EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
154 EW MEETING REPORTER Reporting live from Hawaiian Eye 2013, Big Island, Hawaii March 2013 Reporting live from Hawaiian Eye 2013 Monday, January 21 Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from Hawaiian Eye 2013. "Get everything in writing" isn't always the best advice for an ophthalmology practice, especially since doing so could open a surgeon to a bevy of legal and ethical dilemmas, according to an expert who spoke at the 2013 Hawaiian Eye meeting. "Please don't have written comanagement agreements," warned Alan E. Reider, J.D., M.P.H., a Washington, D.C.-based attorney who represents ophthalmology practices throughout the country. "The OIG has stated publicly and in regulations that an agreement to refer a patient back in exchange for a referral raises serious risk of violating the Anti-Kickback Statute. When you have a contract for co-management, you have eliminated the patient from the equation. The patient is the decision maker in co-management. Patient choice is critical." Mr. Reider added that it is fine to develop a protocol that provides guidance to co-managers. There are instances, however, when getting everything in writing is critical, including having patients confirm their subjective complaints and drawing up a lease when renting space from a referral source, Mr. Reider said. Editors' note: Mr. Reider has no financial interests related to this talk. Ethical challenges and dilemmas for the practicing ophthalmologist Continuing the discussion on ethics, panelists Elias Reichel, M.D., Boston, Richard L. Lindstrom, M.D., Minneapolis, Joel Schuman, M.D., Pittsburgh, and Roger F. Steinert, M.D., Irvine, Calif., joined moderator Carmen A. Puliafito, M.D., Los Angeles, to discuss challenging situations in which ophthalmologists can sometimes find themselves. In one instance, the physicians discussed whether a doctor should use the remaining medicine in a single anti-VEGF vial to treat an uninsured patient who could not afford the injection. "Really the question you have to ask yourselves is, 'Is it ethical, and is it legal?" Dr. Reichel said. "I would say for the greater good of society that this is a good thing and that we should proceed in this case and administer the drug for no charge to that patient." Dr. Reichel said a doctor would not face a Medicare audit as long as the indigent patient is not billed for the injection. "We all use the same drug for multiple patients that we pay for," Dr. Lindstrom said. "When it's a drug that another individual or third-party payer has paid for, I think it gets a little bit sticky. Ethical, I like. Legal, in America, makes me nervous." "This would have been waste. It's drug that you would have had to throw out," Dr. Schuman added. Editors' note: None of the doctors have financial interests related to what was covered during this session. Femto results with traditional cataract surgery Following three easy steps, it's possible for conventional cataract surgeons to match the results of the femtosecond-assisted procedure, according to John A. Hovanesian, M.D., Los Angeles, who spoke on the topic during Monday's clinical session. "In order to have an ideal refractive result, you need to see patients within .5 D of target refraction" with premium IOLs, Dr. Hovanesian said. The wild cards in cataract surgery that limit surgeons from this are "healing" of LRIs, the effective lens