Eyeworld

EW NEWS & OPINION 24 December 2015 Insights by J.C. Noreika, MD, MBA an endorsement of stem cell therapy for hair loss; it seems injurious only to the sucker's pocket book. But others purporting to treat serious neurologic conditions, heart failure, and diabetes prey on the unrealis- tic hopes of desperate patients. An extraordinarily promising field, stem cell marketing is running ahead of legitimate scientific research. Social media and the web will become more potent tools in the hands of an increasingly critical public. Reviews posted to Facebook and Twitter considered "biased and unfair" have doctors crying foul. Kiplinger reports that websites such as surgeonratings.org founded by nonprofit Consumers Checkbook compares surgeons' outcomes and complications across 14 procedures including hip replacement. Medicare claims are scrutinized to generate the ratings. How patient selection is adjusted is not specified. Compli- cation rates are compared to one's peers; volume of surgeries performed is enumerated, volume correlating with better outcomes. The goal of these organizations is to distinguish "good" from "bad" surgeons. One five-star rating purports there is only a 2.5% chance that a surgeon's well-above average performance can be attributed to luck. Does cull- ing Medicare data truly reveal the nuance of surgery's art? Is there not an inherent catch-22? To be a good surgeon, case volume must be high; to have high volume, you must be a good surgeon. An unintended conse- Obamacare exchanges. No jejune forecasts of how many trees will be sacrificed to the writings of Cam- bridge academics who envision themselves the new sheriffs of value medicine. ACOs? Pick up any copy of Managed Healthcare Executive or, preferring something more secular, Forbes Magazine. Sorry, no predic- tions regarding the epidemic—if ophthalmology's periodicals are to be believed—of the heartbreak of ocular surface disease. Reading the tea leaves doesn't portend even a modest task force on meibomian gland dysfunction. Instead, here are four bold divi- nations to ponder. In 2016, the Medicare patient's out-of-pocket expenses will skyrock- et. Plan B will feature the double whammy of higher premiums and increased deductibles and co-pay- ments. Insurance companies and Medicare get paid upfront. You or, more precisely, your checkout staff will be required to collect from a person peeved because he is grow- ing older, has dilated pupils, is less independent and more financially insecure. Once the responsibility of others, you need a strategy to collect what you earn. In November's Health Data Management, the Granger Medical Clinic in Utah "builds more time into its billing cycle, enabling the organization to issue multiple patient statements." This means "it can take three billing statements and a final letter before the clinic makes progress on collecting a payment." Makes progress? Like many retailers, you may wish to keep your patient's credit card data on file to effect a charge once the Explanation of Ben- efits hits the mail slot. A bigger story than 23andMe (www.23andme.com), stem cells will make news in 2016. Stem cell clinics are intimating the wonders of these pluripotential micro 3D printers derived mainly from adipose tissue collected from liposuction aspi- rate. In reality, the FDA has coun- tenanced few legitimate stem cell treatments. Because their offerings are not claimed efficacious and their advertisements—an airline magazine ad offers stem cell therapy by an "expert" who holds a degree in podi- atry—are couched in imprecise, ge- neric verbiage, practitioners fly un- der the regulatory radar. P.T. Barnum would have little trouble recognizing The calendar's last leaf offers a holiday respite to appreciate the events of the past year and anticipate the surprises of the new R obert Burns died in 1796, a mere 37 years after his birth in Alloway, Scotland. His accomplishments are impressive. Acknowledged as the Scot's national poet, he pio- neered the Romantic age of poetry and grew world-renowned contribut- ing classics as "A Red, Red Rose" and "Tam o'Shanter" to the western can- on. The world remembers him as the lyricist of that traditional holiday chestnut, "Auld Lang Syne." Don't know any of the words beyond the first verse? No worries, no one does. We twa hae run about the braes And pu'd the gowans fine; But we've wander'd mony a weary foot Sin auld lang syne. Scottish dialect was his medium. Yet can we not imagine running about the regulatory hills and dales of ICD-10, the Physician Quality Re- porting System, and Meaningful Use III? Have we not plucked the daisies of technologic advances in imaging, cataract rehabilitation, pharma- cologic therapies for neovascular vision loss, and big data's insight from virtualization? Toasting the old and welcoming the new, we have progressed far "since times gone by." Futurists, sibyls and Cassandras are notoriously fickle. Best laid plans rarely evolve as intended, and the next Black Swan may lurk behind the earnings report of Apple Com- puter or Alibaba. But ophthalmolo- gists are intrepid. Few people fancy cutting into eyeballs. My LinkedIn profile purports that I know something about ophthalmology, medicine, IT, and management; I feel a responsibility for these gracious if misappropriat- ed beliefs. I did mention intrepid. You won't find slam-dunk prog- nostications regarding trouble to Boldly we go J.C. Noreika, MD, MBA quence? Who takes on the inherent- ly complicated high-risk cases? The electronic health record (EHR) is yesterday's news. Some practices are already on their second, even third, iteration. Most have yet to get it right. I have contended for 2 decades that EHR cannot achieve its much-hyped potential until ven- dors make its interface invisible to the user. I have also proselytized that the best way to do this is by adopt- ing voice recognition with speech- to-text capability as the input device. It is the only appliance that allows a single person—the doctor— to document a proper SOAP note into an EHR in real time. Doctors don't type to patients; they talk to them. Why not capture this crucial part of the encounter as it occurs? Apple? Windows? The technology awaits. Ask Siri. So raise a flute of bubbly as the clock chimes 12 and recall that Robert Burns' melody has enliv- ened many a New Year, the art of a Highlands poet, protosocialist and supporter of the French Revolution who recommends you "take a cup of kindness yet." Happy 2016! EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for 35 years. Contact information Noreika: JCNMD@aol.com

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