Lindstrom: Opportunity remains despite worrisome megatrends in health care

Issue: March 25, 2019

ORLANDO — Inspired by the quote “Fortune favors the prepared mind,” Richard L. Lindstrom, MD, said in the keynote lecture that trends in ophthalmology and health care may adversely affect patient care and physician career satisfaction, but preparation will mitigate these challenges and may even bring opportunity.

Meeting Course Director Robert H. Osher, MD, introduced Lindstrom as “a lion in ophthalmology” and a “true visionary.”

Lindstrom joked that his lecture might not be the “high point of the meeting because what I see is not good.” Along with John Pinto, he created a presentation on the top 20 megatrends in ophthalmology.

“I really believe that fortune favors the prepared mind, and to some extent, we are trying to open and prepare your minds … and position yourself well,” Lindstrom said. “Those of you who have some trepidation about the future will not be disappointed.”

Health care is a classic bubble market, he said. “By 2040, 100% of the U.S. [government’s] budget would go to health care, and of course” elected figures will not allow this to happen. The health care bubble is attached to a secondary bubble — the U.S. economy.

“Just as a pearl, watch the yield curve … once the yield curve turns negative, we are going to have another meaningful recession. It happens every decade, and we are basically due. It is going to happen in the next 2 years,” he said.

“The present reimbursement environment, while still pretty benign, is still dominated by fee-for-service but is probably going to become increasingly difficult.”

Using insights from his trips to Washington and his position on the American Society of Cataract and Refractive Surgery Executive Committee, Lindstrom said that there is not a single plan 5 years from now that includes fee-for-service in the third-party reimbursement.

“Fee-for-service is going to go away,” he said. It is likely to happen during the next crisis, which Lindstrom predicted is the looming recession.

Robert Osher, MD, + Richard Lindstrom, MD

Robert H. Osher, MD, and Richard L. Lindstrom, MD.

Fortunately, ophthalmology has a cash-pay option, and he recommended getting into those cash-pay opportunities.

Another megatrend is the “grand consolidation” of medical practices, hospitals and health care payers.

Mega practices are “forming more in the big cities than the small towns, so just a thought, one of the great places to practice is in those smaller towns about 50 to 100 miles away from an urban center,” Lindstrom said.

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“We are losing control, to some extent, over patient care, and electronic medical records are part of that,” he said, noting that who benefits the most are third-party payers. “It hasn’t helped me perform my care in any meaningful way, and in some ways, it is harder for me.”

EHRs allow for the ability to evaluate everything a physician does and will lead to preferred practice patterns, and “our independence is going to be reduced and we are going to have to follow those preferred practice patterns or be considered an outlier,” which will result in negative consequences.

Other megatrends presented by Lindstrom included:

Using kiosks and portals to enhance office efficiencies but reduce human interaction;

A reduction in the number of practicing ophthalmologists, which could result in more difficult succession planning;

The end of the era in which a physician could treat just refractive patients;

Integrated MD-OD delivery systems;

The rise of accountable care organizations and medical homes;

The rising cost to start a new practice, which could discourage future independent practices;

Alarm of resurgent inflation and dollar devaluation;

Value-based health care reimbursement;

No decline in patient expectations and demands;

Softening profit death knell for solo practice margins; and

Smaller nest eggs that will result in delayed retirement.

“For most of the older physicians who haven’t been prudent, they may have to work longer,” Lindstrom said. “And the millennial ophthalmologist will have to work a little bit longer than we did. So, if you are planning a long-term career, you are probably not going to retire at 60; you are going to retire in your 70s.”

“And along the way, you are not going to just have just one more great recession; you are going to have three or four, so learning how to recognize them and plan your investments properly with a good financial adviser will help you out.”

“Realize that change is universal, and both change and threat also create opportunity,” he said. “You have the opportunity yourself to survive and thrive in the challenging environment.”

“We are always going to do well in ophthalmology because people treasure their vision.” – by Joan-Marie Stiglich, ELS

Reference: Lindstrom RL. Keynote Lecture: Do You See What I See? Presented at: Cataract Surgery: Telling It Like It Is; February 6-10, 2019; Orlando.

Disclosures: Lindstrom reports no financial disclosures related to this keynote lecture. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm.