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Ophthalmology faces an economic mixed bag under health care reform law
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PHILADELPHIA — Federal health care reform measures may exert a lighter impact on ophthalmology than on other medical specialties, an expert and advocate said here.
"What does this all mean for ophthalmology? Basically, I think you can sum it up in these five words: less than is generally imagined," Michael X. Repka, MD, said during the Arthur J. Bedell Lecture at the Wills Eye Institute Alumni Conference. "This is not the big hit to ophthalmology as it is to many other specialties. It's not the big boon as it is to other specialties."
On average, ophthalmology receives about 60% of revenues from Medicare, which is largely untouched by the health care reform law. However, the law eliminates Medicare deductibles for screening and preventive services and simplifies Medicare Part D for beneficiaries, Dr. Repka said.
Perhaps the only good thing for ophthalmology is that the new law closes the doughnut hole in the Medicare Part D prescription drug payment schedule. This change may improve patient adherence to glaucoma medications, Dr. Repka said.
Ophthalmologists will likely get increased revenue from trauma, pediatric services, diabetic retinopathy and imaging.
On the downside, a long-term increase in demand for services will not be offset by an increasing number of ophthalmic residents. This will require ophthalmology to adopt more efficient practice models. Also, ophthalmologists and other specialists must continue to treat undocumented immigrants without reimbursement, Dr. Repka said.
Dr. Repka is the American Academy of Ophthalmology's medical director of governmental affairs.
- Disclosure: Dr. Repka reported no relevant financial relationships.
Health care service delivery in America represents a classic bubble market. One characteristic of a bubble is for the asset in question to be rising in price even in the face of an abundance in supply. At the moment, America represents about 4.5% of the planet’s population and generates about one-quarter of the planet’s economy. This advantaged position, which by most accounts is destined to slip in the years ahead, now allows us to spend one-sixth of our total national output on health care.
Well-intended efforts to forecast the impact of government health care notwithstanding, the future is unknown. But it seems certain within the career span of most people reading this that U.S. health care costs will have to be rationalized down from roughly 18% of GDP to about 12% of GDP, which would be in line with the other industrial nations.
That would be a roughly one-third drop from today’s spending levels … and for most providers a one-third drop in the fees paid for a given unit of patient care. More draconian fee reform, now or later, seems inevitable in my view. Although we may indeed see several more years of 11th-hour rescues, each applied as a political expediency, such delays in reducing the cost of care will only exacerbate the eventual sharpness of the adjustments. These few years of relative reprieve are being used by the wisest ophthalmologists and administrators to learn how to see more patients with fewer resources and prepare for a more frugal — but still highly survivable and fulfilling — future.
– John B. Pinto
OSN Practice Management
Section Editor
Disclosure: Mr. Pinto is president of J. Pinto &
Associates Inc., an ophthalmic practice management consulting firm.