Comprehensive

[Etorphine]

Where do you see the field headed in the next 20 years? If medicare cataract payments were drastically cut across the board 10 years from now, do you feel the field would survive?

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[MstaKing10]

The same could be said for any field. Would an across the board cut on office visit reimbursement cause the field of internal medicine to vanish? Of course not. One advantage ophthalmology has over other fields is the ability to upcharge on elective procedures such as lasik or premium IOLs. We also do a whole host of different procedures besides cataracts. Also having an office based component and surgical component allows some flexibility to spend more time on one or the other.

Such cuts have already happened in the prior decades and the field is alive and well.

 

[4ophtho]

Cue $100 for refraction and everyone gets a multifocal IOL

 

[Etorphine]

it does seem that a redeeming grace will be premium options going forward that will be independent of cuts....multifocal iols, multifocal contacts, botox, lasik. with where the field is going it does seem like comp is going towards 'cataract subspecialty' though and a cut would really hurt. makes me wonder if doing a fellowship would 'future proof' to a greater degree or if there realistically is no need due to the extent and variety of 'other' procedures out there. comp can probably also survive on many of the subspecialty 'lite' procedures out there...migs, SLT, blephs. the question isn't so much where is comp now but where will it be in 15-20 years. subspecialists aren't going anywhere, but in which direction will comp go?

 

[paging_dr]

No subspecialty is immune to cuts. If cataract fees do get a massive cut, the good thing about comp is the ability to move towards and “justify” 3rd party services (premium IOLs, RLE, etc). Additionally, experience with “light” subspecialty work gives you access to more lucrative procedures of subspecialists, including glaucoma lasers, and intravitreal injections in many places, without the need to follow complicated cases that are “beyond your scope”, which you can refer on. I would argue that these flexibilities allow comprehensive ophthalmologists to weather the cuts better at the end, since cataract surgery only makes up about 20% of a typical comprehensive ophthalmologists’ practice. Also don’t forget that the actual surgery often isn’t the biggest part of the reimbursement (there are also out of pocket diagnostic fees such as optical biometry and topography, and usually YAG capsulotomy on a third to a half of your patients, depending on how aggressive you are).

As I see it, the narrower the focus of your practice, the more vulnerable you are. I would be more worried about being medical retina and seeing literally cuts to just 2 fee codes (OCT, intravitreal injection) have a huge effect on 100% of my bottom line.