Faced with the uncertainties related to the roll-out of the Patient Protection and Affordable Care Act as well as the shift from fee-for-service to fee-for-performance ophthalmology centers need to find creative ways to weather the changes.
Here, Mark L. Gonzalez, MD, an ophthalmologist at The Eye Center at MedStar Washington (D.C.) Hospital Center, discusses challenges facing eye centers and the best value-added services that centers can incorporate to help them thrive in the current healthcare climate.
Question: What are some of the challenges that ophthalmology centers face in the coming year?
Dr. Mark Gonzalez: First, as in years past, the decreasing reimbursement has been and will continue to be a problem. With high overhead costs, many centers run on a relatively tight per case margin. Any decrease in this margin, when multiplied over the entire years' case load, may result in a significant fiscal stress and can shift the financial outcome of a center.
Second, there is the uncertainty of the Patient Protection and Affordable Care Act and how this will affect ASC regulations.
Another challenge is ASC saturation. Over the last several years, ASCs have proliferated to the point that in certain locations (usually urban) it has become more difficult to recruit new physicians in order to increase the center volume and thus profits.
Q: What are some of the best value-added services that ophthalmology centers can add to stay ahead of the curve? What must they consider when adding these?
MG: Speaking from a perspective of a mainly general ophthalmology ASC, one must really look at the cost effectiveness of adding new services. Many centers have looked at adding treatments such as laser cataract surgery, endoscopic cyclophotocoagulation and other minimally invasive glaucoma treatments. As always, if a center can get its physicians to perform minor laser procedures, such as YAG procedures, at the center rather than in the office, that provides added income to the facility.
Also, some centers consider the cost benefit ratio of adding retinal surgery into their ASC practice. Doing so often requires adding a significant amount of new equipment and upgrades, case items for retina are usually longer, but reimbursement is higher.
Q: What are some common hurdles standing in the way of adding those services? How can they be overcome?
MG: There are many hurdles when you talk about adding services. They include cost benefit ratio, volume justification, physician education and adoption. I can tell you first hand since I work in a center, and I've also tried to add some potential value-added services that it is not always easy to get physicians to try to adopt new treatments and equipment if what they have used in the past has worked successfully for them.
Q: Will 2014 be a transformative year for eye centers? If so, how?
MG: This is very difficult to predict with increased governmental control of healthcare. The eye centers that are able to successfully add some of the value-added services will do well while others may struggle to meet the profit margins they had experienced in the past.
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