EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/87458
Passing the hat to patients by John B. Pinto "Poverty is the schoolmaster of character" M r. Anatoly Brunton, our beloved 9th- grade English teacher, was not a snappy dresser. For the entire year, each day he wore one of two thread- bare suits—one brown, one gray. He carried his burden as a still-poor immigrant on his shiny coat sleeves, reminding us—his room of mostly lower-middle class students—how lucky we were to be able to eat every day. Or come to school in safety. Or see a doctor when we were sick. Mr. Brunton had perpetually sad eyes—the kind that even misbehav- ing boys like us settled down for, not wanting to make them even sadder. As we came to learn over that year, he had barely survived World War II and came west after it was over. Each class day, Mr. Brunton would end the class period with a short story from his life. Some funny, some frightening, and all ending with the same appeal: "Appreciate what you have, kids. And if you have a little lunch money left over, please drop it in the jar on the way out. Today is 'Penny Pinching Day.'" Hitting one's students up for their lunch money would probably be prosecuted as a crime today. Mr. Brunton sent the funds, or so he told us, to the people he had left behind in Eastern Europe. Maybe it was true. Why do I share this? Because everyone reading this—even those of you who grew up lean like me, or who have been more recently personally impacted by the Great Recession—are living a life today of relative abundance, relative to your past, perhaps, but also to your future. If you're a practice administrator or a technician—even a front desk clerk—you earn vastly more than Mr. Brunton did as a public school teacher. And if you're an ophthalmolo- gist, you're likely a member of the now-hounded 1%. Enjoy the moment. It may not last. Profound change is coming to eyecare as we all stand at the intersection between our fat, limitless past and the inevitable future limits to healthcare cost escalation. Here are some of the current signposts that the past will not be prelude. • In the last few months we've all heard about a new iPhone app from MIT researchers, NETRA (short for Near-Eye Tool for Refractive Assessment), that when used with a $2 attachment can generate a glasses prescription. While destined for the moment for the Third World, it is just a matter of time before NETRA and its sophisticated derivatives will find their way to some American patients who will find an appoint- ment with their iPhone much more convenient than a trip to your office. Antiphanes • Less elaborately, another new iPhone app "Pupil Meter" is now available, allowing your patients to more accurately untether them- selves from your care. • At last check, a Google search for "buy eyeglasses online" generates 9.7 million hits. • I've recently run into a company, one of several likely to emerge, that plans to launch mini-exam booths. Step into a small cubicle and a few minutes later you've not only been screened for eye disease (and referred on to a collaborating local provider, maybe someone who owns a stake in the booth), but you have a prescription for glasses in hand. • In many states the percentage of Medicaid beneficiaries is growing, while enrollment in private insur- ance plans is shrinking, not only from job loss but from employers hitting the breaking point and having to reduce or withhold health benefits to stay in business. • For the last 33 years, most of the surgeons I know have enjoyed a year-on-year pay raise. Even in the middle of this last recession, most practices have done well with three kinds of fear: surgeons who feared looming fee cuts and redou- bled promotional efforts; commer- cial patients who feared job loss and came in to use vision care and October 2012 • Ophthalmology Business continued on page 22 21