Surgeon finds little incentive behind economics of SBCS

Lisbon, Portugal - Significant financial “disincentives” on the part of governments worldwide are a major contributing factor to why cataract surgeons are reluctant to perform simultaneous bilateral cataract surgery (SBCS), reported Steven Arshinoff, MD, of the University of Toronto, Canada.

Dr. Arshinoff analyzed the health-care financing of SBCS in the Canadian provinces, the United States, and select Western European countries. He sought to assess whether the financial environments of these areas were encouraging or discouraging cataract surgeons from performing SBCS.

“Nine-tenths of my cataract surgery is SBCS,” Dr. Arshinoff said. “I wondered if there were issues other than restricted medical issues in the world that influenced how often physicians performed SBCS in different countries.”

With assistance from a friend with an MBA degree, Dr. Arshinoff collected information from well-known surgeons on financing of SBCS in the physicians’ home area and compared the data with financing for unilateral surgery. The data were analyzed for the similarities and differences in each region as they related to the known patterns of popularity for SBCS.

“In the real world, everything responds to money, and this is why governments agonize endlessly over how they divide money and how nations, by changing 1% to 2% of resources every year, change society over a reasonably short time,” said Dr. Arshinoff.

In presenting the data, Dr. Arshinoff outlined the number of SBCS cases he performs as opposed to his unilateral cases. While he performs his difficult cataract cases with unilateral surgery, he increases his surgical cost efficiency by 15% to 30% when he performs his other cases with SBCS. “Do I make more money?” he asked.

In comparing the physician fee ratios among the Canadian provinces, it was not beneficial for cataract surgeons to perform SBCS compared with unilateral surgery, despite the cost efficiency that can be gained with SBCS. When Dr. Arshinoff extended the comparison to other countries, the same results appeared.

In the United States, private practice surgeons who participate in HMOs do not benefit by performing SBCS because they are paid a salary. However, the HMO benefits with average cost savings of about $700 for every SBCS performed.

“There is no consistent pattern of surgeon reimbursement in different jurisdictions, whether in any country or different countries,” said Dr. Arshinoff. “It’s amazing to see how incredibly varied the different countries finance and reimburse for SBCS.”

Dr. Arshinoff concluded that most countries penalize surgeons financially for performing SBCS, despite the fact that hospital and medical insurance companies incur less costs when they perform SBCS compared with two unilateral surgeries.

“Surgeons likely won’t embrace SBCS until there is something-like in LASIK where you can bill yourself-that makes some sense how they bill and how they are reimbursed,” he added.