Future: More patients, lower fees, but continued rewards

San Francisco-Trends in demographics and economics indicate ophthalmologists face important challenges ahead in their efforts to deliver quality patient care, but these burdens cannot overshadow the personal rewards reaped from the profession, said H. Dunbar Hoskins Jr., MD.

Based on available statistics, he noted that ophthalmologists can expect to see about a 25% increase in the number of senior citizens who come to their practice, which would translate into about a 25% increase in the number of patients with glaucoma. While this segment of the population is thankful to have its medical costs covered by Medicare, the program’s financial troubles are driving new reforms, said Dr. Hoskins, clinical professor of ophthalmology, University of California, San Francisco.

Recommendations from the Medicare Payment Advisory Commission (MedPAC) include cutting spending with more integrated care, reducing reimbursement per unit of service, and improving the efficiency and cost effectiveness of care. It has proposed eliminating fee-for-service and going to diagnostic-related groups. In addition, MedPAC favors cognitive over procedural activities (i.e., a push toward more primary and less specialty care), and wants to reduce pay for overvalued service and set standards for care.

“We have heard all of this before, but forewarned is forearmed,” Dr. Hoskins said. “We know it is coming, and while we don’t know when, we need to follow activities in Congress because it could happen rapidly.”

He said ophthalmologists should be prepared to see a higher volume of patients with less reimbursement per unit of care, and he advised his colleagues to support the American Academy of Ophthalmology’s efforts to define quality standards and the value of services. In addition, he encouraged them to remember that the rewards of being an ophthalmologist are not from remuneration alone.

“No one thanks you like grateful patients do,” Dr. Hoskins said. “We have the opportunity to preserve and restore vision. Take pride in that and take comfort in being part of the finest specialty and in the best career in the world.”