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Technology – to ration or rationalize?
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In an ideal world, there would be no such debate. Practitioners (and their patients) would have unlimited access to all new technologies. Practitioners could run any number of special tests, validating clinical intuitions and confirming diagnoses. Patients would benefit from a thorough evaluation, having their questions answered in a timely fashion. The result? Peace of mind, for all parties.
Unfortunately, this isn’t an ideal world. For starters, technology costs money. Things like corneal topographers, threshold visual field analyzers and excimer lasers don’t just fall out of the sky. They are the fruits of ingenious minds and often the culmination of years of research and development. Yes, corralling an abstract concept and transforming it into a functional instrument isn’t an easy task. It takes time, and time is money.
Limits on compensation
Of course, practitioners are generally not averse to purchasing technology. We recognize its value and are willing to amortize it in the name of providing quality care. Unfortunately, in this era of cost containment, integrating technology has become more difficult. Some insurers impose restrictions on new technology applications, while others simply cap their compensation. Other plans fail to acknowledge emerging technologies, thereby not paying at all. And a few insurers even prohibit discussing these options with your patients (their subscribers). In deed, given the pressures, it’s easy to assume a “bunker” mentality and place a moratorium on all technology. In short, rationing technology doesn’t sound so bad.
Recently, we struggled with this dilemma in my practice. While we’ve had threshold visual field, ocular photography and corneal topography capabilities for over a decade, we felt corneal pachymetry and specular microscopy were logical additions. The clinical needs seemed obvious. Pachymetry would help us identify excessively thin corneas among laser in situ keratomileusis candidates and monitor overnight swell rates in continuous wear contact lens patients. Specular microscopy made sense given our sizable contact lens wearing penetrating keratoplasty, aphakic bullous keratopathy and corneal dystrophy populations. What wasn’t so obvious was how we could justify its cost.
Investigate codes, adjust fees
In the final analysis, our decision wasn’t governed by strict financial analysis. We purchased a pachymeter/ specular microscope because it made good clinical sense… for our practice. Given our philosophy and patients’ needs, we had no other choice. As for how we’ll pay for it, that’s another story. We’ve identified proper procedure codes, eligible diagnostic codes and reimbursement schedules for a variety of insurers. And we’ve adjusted refractive surgery comanagement and continuous wear contact lens prescribing fees to reflect this new technology. Most importantly, we’ve viewed this as a long-term addition, one that will better serve our patients for years to come.
Of course, this really isn’t about corneal pachymetry or specular microscopy. It’s about rationalizing new technology. Whether you’re contemplating the purchase of a patternless edger or a retinal tomographer, the same principles apply. If it complements practice philosophy, augments your skills and benefits your patients, can you really be without it?