PUBLICATION EXCLUSIVE: A modest proposal revisited for local practice growth, development and collaboration

“Alone we can do so little; together we can do so much.”
– Helen Keller

“If you want the long road to success, do it all by yourself.”
– James Jean-Pierre

Fifteen years and three recessions ago, I wrote in these pages about the growing stresses of being an ophthalmologist and how these might be practically, proactively addressed by the profession.

Our pipsqueak irritations back then (remember the anguish of falling below 50% profit margins?) have all grown up into full-throated tribulations. Rising costs. Falling fees. Galloping regulations. Panel lockouts. And all occurring at a time when the average ophthalmologist is now in his or her 50s and finding it harder to muster the energy to lean into the current headwinds.

Here is a reprise of what I wrote then, updated for the times.

The current breath-holding stage we are in

Starting in the early 1990s, in an environment of spiraling health care costs and a stagnant economy, significant national efforts were launched to rein in the entire health care system. This involved a series of trial balloons.

There was an experiment to drive care to the most cost-effective providers, a “centers of excellence” approach, with a limited number of providers in each of several trial cities awarded a discounted contract for cataract care. Then there was an effort to require prospective review for cataract surgery — you had to call up a review nurse for approval on every case. Then Medicare HMO products were encouraged. These efforts and others fell out of favor for three chief reasons:

• The health care system is massively complex and continues to be resistant to global/top-down reform.
• Consumers lashed back. Ours is too litigious and demanding a society to passively accept substandard or rationed care.
• But mainly, health care reform dropped from the scene because the economy improved in the late 1990s and health care inflation was eclipsed by buoyant times.

So where are we now? Basically, where we stand is a little like where we were around the mid-1990s. The country is still emerging from an economic downturn. Health care insurance costs are inflating at a double-digit pace, which makes health care a wonderful political target.

Depending on which health systems analyst you listen to, there are different scenarios for what will drive American health care delivery and payment reform in the years ahead. Will the next national emergency give new voice to the call for a single-payer system? Will pre-paid (HMO) health care spring back to life and continue once more to gain market share? Will cost-shifting from government and employers to patients lead to more rationalized buying habits? Will this in turn slow the pace of health care utilization and cost inflation as patients directly ration their health care spending? Or will we simply muddle through, with a hodgepodge of small changes but no grand design?

•    Click here to read the full publication exclusive, By the Numbers, published in Ocular Surgery News U.S. Edition, October 10, 2016.