Eyeworld

EW NEWS & OPINION 14 July 2015 Chief medical editor's corner of the world tion at home. The applications in ophthalmology are plentiful with new diagnostic tests that will allow patients to diagnose and treat com- mon diseases such as dry eye, ocular infections, and glaucoma at home with the aid of a smartphone and advanced technology. At the end of the day the only hope to improve the quality of healthcare while reducing cost is by fostering and embracing technology. Imagine the cost and quality of vi- sion if we were still doing extracap- sular cataract surgery for 4 million patients a year. The core value for the new healthcare system will be placing the patient at the center of the equation with an emphasis on transparency of services delivered and competition, while worrying not only about cost but also about the principle value of quality of care. There will be an increased interest in health and wellness with our patients taking control of their own lives. In addition, patients will demand excellent services but will also be willing to pay for premium results. The future of ophthalmic healthcare is going to radically change over the coming years, and I believe this will be good news for our patients and profession. EW Contact information Donnenfeld: ericdonnenfeld@gmail.com healthcare consumerism is forcing old delivery models to change and, in an exciting fashion, bringing new players into our field. Ophthalmol- ogy is going to experience tremen- dous changes in delivery in the same manner that Amazon has changed consumer purchases, Google has changed access to information, and Costco has changed hardware stores. New companies in ophthalmology will seize the opportunities available by redefining the role of the physi- cian and patient. With significant change comes significant opportu- nity, and the old and new compa- nies that make the transformative adjustments will flourish in the new healthcare economy, as will the phy- sicians and practices that embrace these changes. A recent survey by the Health Research Institute (HRI) found that consumers are overwhelmingly will- ing to abandon traditional health- care for more affordable, efficient, and convenient alternatives. Of the respondents surveyed, nearly 1 in 2 potential patients said they would choose new options for more than a dozen common medical procedures, such as diagnosing strep throat at home with a home health kit or having chemotherapy administered at home rather than in a hospital. The key ingredient in these radical changes is the patient's ability to obtain evidenced-based informa- this area are quite certain that the model of fee-for-service, which we have all practiced for decades, is going to change dramatically in the very near future. The new paradigm is going to be based on managing lives with accountable care organi- zations, hospitals, and insurance companies vying to have physicians share in the risk of healthcare. We will be reimbursed for managing ocular health and not ocular disease. For the first time, thanks to electronic health records (EHR), outcome analysis will allow payers and patients to assess the quality of care your practice is providing. For cataract surgeons, I predict your vitreous loss rate will be posted just the way cardiothoracic surgeons are judged on their mortality rates following cardiac bypass surgery. The risk of vitreous loss will hope- fully be assessed based on the risk factors for individual patients, but don't count on it. I must admit that I have adopted EHR kicking and screaming; however, I have begun to see the benefit of looking at large numbers of patients to provide evidenced-based decision making, rather than continuing the prac- tices we learned in our residencies. Recently, answers to questions such as the value of intracameral antibi- otics and topical NSAIDs in cataract surgery have been answered by looking at the records of thousands of patients (they are both benefi- cial). EHR-initiated, evidenced-based decision making will continue to improve outcomes and reduce costs by eliminating practices and proce- dures that are wasteful, inefficient, or even harmful in every aspect of healthcare. In addition, EHR allows practices to "mine" patients for im- proved care, premium services, and follow-up examinations. Healthcare, as one of the most inefficient and expensive aspects of our economy, is poised for dis- ruptive transformation, making it the new frontier. A driving force behind the change in healthcare is the empowerment of consumerism by our patients. The Internet has moved from a source of innuendo and misinformation to a valuable ally for patients seeking the most value and quality in their personal decision making. This change in I just got a look at the insurance bill for our office, and while physician reimbursement con- tinues to decline, our insurance invoice climbed 9.5%, and to add insult to injury, our deductibles increased as well. In the United States, healthcare is a $2.8 trillion component of our economy, and while the cost is growing steadi- ly, I am hard pressed to believe the quality of care is improving commensurate with the spiraling expense. There is something wrong with this picture, and there is one thing that Republicans, Democrats, and ophthalmologists can all agree on: The healthcare system in the United States is broken and has to change. After that, there really is no agreement on where we go next. However, there are some guiding principles that some very smart people in Cambridge, Mass., at the Institute for Healthcare Improve- ment suggest should be core values as we move forward. They call these the "Triple Aim." At the Institute they have brought together the best and brightest into a think tank and have spent years studying the Unit- ed States healthcare system. Their conclusion can be condensed into the idea that we as a country need to pursue 3 primary goals, or the Triple Aim: We need better health, health- care, and we need it all to cost less (or not have the expense continue to escalate). Better health and preventive medicine is a core value that we can all embrace. As ophthalmologists, routine retinal exams for all diabet- ics is imperative. However, we can play a role in improving nutrition for all of our patients starting with omega-3 supplementation. Safety glasses when patients are at risk of trauma and UV-blocking sunglasses can also play a significant role in reducing ocular morbidity. These are easy suggestions, and there are many more. The more difficult decision is how we improve healthcare to make it more affordable while increasing quality and value. Most experts in by Eric Donnenfeld, MD Healthcare is poised to change, and this time it might really happen Eric D. Donnenfeld, MD

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