BLOG: Popularize refractive lensectomy, placate payers
The costs of health care in the U.S. are skyrocketing, and insurance companies are taking measures large and small to curb them.
By requiring a burdensome prior authorization process for cataract surgery, insurance companies like Aetna are punishing patients and doctors to address a very small problem, unnecessary cataract surgery. CMS has already created standards for demonstrating the need for surgery. We all learned them in residency, and we all follow them diligently. Further barriers create a danger to patients who are visually impaired and those who share the road with them. Certainly, we as a specialty need to use every avenue to push back. Yes, we must for now comply with prior authorizations, but we should also support proposed legislation, create a stir in social media, promote class action litigation and simply use our influence as physicians to encourage patients to choose insurance companies that allow access to care.
But we should acknowledge that advanced implants have given patients a new motivation to pursue lens replacement surgery — the prospect of spectacle freedom. Does this motivation create a market of patients looking to get their refractive surgery paid for by insurance? Yes, let’s be honest about that. But does it lead doctors to bill insurance for unnecessary cataract surgery? That’s rare precisely because CMS has its clear rules, and every surgeon is aware of the ugly cost of violating the law.
Refractive lensectomy is the answer for these patients, and popularizing it may be important for our future. It’s identical to cataract surgery except that it is performed for a different reason — refractive correction instead of addressing visual disability. It is safe, precise and effective, it obviates future cataract surgery, and many patients are happy to pay for it rather than wait years for their cataracts to meet CMS standards for insurance coverage. After all, they have to pay out of pocket for a premium implant anyway. Furthermore, popularizing refractive lensectomy sends a clear signal that our specialty supports only appropriate surgical claims to insurance. While we shouldn’t have to prove the latter point, the evidence suggests that right now we might need to.
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