Five ophthalmologists talk about the biggest issues facing the field of ophthalmology in ambulatory surgery centers today.
Jorge G. Arroyo, MD, Founder, EYESPOT: I feel very strongly that the future of ophthalmology will parallel the future of medicine. We are facing a looming crisis with the aging population growing exponentially and the number of physicians staying relatively level or dropping with time. In ophthalmology, where we take care of an older patient population, this demographic crisis is one we're facing earlier than other specialties. Ophthalmologists that will succeed in the future must be able to deliver high quality care to a greater number of patients per doctor than we have in the past.
Another challenge we will be faced with in the future is continuing reductions in reimbursement for the services we provide. I believe that ophthalmologists, as well as other specialists, will need to survive within the ever-growing accountable care organization-type model. In order to survive and prosper, all health care providers will need to function at the very top of their medical degree or licensure and collaborate more closely with non-physician providers — in the case of Ophthalmology, optometrists.
Malvin Anders, MD, Chief of Ophthalmology, Los Angeles County+University of Southern California Medical Center: One of the things as a physician I'm wary about is the security of knowing we have the appropriate materials and equipment to treat patients. There has to be a good compromise between cost-effectiveness and quality of care. I've been in situations in ASCs where cost was the driving consideration in the decision-making process and this can result in not having the necessary materials for quality patient care. That hasn't been a big problem in recent years, but returning to that state is always a concern for physicians. On the other side of the coin, however, physicians have to be aware of costs so they can provide care without breaking the bank.
Rajesh K. Shetty, MD, Florida Eye Specialists: I think the most pressing issues for ophthalmologists today are the burden of ever-increasing regulations, the threat of medical liability, and the erosion in Medicare payments, which has been especially aggressive over the past couple of years. CMS has reduced fees for multiple diagnostic procedures along with cataract surgery in 2013. The planned expansion of government insurance programs for uninsured individuals may expand access but will likely lead to further reductions in federal and state reimbursement for individual procedures. That's our number one concern, especially in ophthalmology since many of us deal primarily with Medicare patients.
Benjamin H. Ticho, MD, The Eye Specialists Center, Chicago Ridge: Most surgeons are, above all, concerned with quality of care. How do we deliver the best quality to patients in the safest way for the best results? We have to bring in higher quality technology — not necessarily the latest and greatest — but systems that provide high quality outcomes. The other aspect of care ophthalmologists focus on is efficiency. Especially for a cataract surgeon, volume is important. How quickly can the ASC turnover a room and help the surgeon get the procedure done safely?
You also want the ASC to look clean, sanitary and comfortable. Make the family and patients feel at ease. You don’t need anything fancy, but it's nice to have a clean, welcoming environment.
Brian Boxer Wachler, MD, Director, Boxer Wachler Vision Institute, Beverly Hills, Calif.: Many ophthalmologists are feeling the squeeze of decreased insurance reimbursements and greater degrees of paperwork involved with the practice of medicine. Unfortunately, these trends will continue in the future.
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