BLOG: How to value MIGS
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There’s an old story about a lawyer who has a terrible toothache and asks his dentist to come in on a Sunday to pull the tooth.
When the dentist tells him to meet at the office, the lawyer asks, “How long is it going to take you to pull that tooth, doc?” The dentist says, “About 2 minutes.” “And how much will you charge me?” asks the lawyer. “Two hundred dollars,” says the dentist. “A hundred dollars a minute? How can you charge so much?” asks the lawyer. The dentist replies, “You just meet me at the office to pull that tooth, and I’ll take as long as you want.”
Doctors should not be paid solely for our time. Like the witty dentist in the story, our services should be valued, at least partly, for the outcome we provide. A short procedure is a bonus for everyone involved. In the case of MIGS, the value we deliver goes on for a lifetime, and our responsibility for unreimbursed postop follow-up care goes far beyond the few minutes of the procedure.
Let’s look at a small sliver of the value of MIGS: the cost benefit of fewer drops. Let’s assume 75% of cataract/MIGS patients reduce their drop dependence by one medication for the duration of their 10-year remaining life expectancy, and the cost of drops is a low $20 per drop per month. Using these assumptions, the lifetime medication cost savings of MIGS vs. continuing drops is about $1,800 per patient. If the MIGS device costs an average of $900, that leaves $900 for the surgeon. And that’s if we’re basing value on only medication cost savings and ignoring intangible values such as improving quality of life, preserving the ocular surface, reducing follow-up visits, avoiding the costs of caring for a person who is blind, etc.
As we discuss in our cover story in this issue of Ocular Surgery News, CMS has proposed a drastic reduction in surgeon reimbursement for some MIGS procedures to as low as $34 per procedure. The risks and follow-up care involved in these procedures makes that reimbursement model untenable, and it materially threatens the prospect of investment in future technology. Our patients deserve the life-changing benefits of MIGS devices, and we are eager to offer them. We now need CMS to do some simple math and stop acting like a lawyer with a toothache.
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