EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/111385
February 2013 n m ibu Me s er oll R ed os Cl * or ss e pr Ex Ey el id C om pr es si on Fo rc ep s* * 7 01 8- n��� ki as :M 16 m bu ei M E io ss re xp 7: H ar dt en even outcomes. Patients value ���communication, treatment and diagnosis, and scheduling.��� This does not bode well. Patients might be reminded of the apocryphal ���be careful what you wish for��� (which most assuredly is not an ancient Chinese proverb). History is not on the side of ���communication��� and ���scheduling.��� As reimbursement for Medicare (and Medicaid) services ratchet downward, providers have three options: cut cost, increase volume, or quit. Clinical practice, like any service business, has defined cost centers, the most important being staff, space, and technology. There are hidden costs imposed by taxes, regulations, and licensing; these are uncontrollable. Once the cost of business is pruned, only earnings remain the prey. Increasing volume���throughput���of patients? If access to an already strained system is challenging, the Affordable Care Act���s 30 million newly insured intensifies the problem. ���Communication,��� when doctors must schedule more patients to pay the bills? ���Scheduling,��� when the incentive to see the additional patient is excessively discounted? Not likely. Most Americans will settle for proper diagnosis and treatment even if delayed. Satisfaction be damned. As early as 1914, Buick earned the sobriquet ���the doctor���s car,��� in acknowledgement of its appeal to the upwardly mobile professional. Seventy-two years later, a series of letters between Uwe Reinhardt, the irrepressible Princetonian, and Dr. Arnold ���Bud��� Relman, then editor of the New England Journal of Medicine, was published in Health Affairs. After their inspired, often tongue-in-cheek repartee contesting the merits of forprofit medicine, Reinhardt opined he still wanted his physician to drive a Cadillac. He thought it good for morale. Would you settle for a Buick? EW 801 71 has a credibility problem. One is reminded of the iconic line in ���Cool Hand Luke,��� ���What we���ve got here is a failure to communicate.��� We live in an age of the expected medical miracle. People live longer than ever, cancer is largely a chronic disease, the treatment of heart disease obviates the denial of the cigarette, glazed donut, and hours in the recliner, even death from homicidal gun violence has been greatly truncated. Cataract surgery? Let���s do an IOL that provides better distance and near vision than you ever knew���without glasses! Three months of post-operative care, free! For less out-of-pocket money than a pedicure! A wee-hour���s infomercial? If only. Where to start? The average medical student at my alma mater, Jefferson Medical College, Philadelphia, graduates with $176,000 of debt after four years of post-graduate education that presume another four or five years of additional training. In the state of Ohio, that tuition debt amounts to about 2�� years of a family of four���s median income, according to 2011 data. The government subsidizing medical tuition, as in Germany? Sorry. So what is the problem? Socioeconomically, ���richdoctor��� is one word. And this nation has a problem with ���rich,��� the 1% (or whatever percentage just above your personal economic stratum), the successful, the ambitious, the prudent, and, certainly, the risk-taker. The small business risk of private practice is substantial, no small reason the model is in rapid decline. The nabobs all agree on one thing. It���s not exactly the cost of healthcare that is inordinate. It���s the lack of ���value��� or, more precisely, the ���waste.��� Ask 100 patients what medical ���value��� is and you get 100 different answers. Like Supreme Court Justice Potter Stewart���s definition of pornography, most patients ���know it when they see it.��� Waste is more seditious because it manifests retrospectively. An ICU stay for the terminal Medicare patient is wasteful if the patient dies. But what if he lives? If patient satisfaction is a surrogate for value, a survey by the Physicians Foundation found little correlation with education, training, experience, information technology, Dry Eye Lid Squeezers Meibum Expression Is Recommended As A Subsequent Procedure To Meibomian Gland Probing, Insuring The Patency Of Meibomian Glands. Call 800-637-4346 For More Information. Editors��� note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for more than 30 years. 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 s 4EL s &AX %MAIL )NFO 2HEIN-EDICALCOM s 7EBSITE WWW2HEIN-EDICALCOM $EVELOPED )N #OORDINATION 7ITH 3TEVEN , -ASKIN -$ $EVELOPED )N #OORDINATION 7ITH $AVID 2 (ARDTEN -$ Contact information Noreika: JCNMD@aol.com 2HEIN -EDICAL 3TYLIZED %YE 1321 Rev.A BABB