Eyeworld

January 2011 "A very cloudy picture" As far as Medicare fees are con- cerned, Pinto said it's a very cloudy picture. "Most thoughtful analysts and Washington lobbyists and the rest don't believe for a minute, par- ticularly with the new Republican Congress, that the sustainable growth formula will be applied and that there will be a 23% cut in Medicare," Pinto said. "However, anything can happen, and it's im- portant practices think ahead and basically do the 'what if' question. What if some or all of such a major double digit cut did occur, how would we mitigate for that?" Pinto said one way to position a practice for the future is by ophthal- mologists and optometrists working together in an integrated setting. "There would be a tendency for ophthalmologists to want to do more primary care work and to dis- pense more avidly and to move into segments that are optometric, which would tend to increase the number of optometrists and ophthalmolo- gists who are working together in the same practice," he said. Pinto said because of Medicare fees being cut, ophthalmologists and other physicians are shifting more of the cost of care over to patients. That can be seen in the premium IOL market, where patients are billed directly for those items. For instance, a refraction fee is some- thing that is now charged but was not previously. "The broad thing we know for some great certainty is that the amount that providers will be paid for any one unit of service, whether that is a cataract surgery or complete eye exam or a test, is going to be lower than it is today," he said. Become more efficient Efficiency, too, is going to be more important than ever. "It's incumbent on providers to learn how to become more efficient and to be able to turn out more continued from page 40 units of work per hour of the day," Pinto said. "Some doctors, for exam- ple, will see 1,000 patients per month. Other doctors will top out at 300 patients a month and gasp and sputter. Those who are in the latter category are going to be quite pun- ished if they are unable to change in the world ahead." Still, physicians have to remain in a wait-and-see mode. "We're all in a stiff upper lip era right now. We're all in a breath- holding mode to figure out what the federal government is going to be doing with Medicare spending," Pinto said. "Medicare spending is going to drive payment levels in the private insurance sector, and there's really nobody who knows the trajec- tory of these things." U.S. heathcare costs are cur- rently a staggering 18%of the gross domestic product (GDP), nearly twice what it is in other developed nations. If the GDP continues to stag- nate, Pinto said, there might be more pressure on the government to ration either dollars or care for the nation. "I'm confident that the field of ophthalmology is plenty smart enough to be able to deal with what- ever comes around the corner," he said. "But everybody has to tune up their game and certainly the move toward an integrated delivery system is one part of that tuning up process." EW Contact information Durfee: durfeed@comcast.net Pinto: pintoinc@aol.com Preece: dpreece@bsmconsulting.com EW FEATURE 42

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