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What effect would the proposed cuts in Medicare and TRICARE compensation have on ophthalmology?
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Cuts may affect patient interactions
 David R. Hardten |
We are at a crossroads of patients getting older and needing more care, where there are more things we can do in medicine, and yet, there is potential for reimbursement to go down significantly. That leaves us, as ophthalmologists, faced with trying to provide more care and better care for less money, which is tough to do because we are faced with increasing labor costs, increasing technology options and other overhead expenses.
The answer seems to be in becoming more efficient in our care and becoming more conscientious in our hiring practices.
We will have to try and make sure that people have the right level of training to take care of patients for their specific problem. We will most likely find ourselves relying on physician extenders at some level, and that might be assistants or technicians, and in some areas, that may mean optometrists, ophthalmologists, medical ophthalmologists, surgeons and technicians working together — a wider variety of providers that is trying to tier it toward the most cost-effective level of care.
Unfortunately, what winds up suffering in all of this is the interaction with the patients. The interactions become shorter and less personalized, and patients obviously will not like that. But times are such that patients are going to have to understand that that is part of what suffers when there are lots of cuts in reimbursement at the same time as having to take care of more patients.
David. R. Hardten, MD, is OSN Cornea/External Disease Section Editor.
Little impact in the short term
 William L. Rich |
After the historic passage of health care reform, many are trying to divine the impact on their constituencies. Ophthalmology receives the highest percentage of its revenue from Medicare, so many of us are concerned about the potential negative effects on payment and beneficiary access.
In the short term, ophthalmology does very well. Between 2010 and 2013, we will see robust increases in payment from payment reform initiated by the Obama administration before the passage of the new bill. Most of the Medicare cuts used to fund the expansion of insurance comes from Medicare Advantage Plans, so they will have a minimal impact on the profession or our patients. These plans received extravagant payments of 117% of Medicare fee-for-service, and now this money will be diverted to fee-for-service and the uninsured. It is in the out-years where there will be some potential problems.
Our greatest liability comes after 2015. The legislation provides for the formation of an Independent Medicare Advisory Board, which by law must suggest savings if Medicare growth exceeds the consumer price index, which it always does. The problem is that hospitals, hospice and dialysis units are excluded until 2020, so physicians are at risk. The good news is that the only ophthalmic services in the top 20 for Medicare total costs are cataract and glaucoma, and there is little variation in costs or quality so it is unlikely they would be the main targets of cuts.
William L. Rich III, MD, FACS, is with the Governmental Affairs Division of the American Academy of Ophthalmology.