, not looking for reduced cost, but seeking the newest and best treatments that will simply not be available to them in the U.S. This is already beginning, and it will accelerate. This is bad for America in many ways, but the trends are already strongly in place and, sadly for us, unlikely to be reversed in the foreseeable future.
For the ophthalmologist practicing outside the U.S., this will represent a significant opportunity, and many are wisely positioning themselves to take advantage. Still, as far ahead as I can see, I remain optimistic for the prudent and prepared American ophthalmologist. There are few other surgical specialties, other than those limited to elective patient-pay procedures such as plastic surgery, that are as well-positioned to not only survive, but prosper in the new environment now unfolding. Good vision is highly valued. We have many offerings that are paid for directly by patients, we can own and operate an ASC and optical dispensary, and we can easily integrate with other caregivers to leverage our training and skills.
Each generation faces significant challenges. The next is no exception. The challenge will be to continue to provide the high-quality compassionate care our fellow citizens deserve while remaining financially successful enough to survive — and preferably prosper. I see most of us succeeding, but not without a good understanding of the issues, the ability to accept change and adapt to it, good planning and execution, and perhaps a little luck. Our patients deserve nothing but our best effort, and in the end, our success will almost certainly depend on how well we serve them.