Breaking News Related to Macular Degeneration, Cataract, Glaucoma, Corneal Disease and Other Eye Conditions » Practice Tips

Will Your Eye Surgery Center Purchase a Femtosecond Laser for Cataract Surgery?

Dr. Ari Weitzner — Mon, 12 Sep 2011 15:41:52 +0000

Last week Becker’s ASC Review for ambulatory surgery centers asked the question: Why aren’t more eye surgery centers buying femtosecond lasers for cataract surgery from manufacturers such as LenSx and LensAR?

The article shares insights from premier cataract surgeons around the country who acknowledge that while femtosecond lasers will likely revolutionize cataract surgery there are lingering questions about how to cover the cost of the machines (equal to about $500,000) since Medicare will currently not allow providers to charge extra for this new technology (except in cases of cataract surgery including insertion of a premium IOL).

Other surgeons indicated they may wait to see how the technology evolves rather than buy the first machines on the market.

Finding space for the machines in a crowded surgery center and scheduling use of the machines into the surgical workflow were also cited as issues to address.

We invite readers to share their comments on these issues below.

Here is a link to the full article in Becker’s ASC Review.

Opinion: Healthcare Economics-Is Dr. Mackool Part Of A Trend?

Dr. Ari Weitzner — Mon, 15 Aug 2011 14:28:30 +0000

I just saw a letter from a patient where Dr. Mackool, arguably one of the best cataract surgeons in the world, no longer accepts Medicare. His resignation puts into sharp focus the problem with the healthcare reimbursement system- it pays a top notch surgeon like Dr. Mackool the same as an average surgeon or a surgeon fresh out of training with a fraction of his experience. In my humble opinion, healthcare is like any other commodity- competition lowers prices and improves quality. And if doctors are paid the same regardless, you’ll have higher prices and lower quality. I therefore agree with the overhaul of health insurance- instead of setting fees to doctors, better to give Americans insurance premium price support and let Americans choose their insurance plan. You will then see an explosion in doctor-rating services (like Healthgrades, AngiesList etc.), and patients will choose insurance plans that have the better doctors. Institutions like the Mayo Clinic and Cleveland Clinic will contract with insurance plans all over the country. Expensive insurance plans that offer acupuncture, low co-pays (which encourage over-utilization) etc. will go out of business. Bottom line- we need more capitalism in healthcare. So, if Medicare patients want access to the better doctors, they have to realize that the system is completely broken and needs an overhaul, or the better doctors will simply follow Dr. Mackool’s lead. Lastly- payments to doctors is only about 10-15% of healthcare dollars. We still need to tackle the high cost of technology, drugs and bureaucracy.

American Academy of Ophthalmology Develops Checklist to Help Members Achieve Meaningful Use of Electronic Health Records

Dr. Ari Weitzner — Mon, 25 Jul 2011 15:54:39 +0000

The Centers for Medicare and Medicaid Services (CMS) has launched a program to provide a financial incentive for the “meaningful use” of certified electronic health record (EHR) technology. CMS hopes that doctors who implement and meaningfully use EHR systems will reduce medical errors, and improve medical decisionmaking.

“Meaningful use” (MU) has several components:

The use of a certified EHR in a meaningful manner, such as e-prescribing.
The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
The use of certified EHR technology to submit clinical quality and other measures.

Earlier this month, the American Academy of Ophthalmology announced creation of a checklist to help ophthalmologists comply with meaningful use, and make EHR systems as intuitive and efficient as possible for ophthalmology practices. The list sets forth seventeen essential, and six desirable features in EHR systems for ophthalmology practices in the areas of clinical documentation, ophthalmic vital signs and laboratory studies, medical and surgical management, and ophthalmic measurement and imaging devices. Some of the feature recommendations include:

Supporting documentation with respect to transitions between the office and operating room
Capturing, tracking and displaying “vital signs of the eye,” such as visual acuity
Incorporating hand-drawn sketches or annotations into records

Read more on the Healthcare IT News website.

Read the AAO press release.

Bausch and Lomb and Ista Drug Reps Only Ones Left Giving Samples

Dr. Ari Weitzner — Thu, 03 Feb 2011 09:19:14 +0000

What gives? Alcon and Allergan have stopped giving us ophthalmologists any more samples, while B&L and Ista still are. I’m not sure why. I know drug reps have stricter rules to follow lately regarding giving out gifts (even a stupid pen is considered a gift), but I thought drug samples were still OK.

Should You Drop Your Bottom Payors?

Dr. Ari Weitzner — Mon, 08 Nov 2010 14:45:27 +0000

Take a look at your payment patterns (any billing software can do this), and see which payor pays you the least. Then drop that payor (don’t inform the insurance plan just yet- just tell patients you no longer accept their insurance). Unless you have an extremely light schedule, I bet that you won’t miss it, and then, in a few months’ time, drop the next payor. Keep doing that until your schedule gets too light. We have to stop seeing patients for peanuts. Some of these patients will stay and pay out-of-pocket (give them a discount, but a fee higher than what you were getting), and you’ll be seeing more patients with plans that pay higher fees. That’s why even if your volume goes down, you’ll probably still make more money. Hell- even if your income stays the same, at least you are not working as hard.

Is Accepting Insurance A Bad Business Model?

Dr. Ari Weitzner — Mon, 11 Oct 2010 15:13:30 +0000

For those of us who still accept insurance, we really have to admit it’s a bad business model and one we would never adopt a priori. They basically pay us less and less to see more and more patients. We have to pay very good money for claims submission software/hardware/personnel, they often take too long to pay, and they reject claims that need to be resubmitted, often for no good reason. I wonder how bad it has to get before we all refuse to accept insurance en masse- then, finally, we’ll have some leverage and things will improve. But as long as the government is trying to cover more and more people, and we all know there is not enough money in the system, we will continue to work harder and harder for less money. Not so long ago, we doctors got paid upfront in cash and the patient submitted their bills. No accounts payable for us. No fancy computers to submit claims. No personnel to monitor payments. We need to go back to that somehow. Hopefully(!) things will get so bad that we doctors will stop accepting insurance, like many of us do with Medicaid, and things will turn around

Does It Make Sense for an Ophthalmologist to Do Refractions?

Dr. Ari Weitzner — Sun, 10 Oct 2010 18:04:54 +0000

I have been forced to see more patients per hour due to fee cuts, and I therefore simply do not have the time to do refractions. I now give all my patients a letter explaining this, and I advise them to see an optometrist, or they can pay me $100 for a refraction (very few take me up on that offer). I explain to them that a refraction is not necessary if they are satisfied with their vision. I must say, practicing has been so much more enjoyable. I realize now how frustrating refraction had become for me. The vast majority of my patients understand my predicament and do not give me a hard time. A few do and require more explanation.

Should Ophthalmologists Add Hearing Services? Sell Hearing Aids?

Dr. Ari Weitzner — Fri, 04 Jun 2010 23:11:30 +0000

A number of ophthalmologists have contracted with PHSI and other companies who either totally or partially provide turnkey operations where hearing services and subsequent sales of hearing aids are provided to patients. Some say it’s not ethical, but I disagree. the question is whether it’s appropriate. In other words, would it not be better to send these patients to hearing professionals or ENT?

Congress Delays Medicare Pay Cut

Dr. Ari Weitzner — Mon, 12 Apr 2010 22:42:01 +0000

Hurray! Congress has voted to schedule a vote later this week to delay the 20% fee cut til May 1. They are also drafting legislation to ‘fix” this annual problem of reversing Medicare fee cuts, by freezing the fees for five years. Great idea, guys! Keep up the good work! I am seriously considering dropping Medicare, or, charging a mandatory $40 refraction fee for every visit. Otherwise, I really don’t see how my practice can be profitable with these fees.

Don’t Use Consult Codes

Dr. Ari Weitzner — Tue, 09 Feb 2010 00:15:02 +0000

Medicare has now eliminated the use of consult codes in the office. You have to use the 92o04 or 992o4 codes (ophthalmology and E/M), but not that 99244 (consult). The difference is around $30-40. Of course, you’re going to end up treating the patient as a consult and writing a letter to the referring doctor like in any other consult, except you’re getting paid less, for no good reason. Yay!