Don't go postal, go dental: remain aloof to organized medicine

September 1, 2009

While ophthalmology has traveled down the road harnessed to organized medicine and thereby exposed to all of the exploding impediments to practice, dentistry has alertly remained aloof to these changes and continues to be viable, productive, and secure.

Key Points

Remember the critical principle that all of our expenses are capitalized; yet, our reimbursement is largely socialized and is hurtling toward full loss of revenue control? Any first-year business school student would state that this is simply not sustainable. Further, there is no way to adjudicate the concept of paying us for outcomes and disease management (i.e., capitation) rather than actual work and services on the patient's behalf with the current medico-legal environment that demands defensive medicine just to avoid career-threatening litigation.

A short-term option is to determine individually which insurances may remain viable for limited periods and limit our participation to those. But this is an ineffective long-term approach, hopping from one revenue rock to another until each is under water financially. All insurances look to the declining Medicare payment standard to mimic in order to maximize their own financial position.

As ophthalmologists, we are in a unique position to travel down a different pathway to sustain the quality of our profession, and there is a well ensconced health-care profession model that provides the roadmap. Rather than going "postal" in the midst of all of this turmoil, we should go "dental."

The analogies between the dental and ophthalmological fields are far stronger than those with other medical specialties. We both are virtually 100% outpatient for services. We both are technology-dependent. We both have office flow and layout that are similar, and our services are relatively cost analogous, too.

Of course, there are only two eyes as opposed to 32 teeth, which theoretically should reduce the ophthalmology financial burden on each patient over a lifetime versus dental care. Dentistry has cleanings, we have refractions. They have crowns, we have cataracts. They employ hygienists and technicians; we employ certified ophthalmic assistants or certified ophthalmic technicians.

The similarities are haunting, all except for our practice business models. While ophthalmology has traveled down the road harnessed to organized medicine and thereby exposed to all of the exploding impediments to practice, dentistry has alertly remained aloof to these changes and continues to be viable, productive, and secure.

There is no reason why we, as eye doctors, could not transition efficiently to a model wherein eye-care services were removed financially from the rank and file of Medicare and insurance domains. Because cataract surgery is the number one surgery performed within the Medicare system, relieving this one procedure from Medicare's responsibility would have a great impact.

As I'm sure many of your patients have articulated, they would gladly pay substantially more than the few hundred dollars we now receive for the benefit of receiving high-definition vision that rejuvenates every aspect of their lives.

Remembering that each patient would typically only have to pay for this twice in a lifetime, it seems like a very viable approach.

Premium IOLs and laser vision correction offer limited versions of this model, but there is no reason these concepts can't extend to the vast majority of services we provide. Just as in dentistry, the marketplace would calibrate our fee structures, and the capability of offering free or reduced-cost services to our patients in need would once again be restored to our profession.

This is one of the most effective ways to reach out and provide for many less fortunate citizens-a luxury that most of us haven't been able to afford in this modern era of socialization of medicine.

As we face a professional abyss, the likes of which none of us could have imagined, I would urge that our colleagues carefully consider this option and speak to our leadership about their views.

If our President so effectively articulated the message of "Yes, We Can" and has invoked such sweeping reform across our country, we, as ophthalmologists, are in a unique position within medicine to reform our own profession in order to sustain the quality, access, and state-of-the-art care that our patients so rightly deserve.

By Steven T. Berger, MD, Baystate Eye Care Group, Springfield, MA.He can be reached at 413/783-3100 or stbmd@cox.net
. Dr. Berger did not indicate any financial interest related to the subject matter.