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IRIS Registry expected to benefit physicians, patients and all of ophthalmology
The federal and state governments are now the No. 1 purchaser of health care in America. They, like any purchaser of goods and services, want good value for the money they spend on behalf of their citizens. This should come as no surprise to any of us, as we each individually want the same.
If we are purchasing a new home, a new car or a piece of equipment for our offices, we want a good value. Of course, defining value is a complex issue, and each of us might have a somewhat different definition, but in general, it is the benefit received or perceived, including objective and subjective factors, divided by the cost.
The health of an individual or a collective society as a whole is an extremely important and valuable goal. A healthy individual or society is much more productive and content than one ridden with disease. The burden of disease and social discord is enormous in terms of both economic cost and loss of quality of life.
So, do those who matter in America, our payers and our patients, believe they are getting good value today for their enormous expenditure on health care? The bottom line, as I interpret survey after survey, is they do not. We spend approximately 18% of the gross domestic product on health care in America, approximately $2.5 trillion a year, and both our government and our citizens when questioned state they do not believe they are getting a good value. No other advanced country in the world spends more than 15% of GDP on the health of their citizens, and most are closer to 12%.
Personal opinion: Health care spending in America at more than 15% of GDP is not sustainable, and we who provide health care to America must convince our government and our fellow Americans that they are getting a good value or suffer significant consequences.
The last 3 years, after decades of increasing cost as a percent of GDP, health care spending has stabilized at approximately 17.9% of GDP. If inflation in total health care spending is held to 2% or less and our national GDP grows at 3% or more, we can hope to reach a sustainable 15% of GDP by 2020 or before. This is an important goal and would, in my opinion, create a soft landing for us ophthalmologists. At 15% of GDP, health care spending will still grow 3% or so per year, and with eye care’s share estimated at between 2.5% and 3% of total heath care spending, we will have $65 billion to $75 billion a year and growing to share. That, and the fact that there is a flat to declining number of ophthalmologists in the face of exploding demand as our population ages, means we will all be as busy as we wish and well compensated, as well.
As an added bonus, we ophthalmologists are blessed with far more opportunity than most of our 800,000 fellow physicians. For example, we can own part or all of an ambulatory surgery center and participate in a growing number of patient cash-pay services that are highly valued, starting with glasses or contact lenses and extending through refractive corneal surgery, refractive cataract surgery and/or aesthetic plastic surgery. My wife tells me I am at times a delusional optimist, but for the ophthalmologist and ophthalmology practice that position themselves well, I see a soft landing and a bright future as we collectively adjust health care spending in America toward a sustainable 15% of GDP.
What about the other half of the value equation, the actual and perceived quality of the benefit received?
In Medicine, this is measured by analysis of the outcome generated, and it has both an objective and a subjective component. A great cataract operation with no complications and 20/20 uncorrected vision is surely a great objective outcome, but equally important is the patient-reported outcome of the preoperative, intraoperative and postoperative experience.
The ophthalmology health care experience of the future, in my opinion, needs to be more like a visit to Nordstrom than Kmart if we are to convince our government and our fellow citizens that they are indeed getting good value for their hard-earned (or borrowed) dollar. There is only one way to prove that we are providing high-quality patient-friendly care, and that is to objectively measure the outcome generated in a significant cohort of patients. Such outcomes analysis is hard to do, very expensive and outside the capability of all but the largest practices or integrated health care delivery systems. The Mayo Clinic, the Cleveland Clinic, the Kaiser system and perhaps a few large sophisticated practices can do it well, but the vast majority of us cannot without help. To the rescue and in a timely fashion comes the American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) Registry.
To jump to the bottom line: Every ophthalmologist should not just walk but run to sign up for this program. Not only will it provide great value to the individual ophthalmologist and his or her practice, but it is critical to the success and future standing of ophthalmology in the U.S. as a whole.
The next step, just like for the drugs and devices we use, will be third-party evaluation of the comparative effectiveness of one procedure vs. another in regards to value — say, cataract surgery vs. transurethral prostatectomy or a prosthetic knee or hip. We are going to be measured as individual ophthalmologists, one vs. another, as to the value we provide our patients when doing a cataract operation. But we are also going to be measured one specialty vs. another regarding the value we bring to society vs. primary care and each specialty and subspecialty. We will all be competing for our share of the finite financial resources available to spend on the overall health and well-being of America’s citizens. Big data, collected in a registry like IRIS, with as close to 100% participation as possible by America’s ophthalmologists, will give our leaders the hard data required to preserve and, optimist that I am, perhaps even enhance the very special position we ophthalmologists find ourselves in today as a respected and valued specialty.
So, sign up for IRIS, and actively participate. It will benefit you, your fellow ophthalmologists, your patients and your beloved specialty as a whole.