EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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58 EW MEETING REPORTER Reporting live from AAO/APAO 2012, Chicago December 2012 said Kevin M. Miller, M.D., Los Angeles. ���It���s great technology, but the question I���m going to pose is, who���s going to pay for all of this? Especially in the systems in which most of us work, both government and private-based systems.��� ���When it comes to refractive patients, it���s pretty easy,��� he said. ���None of these systems cover this as a benefit, so patients will just pay out of pocket. But that���s not true of cataract surgery, it���s not true of corneal surgery, it���s not true of glaucoma surgery, and on and on.��� Beyond the basic cost of the laser and add-ons, there are financing and service charges that could hypothetically add up to more than $800,000 at 8 years. He said while the technology offers better incisions, rounder capsulorhexis, and lower cumulative dissipated energy, the cost of the machine versus the benefits is still questionable. ���What are you really getting? Why are you buying this laser? It���s for marketing advantage. In 2012, that���s what you���re buying for half a million dollars,��� Dr. Miller said. ���Now down the road, other things will become more important, but you���re getting marketing advantage at this point.��� He said that it will be difficult for physicians to recoup the cost from cataract patients because the procedure is paid for by Medicare, and an additional cost for the laser will not be covered. Editors��� note: Dr. Miller has financial interests with Alcon and Abbott Medical Optics. Non-bacterial infectious keratitis a topic of discussion among many physicians Editors��� note: This Meeting Reporter contains original reporting by the EyeWorld news team from AAO/APAO 2012, Chicago. A session devoted to non-bacterial infectious keratitis featured presentations from several doctors on advancements, risks, and important things to remember. Ivan Schwab, M.D., Sacramento, Calif., specifically touched on herpetic simplex keratitis. He said this can sometimes be a ���diagnostic peril��� because there is not always a dendrite, but it���s important to have a high degree of suspi- cion. ���The key here is that you have clinical tools,��� he said. It���s generally not perilous, although it can be, he said. Dr. Schwab said that topical solutions are not always needed for this and can even cause toxicity in some cases, and steroids are rarely needed for treatment. He also said that all available tools should be used and if using steroids, to use at the lowest possible dose. To provide ���ocular predictions,��� Vincent P. de Luise, M.D., Waterbury, Conn., discussed systemic disease associations with keratitis. First, he said, when confronted with these kinds of problems, physicians must ask themselves what this is and how to proceed. ���The peripheral cornea is vascularized, and therefore it is susceptible to immune and infectious consequences,��� he said. Keratitis can either be interstitial or peripheral ulcerative. Dr. de Luise shared a mnemonic that he made, ���VAST CRIMES,��� which he said ���can remind us that a number of things can cause peripheral ulcerative keratitis,��� including viral or immune disease, contact lens keratitis, and rosacea. Editors��� note: The physicians have no financial interests related to their comments. U.S. health policy and ophthalmology The mood at this year���s American Academy of Ophthalmology meeting ���is one that can best be described as anxious and uncertain about moving forward,��� said David W. Parke II, M.D., chief executive officer, AAO, San Francisco, a move he called ���absolutely natural.��� Physicians understood ���Healthcare 1.0��� but this new iteration is incompletely understood, he said. A Republican presidency may have altered some of the healthcare changes, but ���that was not going to be the case unless one party had total control in all three and had a filibuster-proof majority in the Senate,��� he said. But with healthcare costs rising to 16% of the U.S. gross domestic product and growing, those costs are unsustainable over the long term, Dr. Parke said during a press conference. ���The typical American���s healthcare costs after Medicare is about $300,000-500,000, yet they only have about $65,000 in retirement funds,��� he said. Dr. Parke predicted that the future will see more physicians in big groups or hospitals. Michael X. Repka, M.D., Baltimore, said that the business of medicine ���is not just about the dollars,��� although there are business issues ophthalmologists need to know���including the Physician Fee Schedule that is reducing cataract surgery costs by about 13.5%. Since the amount of payment is tied to the amount of time a procedure takes, ���one of the problems we have and that everyone has is that we���ve gotten better and faster, and the time it takes to preform a service is integral to the value it gets from the Centers for Medicare and Medicaid Services,��� he said. Another issue facing ophthalmologists is that when two diagnostic tests are performed on the same day, the less expensive of those tests is going to be reduced in value by about 3% of the total price. ���These are important reductions,��� he said, but ophthalmology is one specialty that is particularly successful with e-prescribing. ���The bonuses we���re receiving from e-prescribing and [Physician Quality Reporting System] PQRS can offset the losses we���ll be incurring.��� The sustainable growth rate (SGR) is set to reduce payments to physicians by 26.5% beginning Jan. 1, 2013, unless Congress bypasses it again. ���We don���t like short-term fixes, but I wouldn���t decline a short-term fix for this problem,��� Dr. Repka said. Robert A. Copeland, M.D., Washington, D.C., predicted some dire shortages in the near future��� that by the end of the decade, there will be a 90,000 deficit of physicians, which is expected to increase to a deficit of 159,000 by 2020. ���The major driver for this deficit is the aging population,��� he said. By 2020, 39% of the U.S. population