Sometimes I sits and thinks
Click Here to Manage Email Alerts
Ah, the doldrums of summer.
A Great Lake becalmed, only the most gentle of breezes caressing a landscape freshly watered by Mother Nature herself. I pull up a chair and put up my feet, and like my very own Winnie the Pooh and Hobbes, my furry little companions Sasha and Bohdi sit nearby, ready to parse the mysteries of the world of dry eye disease (DED). As I sits, these are some of the things I thinks ...
Meetings in real life are much, much better than anything happening on a screen. I mean, like, a bazillion times better.
Even better are meetings where you have give and take between faculty members. Up the ante and allow the audience to ask questions or — gasp! — disagree out loud with the luminaries on the podium? The “pearls per minute” ratio goes up, like, a bazillion times.
Having said all of that, and after attending an American-European Congress of Ophthalmic Surgery meeting in Utah that was nothing less than sensational, I sits and thinks at home today while many of my colleagues are landing in Las Vegas for the first in real life American Society of Cataract and Refractive Surgery meeting in 2 years. July is a super busy time for the White family, and I just couldn’t find the time to get to two conferences in 1 month. Why AECOS and not ASCRS? There’s really no talking back and forth at the ASCRS sessions.
And, well, you know, Vegas in July.
Which makes me think: It’s 110° in Vegas, but it’s “dry” heat. We all know that our colleagues in Denver and Salt Lake, the high deserts of the West, see more symptomatic patients than our brethren and sistren in the swamps of Louisiana or the Everglades. Why don’t we hear more from y’all about DED?
Random thoughts fly by like so many midges. Were you aware that something like a third of all devices purchased by practices are never used? It’s true. In the dry eye world, big stuff like iLux units (Alcon) and TearCare machines (Sight Sciences) sit alone in closets and corners, all alone, longing for their chance to help. I imagine the same thing is true with topographers and other fancy expensive stuff, although it may just be a dry eye thing.
Of course, it’s totally understandable if some crazy government or insurance policy creates a situation in which your practice would actually lose money if you used that fancy gadget. I admit that I am still flabbergasted that three Medicare Administrative Contractors have published a fee schedule for LipiFlow (Johnson & Johnson Vision) that doesn’t even come close to covering the cost of the activators used for treatment. $38! Where did that even come from? And now we hear that at least one has declared that TearCare doesn’t even merit $38. Come on! That’s just crazy talk.
Hmm, I must have gotten a little agitated about that thought. Bohdi just jumped up and started licking my snoot. I’ll just sits and maybe not thinks for a minute.
OK, he’s snoozing under my chair again. But I can’t stop thinking about how it has come about that nonmedical people have so much say in what we can offer our patients. (Warning: crusty old guy moment coming.) I mean, back in the day, we just wrote for a script or a test or scheduled a procedure to make someone better. Nobody went unseen or untreated, at least in the places I practiced. Medicare and even Medicaid paid well enough that everyone saw, well, everyone. No insurance? No problem. We saw those folks for a token payment.
Or a chicken. One time I got paid with a chicken.
You didn’t hear about hospitals going bankrupt or read 10,000-word exposés in The Wall Street Journal about huge nonprofit institutions gouging uninsured patients. The big commercial health insurance companies’ appetites were held in check by competition from the equally massive and powerful nonprofit Blue Cross/Blue Shield companies. Who thought it was a good idea to allow the Blues to undergo a for-profit conversion all across the country?
And while I’m at it, did anyone in the star circle that came up with the Affordable Care Act think about what would actually happen when all of the biggest health care institutions in the U.S. took the ACA at its word and started gobbling up their local competitors? Biggerer and biggerer, as Calvin might say, but are they betterer?
I’m all for efficiency, but there’s no way to “Six Sigma” a new DED patient exam.
The wind is starting to pick up. My two furballs are getting restless. Could it be a sign? Some sort of signal that there might be some hope for our patients, dry eye or otherwise? I close my eyes for a moment, and I thinks really hard. Who can change this picture? Who has the power to change what has happened to health care in the U.S.? I dream about practicing more like we did before. Our patients want us to be able to practice more like the way we did before. Our patients ...
Wait. That’s it. Our patients! I am convinced that nothing will change until and unless our patients decide that they have had enough. No more Six Sigma and the infernal phone message trees between them and the doctors they see. Nope. Change will come when people who are cared for by the Vance Thompsons of the world tell everyone else that there is a better way. You can be big, and Vance Thompson Vision is very big, but you can still demonstrate that you care about each person you see.
I think that’s it. Our patients will be the key. DED patients are perfect for the job. I look over the lake, and I see all of those patients who’ve been cared for by Vance, by Cynthia Matossian and Laura Periman, by Harvey Fishman and the Drs. Toyos. Maybe if they rally other DED patients and let them know there’s a better way. Maybe if we turn ’em loose!
Whoa. That’s some heavy thinksing. Probably too heavy. Time for a couple of gulps of that summer breeze and a little toe wiggling in the grass. It’s the dog days of summer, and Sasha and Bohdi have chosen to nap. You know, sometimes we three sits and thinks.
And sometimes, we just sits ...
A tip of the cap to sportswriter Bill Reynolds of The Providence Journal, who wrote weekend columns with the thoughts he thought each week and who inspired a much younger me to write in my own voice. Bill, if you ever see this, I hope Bunky is enjoying his retirement.
- For more information:
- Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: dwhite@healio.com.
Collapse
Read more about
Click Here to Manage Email Alerts