4 biggest issues in ophthalmology

From reimbursements to staffing, six ophthalmology leaders spoke with Becker's ASC Review on the biggest issues facing the ophthalmology industry today.

1. Reimbursement challenges

Ophthalmologists nationwide are struggling with reimbursement decline and payers' "excessive" prior authorization requirements.  

"The continued downward trend in reimbursement balanced with the climbing cost of doing business" is affecting ophthalmologists, Michael Redmond, MD, of Louisiana Eye & Laser Center in Alexandria, told Becker's

This is exacerbated by patients converting from private to public payers, he added. 

Other ophthalmologists echoed these thoughts. 

Jenifer Lyons, MD, of Lyons Eye Care in Portland, Ore., said the biggest issues she sees are declining reimbursements and increasing fixed costs. 

The increase in costs of supplies and staff paired with this reimbursement decline is a problem Emilio Balius, OD, of Miami-based Aran Eye, also is witnessing in the industry. 

2. COVID-19

Ophthalmology saw a 18 percent decline in patient volume during the COVID-19 pandemic, and the challenge of maintaining a safe environment still is affecting some ophthalmologists. 

"This is an all encompassing issue," Jerry Orloff, CEO of Southern Eye Center in Hattiesburg, Miss., told Becker's. "Can patients safely come to the office? Even if they can be provided a safe and therapeutic clinical environment, will they perceive it as such? With all manner of information and misinformation bombarding people every day, how will their interpretation of all of this information affect their choices?"

Keeping staff safe and functioning short-staffed because of COVID-19 quarantines or infections also is a problem, Mr. Orloff said. 

3. Declining private practices, increasing consolidation

For Sri Maguluri, MD, of Chicago-based Lake Shore Retina, the biggest issue is the declining number of private practices. 

"It is important to have these practices to allow for a more personalized, individualistic care, and a more one-on-one collaborative care," she told Becker's. "Also important to note that there is more patient satisfaction and less red tape. I think one has to nurture policies encouraging new residents and fellows to pursue these ventures, and not have corporate consolidation and buy-out of these practices."

Ophthalmology is unique because it can operate outside of a hospital setting, she said.

"This is important in the realm of pandemics that we can see patients outside of hospitals to mitigate overwhelming hospitals and at the same time prevent blindness,'' she said. 

Additionally, the industry is consolidating, making it difficult for smaller practices to succeed. 

"Private equity is getting bigger and starting to control market share more difficult for smaller or new doctors to get ahead," Dr. Balius said.

4. Staff recruitment

COVID-19 exacerbated an already-difficult process of staff recruitment, Dr. Redmond said. 

"There is a shortage of doctors, and especially glaucoma and retina is very expensive to recruit," Dr. Balius said.

Mr. Orloff agreed. 

"There is a substantial upward pressure on wages due to a combination of recent increase in inflation in the economy in general, wage inflation based upon competition for qualified staff and a reticence on the part of some parties to return to work following COVID-19 closures," he said.

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