Eyeworld

14 0319 EyeWorld Ad indd 1 3 2:31 PM EW CATARACT 20 June 2014 by Stephen Lane, MD Distinguishing cataract surgery from refractive correction Avoid patient confusion by explaining advanced technology IOL (ATIOL) procedures as two distinct services T he implantation of presby- opia-correcting or astigma- tism-correcting IOLs (known collectively as ad- vanced technology IOLs, or ATIOLs) and/or the utilization of a femtosecond laser during a cataract procedure are commonly referred to as "cataract refractive surgery" or "refractive cataract surgery." While these terms are well understood by surgeons and staff, they can inadver- tently mislead patients into thinking that the procedure is a single service consisting of a special type of cataract surgery. Other similar terms such as "premium cataract surgery" constructed in a manner that is con- sistent with a two-service model and hence better understood by patients and their families. The bills for the cataract procedure (one from the facility for the OR and supplies, and another from the surgeon for diag- nostics and professional services) are no different than the bills that a patient who opted for a conven- tional IOL receives. These bills list the provider's charge, the payment from the insurer, and the insurance write-off. The other bills that the ATIOL patient receives are for the full charges for the noncovered service of correcting presbyopia or astigmatism (or both in the case of a presbyopia-correcting IOL coupled with an arcuate cut if performed). If charges are managed this way, then the following analogy can be used to help cataract patients better understand the billing for ATIOL procedures or procedures involving cataract surgery plus an arcuate cut for astigmatism correction. The anal- ogy is the story of a person who is involved in an accident resulting in a broken cheekbone. A plastic surgeon repairs the injury, and the surgeon and facility each bill for a cheekbone repair to the patient's insurance because it is a medically necessary, covered service. The pa- tient is responsible for the copay (and deductible, if applicable) for the cheekbone repair. If that same patient would like to have cosmetic nose enhancement performed during the same operative session as cheekbone repair, then cosmetic rhinoplasty will be billed as a distinct service separate from the cheekbone repair. The surgeon and facility will gain consent to perform two distinct services prior to surgery: cheekbone repair covered by insurance and the cosmetic rhinoplasty for which the patient must pay in full. This depiction of two services occurring during the same surgical event is something that cataract pa- tients can understand. They realize why the hypothetical patient would pay fully for the cosmetic service, even though it is being performed in conjunction with a service that is covered by insurance. Eye surgeons and staff can then liken that situa- tion to cataract surgery with an ATIOL. To help with the analogy and how it mirrors ATIOL billing, a new animated cartoon that teaches the two-service concept to surgeons and staff can be found on EyeWorld rePlay (scan QR code to view the video). When talking to patients about which IOL is a good choice for them, first we explain how a con- ventional IOL treats the cataract but will not correct their presbyopia or astigmatism that causes them to need glasses. Then we describe ATIOLs and explain that, in addition to being a part of cataract surgery, it has a design feature that is not continued on page 22 can also imply that the only service being provided is cataract surgery and that "premium" describes a special approach to cataract surgery that reduces the need for glasses. When patients think their pro- cedure was just a special flavor of cataract surgery, it can raise con- cerns related to the provider's sepa- rate charges to the patient for the noncovered service of presbyopia or astigmatism correction. Unless pa- tients understand that two separate services are being provided, they may erroneously think that the bill for the noncovered service is a charge for cataract surgery. This pa- tient confusion can lead to mistrust of the surgeon and staff and anger from the patient. I believe a better way to describe cataract surgery with ATIOLs is to properly depict the procedure as two separate services that are being provided within the same operative session. One service is covered by insurance (cataract surgery), and the other service is not covered (presbyopia or astigmatism correc- tion). Once patients understand that two services are being provided, then the bills they receive from the physician and the facility can be Americans unaware of link between common drugs, light irides, and UV-related ocular disease A majority of Americans are unaware that taking common drugs and having light-colored eyes can make people more vulnerable to UV exposure, according to the American Academy of Ophthalmology (AAO, San Francisco). In a national Harris Poll of more than 2,000 U.S. adults commissioned by the AAO, there were two major gaps in UV safety knowledge. One-third of adults use medications that may increase photosensitivity. However, 49% are unaware or do not believe those medications can cause photosensitivity. These photo- sensitizing drugs include antibiotics containing tetracycline or fluoroquinolones, some birth control and estrogen pills, and certain anti-inflammatory pain relievers, such as ibuprofen and naproxen sodium. Second, 54% of Americans have blue, green, or hazel eyes. Yet, only 32% of those with light eyes and 29% of all polled know light eyes are more susceptible to UV damage. The survey also found that 83% of Americans wear sunglasses, but only half (47%) said they check for a UV protection label before buying them. Only 32% make their children wear UV-blocking sunglasses. EW Watch this video on your smartphone or tablet using your QR code reader. (Scanner available for free at your app store.) 20-31 Cataract_EW June 2014-DL_Layout 1 6/3/14 12:20 PM Page 20

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