EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78716
March 2012 Update in Riviera Maya, Mexico. Attendees gathered at "Breakfast With the Ethicist"—the second in two days led by John D. Banja, Ph.D., medical ethicist, Center for Ethics at Emory University, Atlanta, and the newest member of the ASCRS Executive Committee—to brainstorm ideas on how to counsel patients when it comes to payments and finances. "Doctors are not trained salespeople and until pre- mium lenses, [they] didn't have to be," said attendee Frank Burns, M.D., Louisville, Ky. "I've found that it's beneficial to have a trained coor- dinator to handle that." Dr. Banja added that he thinks giving patients a pricing structure in writing is "ab- solutely required." As for counseling patients about paying above and beyond what insurance or Medicare will pay, David Brigham, M.D., St. Louis, said he found it helpful when talking to patients to liken premium lenses to hearing aids or dental im- plants, both of which patients pay top dollar out-of-pocket to have. Most attendees agreed that patients are not shy when it comes to asking a physician about costs associated with extra tests or premium lenses. Physicians, however, may come EW MEETING REPORTER 123 Continue NSAIDs for at-risk CME patients across as awkward or even unknowl- edgeable, especially since there are so many different kinds of insurance plans and the physician often doesn't know the status of the net- work or the individual patient's co-pay or deductible structure. "Medicare and insurance make it really difficult to have these discus- sions," said Jay Montgomery, M.D., Clinton, S.C. "We don't know what it's going to cost the patients a lot of the time. If we tell them what we charge, it may be way more than what the patients end up paying." R. Doyle Stulting, M.D., Woolfson Eye Institute, Atlanta, said he often will tell patients how far reimburse- ments have fallen over the years. "If [patients] ask me about service fees, I use that as an opportunity to edu- cate them," he said. "I really think they get it."Patients also "get" the value of a sight-saving procedure, said Leon C. Lahaye, M.D., Lafayette, La. "Good healthcare is expensive, but cataract surgery is the best buy in medicine," he tells pa- tients. Many clinicians believe that a patient at risk for cystoid macular edema (CME) should be front-loaded with topical NSAIDs prior to having cataract surgery, but one retina ex- pert said surgeons can't forget about post-surgical treatment, too. "A lot of attention should be paid after the procedure," Keith A. Warren, M.D., president and CEO, Warren Retina Associates, Overland Park, Kan., said during a spirited and interactive session on multidisciplinary ap- proaches to management of difficult cases. Dr. Warren said that corticos- teroids also should be used. "The du- ration of therapy should be longer. Patients can rebound and get in- flammation or CME if they are taken off the medications [NSAIDs and corticosteroids] too early." He ad- vised that post-surgical therapy should last at least 8 weeks. Panelists discussed the different types of NSAIDs that they offer to patients. "I think all three of the nonsteroidals are excellent," Eric D. Donnenfeld, M.D., co-chairman, Cornea, Nassau University Medical Center, East Meadow, N.Y., said. Thomas continued on page 124 ᑂᑇᑕᑖᑀᑇᑓᑈᑀᑁᑗᑖᑔᑒᑇᑖᑉᑈ ᑃᑅᑄᑀᑆᑉᑕᑖᑑᑓᑐ ᑀ ᑖ−%%1ᑀᑧ−,(&ᑧ,ᑱᑰᑀ&ᑱᑧ+−∗ᑱ&ᑱ∋,ᑀ( ᑀ#∋,∗ᑧ(ᑩ−%ᑧ∗ᑀ%ᑱ∋+ᑱ+ᑀᑧᑩᑩ(∗ᑰ#∋!ᑀ,(ᑀ,∀ᑱᑀᑕᑠᑅᑗᑤᑡᑀᑇᑇᑐᑉᑐ ᑀ ᑒ∋1ᑀ,1)ᑱᑀ( ᑀ%ᑱ∋+ᑱ+ᑀᑂ&(∋( (ᑩᑧ%ᑄᑀ&−%,# (ᑩᑧ%ᑄᑀ,(∗#ᑩᑃᑀ/#,∀ᑀᑧ∋1ᑀ,1)ᑱᑀ( ᑀ+,∗−ᑩ,−∗ᑱᑀ ᑂ∗ᑱ ∗ᑧᑩ,#.ᑱᑄᑀᑰ# ∗ᑧᑩ,#.ᑱᑃᑀ(∗ᑀ&ᑧ,ᑱ∗#ᑧ%+ᑀᑂᑢᑙᑙᑒᑄᑀ (%ᑰᑧᑨ%ᑱᑄᑀ∀1ᑰ∗()∀#%#ᑩᑃ ᑡ),#ᑤ)∀ᑱ∗#ᑩ ᑗᑡᑘᑀᑢᑣᑡ ᑀ ᑙ−%,#)%ᑱᑀᑗᑡᑘᑀ&ᑱᑧ+−∗ᑱ&ᑱ∋,ᑀ#∋ᑀᑧ#∗ᑀ(∗ᑀ#∋ᑀ+#,− ( ᑀ,∀ᑱᑀ (%%(/#∋!ᑀ)ᑧ∗ᑧ&ᑱ,ᑱ∗+ᑑ ᑀ ᑕ ᑱᑩ,#.ᑱᑀᑖ(ᑩᑧ%ᑀᑘᑱ∋!,∀ᑀᑂᑕᑖᑘᑃ ᑀᑀᑢ(/ᑱ∗ᑄᑀᑧᑰᑰᑀ)(/ᑱ∗ᑄᑀᑩ1%#∋ᑰᑱ∗ ᑀᑀᑙ(ᑰ−%ᑧ,#(∋ᑀᑥ∗ᑧ∋+ ᑱ∗ᑀᑖ−∋ᑩ,#(∋ᑀᑂᑙᑥᑖᑃ ᑀᑀᑢ(#∋,ᑀᑤ)∗ᑱᑧᑰᑀᑖ−∋ᑩ,#(∋ᑀᑂᑢᑤᑖᑃ ᑀᑀᑔ1%#∋ᑰᑱ∗ᑀᑧ0#+ ᑀᑀᑣᑧᑰ#−+ᑀ( ᑀᑩ−∗.ᑧ,−∗ᑱ ᑀᑀᑓᑧᑩ∃ᑀᑖ(ᑩᑧ%ᑀᑘᑱ∋!,∀ᑀᑂᑓᑖᑘᑃ ᑀᑀᑥ∀∗(−!∀ᑀ (ᑩ−+ᑀ+ᑩᑧ∋+ ᑀᑀᑣᑱ%ᑧ,#.ᑱᑀ,∗ᑧ∋+&#++#(∋ ᑦ#+#,ᑀ−+ᑀᑧ,ᑀᑀ ᑓ((,∀ᑀᑁᑇᑉᑆᑈ