Summer breezes: Thoughts while I sits and thinks
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It’s hot outside. Like the heat of my youth hot. My sleeping dogs, companions for all my previous “sits and thinks” summer columns, will only lie indoors with the air conditioning on.
To be fair, I really don’t think it’s any hotter than the summers of my youth, a time when beaches and back porches could only be traversed in Chucks or flip-flops. But with the summer has come a summer breeze, and I have been able to sit and think a bit, even if the dogs decline to keep me company...
Will the $2,000 out-of-pocket max for Medicare patients actually happen? If it does, how does that math work without adding billions of Benjamins to the national debt? Honestly, it just seems too good to be true.
Lots of soccer on the telly inside. The Euro Cup with England facing off against Spain started the day for Fox Sports. So of course, I opted for the Scottish Open because everyone knows that you are far more likely to see a hole-in-one in sideways rain on a Scottish links course than you are to see a goal scored in regulation when England are playing. And a Scotsman won for the first time since 1966!
Yeah, I actually know that the English squad is all about playing for a draw, and I just wrote “England are.” We finally got Apple TV+ so that we can watch Ted Lasso, and I’m counting down the days until the new season of Welcome to Wrexham starts. I don’t even know who I am anymore.
OK, why not? Let’s make this year’s quiz a soccer quiz. Following the Euro Cup, Fox Sports is bringing us the Copa América, the Western Hemisphere’s continental championship. How many Copa titles did the great Pelé win with Brazil? Answer below.
Boy, are the pharmacy benefit managers (PBMs) and insurance companies struggling with all our new dry eye disease (DED) drugs or what? They’re going all “step therapy” on us, but they haven’t made even the tiniest effort for those steps to make sense. I mean, what are we to do with a prior authorization for Xdemvy (lotilaner ophthalmic solution 0.25%, Tarsus Pharmaceuticals) that is denied because the patient hasn’t failed on more than one artificial tear?
What are you reading this summer? I just finished Don Winslow’s City trilogy, a crime family story that moves back and forth between Rhode Island and parts West. It turns out that Winslow, pretty much my age, was growing up in Rhode Island at the same time as my siblings and I were. In City on Fire, he nails the details of 1980s Providence and the Little Rhody beaches. Protagonist Danny Ryan heads to California in City of Dreams before coming full circle and returning to the shore of my youth in City in Ruins. You don’t have to be in Narragansett to take these books to the beach. Want a little background reading before you start? Pick up The Prince of Providence and learn about competent corruption.
Sometimes a new product enters our world, occasionally one that a significant number of us will enthusiastically embrace and seek to utilize. In the process, we occasionally learn something about an entire category. A more precise indication, perhaps, or a better understanding of a billing nuance. I think Lacrifill (Nordic Pharma) is a good example of this phenomenon in the dry eye world. For instance, I have learned how many tricks there are to getting paid to do anti-VEGF injections and that none of them work for punctal occlusion.
Lacrifill has also taught me that just as electronic medical records were developed without any thought given to the negative impact they would have on doctors and their staff, no one has taken the time to think about how silly rules about what you can and can’t charge for in a single visit generate a burden for our patients. If I examine a patient and diagnose aqueous-deficient DED, I cannot occlude their puncta at that same visit and seek compensation for both the exam and the occlusion. The patient must return another day.
Did you know that you can cut a Boston Whaler into three pieces and none of them will sink? Really. Pretty sure that’s gonna come up in conversation for you before Labor Day. You’re welcome.
Here’s a preview of next month’s annual anti-inflammatory review: speed thrills! Now more than ever, it is important to achieve rapid improvement in both signs and symptoms of DED regardless of the setting. We now have a plethora of treatments that any eye doctor can bring to bear on the problem and get prompt results.
Could someone please explain why urgent care centers and emergency rooms prescribe antibiotic ointment to be used four times a day for people with a red eye? It’s a real head-scratcher for me, especially when a patient comes to us for follow-up and they are using ointment in both eyes! Maybe it has something to do with that follow-up. Unlike giving a patient with an abrasion a full bottle of tetracaine for the pain, thereby guaranteeing that you won’t see that patient until the bottle is empty or the ulcer impinges on their pupil, every patient put on ophthalmic ointments makes a beeline for their follow-up to find out how to stop taking it.
Shout-out to Mark Cuban and Cost Plus Drugs. PBMs are still in the news for increasing patient out-of-pocket costs and erecting barriers that often prevent patients from obtaining effective generic medications. Mark Cuban’s company buys generic medications directly from the manufacturer, adds a standard markup that is the same for every drug regardless of its cost and charges a small fee to ship the product. Cost Plus Drugs can be found in the pharmacy section of your EMR (literally the only thing that works in your EMR), and you can e-prescribe just like any other pharmacy. Man, it would be so cool if they had more ophthalmic drugs like, say, epinastine, bromfenac and moxifloxacin available. Whaddaya say, Mark?
Quiz answer: Trick question. Zero! Pelé is the only player to have won three World Cups, but he never played on a team that won either the Copa América or South American Championship.
That’s a wrap from the North Coast of America and this summer’s sitting and thinking. That gentle breeze is well on its way to becoming a gale, and the lake before me is now a boiling cauldron of white caps. Rain is on the way, and I have to get my pups out for a walk before it gets here. I promise to get back to the basics in a couple of months, but in the meantime, Sasha, Bohdi and I wish you gentle breezes, some time to sit, with or without thinking, and perhaps a sleeping dog or two to lie beside you while you do.
- For more information:
- Darrell E. White, MD, of SkyVision Centers in Westlake, Ohio, can be reached at dwhite@healio.com.
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