Boom or bust: where is ophthalmology headed?

Positive thinking in a (too often) negative environment

The last few years have brought a great deal of pessimism to many ophthalmologists. Articles and lectures have suggested that cataract surgery and other common eye care procedures are becoming money-losing propositions. These “doom and gloom” predictions by self-appointed experts fuel a tone of discontent, even among highly successful practitioners. After all, threatened (and real) reductions in reimbursement, well-funded commercial competition, expanding optometric scope of licensure, below cost pricing in the elective services market, and seemingly endless new compliance and other regulations make it feel to some that ophthalmology is being singled out for attack.
There is no question that all of medicine is changing rapidly, and that most of our clients hover between nervous and paranoid about the changing times. The sense of negativism among doctors is both pervasive and unfortunate. For many, it is stagnating, as they fear to take any action, lest it be in the wrong direction.
To the casual observer, near term events have cast a pall on the future of ophthalmology. This gloom however, is not warranted. In our view, the long-term fundamentals of supply and demand for eye care services remain excellent. In fact ophthalmologists—and their patients—are likely to do just fine, assuming they adapt instead of stagnate.
What justifies this contrarian view? Perhaps it comes from taking a long-term perspective, coupled with a belief that demographic change is the principal force driving patient demand for medical services, including eye care, in an ever increasing world of technology that allows you to do more.
The success of an ophthalmology practice turns on the volume of patient demand. The more patients examined, the more opportunity to discover pathology leading to surgery or other lucrative procedures. And what drives patient demand? With the exception of pediatric ophthalmology, demand is principally a function of patient age.
Most surgery and procedures are performed on mature adults, those past the age of 50. Few ophthalmology practices have less than fifty percent Medicare patients, and many market themselves to have more. Knowing that ophthalmologists depend on older people to populate their practice, are you intelligent about your location or are you in an over-served area of younger people? You do have a choice where you practice.
Obviously more patients without the ability to see them efficiently is not a change in the right direction. Fortunately one of profound changes is in the rapidly accelerating information flow. Medicine has been generations behind other disciplines in electronically developing, using and sharing data. In this new era, practicing and making decisions in your own practice bubble is giving way to computerized information systems may tell you what percent of symptoms like your patient’s indicate a certain condition and what percent of those will have successful outcomes with different treatments. Such data will help physicians practice more effectively (and quickly). Clearly, more information is available when records are shared throughout user networks, and where records stored electronically can be recalled for comparison, making more of the “whole person” available.
Computerized information technology also gives rise to standardization of reporting and sophisticated cost monitoring. The annoyances of utilization review (both prospective and retrospective) are in part a phase as doctors and payors move towards a synergy in their decisions, probable outcomes and related costs. Each of the players needs to become more comfortable with each other, and with evidence based medicine we move in that direction. With continued use and sophistication of these systems will come more comfort and expertise, the result will most likely be less friction over someone looking over your shoulder, and more perceived benefit from a second opinion.
Technology advances also present opportunities for practice management. Consider how you use your office computers now versus how you used to use them. Images can be stored and retrieved for later comparison. Computer based business transactions should be fully embraced. Virtually every business operation from purchasing supplies to eligibility verification to practice marketing and record keeping can be enhanced and streamlined by computer and high speed internet based operations.
Unprecedented demand from the baby boomers, coupled with new tools and talents, offer forward-looking ophthalmologists an opportunity for practice success in the years ahead. Those practices that see and embrace the fundamentals, envision the possibilities and position themselves advantageously, should see only change, and the opportunity to get ahead of it.
Pessimistic doctors too easily overlook the issue of choice. Would you really trade places with your lawyer friends, practicing a profession fraught with self-doubt, work that comes home with them and turnover far beyond that seen in medicine? Or, with your corporate colleagues, whose industries from manufacturing through banking lay off capable people in their rampant “downsizing?” Perhaps, with a level head, and some clear decision making it is the ultimate full time employment, if you are realistic, embrace the change, and go with it rather than fear it and put your head in the sand.

Several constants

Even with this change, there remain several constants. One is that the U.S. population continues to need physicians and their skills. The demand for diagnosis, treatment, cure, care-giving and health maintenance will not go away, and it will remain physician-centered. The baby boomers are coming into their own, and this is good for ophthalmologists.
Second, medical practice continues to be a unique way to combine technical challenge with service to others. While paying well, it provides personal activity deserving—and receiving—respect which lawyers, bankers and business people cannot approach.
Third, your practice will continue to change and evolve just like every medical practice. No longer do you carry a “black bag” as your grandfather did, or get paid in goods. You have the benefit of technology that your fathers did not have. Today, your techs electronically enter the history, plan, etc. for the patients queued up to see you in your high tech offices, built around your convenience. You operate in surgery or laser vision centers that you own interests in. Your Medicare (and other) patients (payors) are billed electronically and you are paid directly into your accounts from Medicare. From FAs, OCTs, YAGs, and other high tech equipment, the technology available to you has increased the speed and efficiency of your diagnoses and treatment.
Fourth, when you consider what you should be doing, know that the changes are affecting everyone. You are not alone. We hear clients talk about putting off mergers or hiring associates, for fear of the cutbacks in medicine. If everyone is going to have the same general cutback, would it not be prudent to try to get ahead of your competition? Perhaps you could control your expenses by being in a more efficient (larger?) group? Would this not allow you to invest in better technology, management, and marketing?
Truly, going forward practicing ophthalmology will be “different.” Embrace the change. Different does not mean bad. To date realistically, the changes have worked out pretty well for you.

ABOUT THE AUTHOR

Sandra E. D. McGraw, Esq., is an attorney with Health Care Law Associates, Inc., and a consultant with The Health Care Group. Both are based in Plymouth Meeting, Penn. She can be contacted at 610-828-0360.