HEALTH CARE REFORM
Until recently, when Republican Scott Brown became Massachusetts’ newly elected senator, health care reform seemed inevitable. Despite this apparent setback, the fact remains that the Patient Protection and Affordable Care Act and the Affordable Health Care for America Act have been passed by the Senate and House and await consolidation. During the 2010 State of the Union address, President Obama urged Congress not to “walk away from reform,” indicating that the battle for health care reform is far from over.1
At the American Academy of Ophthalmology Annual Meeting in October 2009, Eyetube TV assembled a panel of cataract and refractive surgeons for the “Health Care Reform Roundtable” (http://eyetube.net/ v.asp?ripene). Moderator Stephen Slade, MD, was joined by a diverse group of ophthalmologists who work in a variety of financial environments, including Rosa Braga-Mele, MD, an ophthalmologist practicing under the Canadian health care system. There are five video clips in all. In the first, panelists discuss how declining cataract reimbursement fees might affect our current business models. Steven Dell, MD, makes the point that, due to relatively fixed resources for payments and a large increase in cataract volume from aging baby boomers, a reduction in cataract reimbursement is likely whether health care reform is passed or not. The game plan for these refractive surgeons is generally to perform more refractive cataract surgery and to charge additional fees for the management of presbyopia and astigmatism.
How will the management of glaucoma be affected by declining reimbursements? The volume of new patients will increase tremendously over the next few decades. The number of people in the United States with openangle glaucoma is estimated to rise from 2.22 million in the year 2000 to 3.36 million in 2020.2 How will glaucoma specialists adjust their practices to accommodate this influx of new patients? Will some stop accepting insurance? Will some charge out-of-pocket fees for newer glaucoma procedures not currently reimbursed by commercial or government payors? Given that the number of practicing glaucoma specialists will remain relatively stable, how can they deliver the same quality of care to 150% of their current patient volume?
These questions beg a discussion of tort reform, which is addressed in a segment titled “Tort Reform and the Practice of Defensive Medicine” (http://eyetube.net/ v.asp?winidd). The panel identified a disconnect between physicians and legislators, who often do not acknowledge the impact of defensive medicine on health care spending. Dr. Dell suggests that, if tort reform is not passed with health care reform, spending on defensive medicine will likely increase dramatically. Interestingly, in Canada, liability issues are less significant. Dr. Braga-Mele notes that, although this is partly due to cultural differences between our countries, the issue is also mitigated in Canada because malpractice insurance is less expensive and partially subsidized by the government.
THE CANADIAN HEALTH CARE SYSTEM
In a segment titled “A Canadian Ophthalmologist’s Perspective on Universal Health Care and Participating in the Legislative Process” (http://eyetube.net/v.asp?redewo), Dr. Braga-Mele describes the Canadian system and addresses a few common misconceptions. For example, Canadian ophthalmologists can opt out of the entire system and charge cash for cataract surgery, or they can offer premium IOLs and charge a fee in addition to the standard government reimbursement. Although her current waiting list for cataract extraction is only 1 month, Dr. Braga-Mele concedes that, several years ago, before the government put more money into the program, her waiting list was 1.5 years. What advice can she offer to US ophthalmologists facing greater governmental control over health care spending? Despite suggesting that the Canadian system is “not that bad,” she states that “ophthalmologists as a whole have to stand united” in their fight against fee reductions.
HEALTH CARE LEGISLATION
In the final segment, titled “Forecasts and Opinions on Health Care Legislation” (http://eyetube.net/v.asp?loflal), the panel agrees that ophthalmologists and US citizens alike still have no clear idea of what lies ahead. As with the Canadian system, there is consensus that the US government will allow physicians either to practice outside the system—which decreases the government’s financial obligations—or to charge a premium for refractive IOL technology. Finally, Karl Stonecipher, MD, urges us to “lose the labels” and approach health care reform not as members of any particular political party but as physicians. Furthermore, he urges us to get involved by simply calling our representatives or, better yet, by cancelling a patient day and visiting them in person. He notes that “it can sway the way that they are going to vote.”
Section editor Nathan M. Radcliffe, MD, is an assistant professor of ophthalmology at Weill Cornell Medical College, New York-Presbyterian Hospital, New York. Dr. Radcliffe may be reached at (646) 962- 2020; firstname.lastname@example.org.
- Text: Obama’s State of the Union Address. The New York Times. January 28, 2010. http://www.nytimes.com/2010/01/28/us/politics/28obama.text.html. Accessed February 2, 2010.
- Friedman DS, Wolfs RC, O’Colmain BJ, et al. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmol. 2004;122(4):532-538.
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