$463 Cataracts

[MedScholar18]

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It's final. Insurance payment to surgeons for cataract surgery is $463.

After overhead we get what $200?

 

[RetinaDude]

It’s crazy how much reimbursement for cataract surgery has fallen. That’s why most cataract surgeons make up for it in volume and premium IOLs. But, really no problem with the volume part because most all the cataract surgeons in my area are slammed with cases. We will need more ophthalmologists.

 

[Slide]

Vitrectomy falling too, but with the increase with injections, I'm actually not too plussed since most of us make our volume from clinic anyway.

 

[Gonio5]

It's final. Insurance payment to surgeons for cataract surgery is $463.

After overhead we get what $200?

The post op visits are included in the fee so that's about 3 post op visits and surgery for $463. That is about $110 per visit or surgery, which is less than 4 patients coming in for one office visit each. At that rate, cataract surgery is a money loser without premium IOLs. A good cataract surgeon and good experience is not the ophthalmologist walks in to the OR, does surgery and leaves. In my own mind, if I peg the value of an office visit at 100, then I peg the effort of cataract surgery and 3 post op visits as 700 of my own units.

If all cataract surgeries pay $463, I would stop cataract surgery at about age 50-55.

 

[dantt]

It's final. Insurance payment to surgeons for cataract surgery is $463.

After overhead we get what $200?

After overhead you get zero.

 

[Dr.Wab0705]

Obviously it is impossible to predict the future, but how do y'all think this will affect the practice in the more distant future? I am currently interviewing for residency positions and this seems extremely worrisome, especially if reimbursement continues to trend down.

 

[Ophthodoc2018]

I actually think ophthalmology is one of the more safe fields in medicine because there is an option for cash pay procedures. If you think ophthalmology is the only field that’s getting cut, it is not. Every single specialty is getting affected by Medicare cuts and everyone is having to work harder.

But I still think there will be a point where doctors across all specialties stop taking insurances (sad state in USA).

 

[Slide]

I actually think ophthalmology is one of the more safe fields in medicine because there is an option for cash pay procedures. If you think ophthalmology is the only field that’s getting cut, it is not. Every single specialty is getting affected by Medicare cuts and everyone is having to work harder.

But I still think there will be a point where doctors across all specialties stop taking insurances (sad state in USA).

People always say its doom and gloom but I think this time the cuts have hit the tipping point where we will see a combination of office based surgery, Medicare opt-outs (which does come with its advantages), and hard pushes towards consumer sales and add-ons like dermatology. Some of my buddies have half-jokingly mentioned that now is a good time to really get proficient in pneumatic retinopexy.

 

[Ophthodoc2018]

Out of curiosity, How will OBS help with reimbursement decline besides doing more premium? The issue with dropping Medicare is that if the general public doesn’t have a lot of savings/retirement cushion, I fear that people won’t have enough capital to go a physician who doesn’t take their insurance.

 

[TheLesPaul]

Out of curiosity, How will OBS help with reimbursement decline besides doing more premium? The issue with dropping Medicare is that if the general public doesn’t have a lot of savings/retirement cushion, I fear that people won’t have enough capital to go a physician who doesn’t take their insurance.

you can charge the patient a "facility fee"

 

[dantt]

The post op visits are included in the fee so that's about 3 post op visits and surgery for $463. That is about $110 per visit or surgery, which is less than 4 patients coming in for one office visit each. At that rate, cataract surgery is a money loser without premium IOLs. A good cataract surgeon and good experience is not the ophthalmologist walks in to the OR, does surgery and leaves. In my own mind, if I peg the value of an office visit at 100, then I peg the effort of cataract surgery and 3 post op visits as 700 of my own units.

If all cataract surgeries pay $463, I would stop cataract surgery at about age 50-55.

Medicare/3rd party payors do not value good outcomes/good experiences. Evidently some patients do not either. I have had patients tell me they can get their postop drops free at the county hospital. They sure can. They are totally free to get their care there if they so choose.

 

[i-doctor]

Some of us co-manage with O.D’s, who then get 15-20% of the $463. Even worse.
Also, reimbursements to ASC’s are also being cut. So ASC income won’t be improving any…

 

[dantt]

Some of us co-manage with O.D’s, who then get 15-20% of the $463. Even worse.
Also, reimbursements to ASC’s are also being cut. So ASC income won’t be improving any…

Do you really want to do 3 postop visits for $90? The ODs don't.

 

[RetinaDude]

Do you really want to do 3 postop visits for $90? The ODs don't.

I’ve often been curious about this as well because postop visits can be painful (for the doc) dealing with patient complaints and/or unreal expectations. But, large OD comanagement groups exist, and flourish. Optometrists from a wide geographic area will bypass numerous very well trained cataract surgeons, within their own city area, to send their cataract patients to a comanaging friendly cataract surgeon further away. So, unless there’s a reason I’m not aware of, that $90 for 3 postop visits must be worth it, otherwise they’d send these patients to a cataract surgeon in their own city who doesn’t comanage (but sends the patient back after the postop period)

 

[TheLesPaul]

how is comanaging not a Stark law violation?

 

[eyeeye_captain]

how is comanaging not a Stark law violation?

🤷 Maybe ask our PE colleagues as well

 

[dantt]

I’ve often been curious about this as well because postop visits can be painful (for the doc) dealing with patient complaints and/or unreal expectations. But, large OD comanagement groups exist, and flourish. Optometrists from a wide geographic area will bypass numerous very well trained cataract surgeons, within their own city area, to send their cataract patients to a comanaging friendly cataract surgeon further away. So, unless there’s a reason I’m not aware of, that $90 for 3 postop visits must be worth it, otherwise they’d send these patients to a cataract surgeon in their own city who doesn’t comanage (but sends the patient back after the postop period)

The answer is complicated. Its definitely not about the $90 for 3 postop visits.

Some things in no specific order.

Presence/absence of an optical shop.
Does medical ophthalmology vs surgical only.
Does/does not offer certain premium IOLs/femto/etc
Upgrade rates and whether the optometrists can participate in premium IOLs financially
Optometry "friendly" (does not talk **** about the local ODs, refer to them as doctors, etc)
Relationship building / OD visits / dinners / CEs / etc

 

[i-doctor]

The answer is complicated. Its definitely not about the $90 for 3 postop visits.

Some things in no specific order.

Presence/absence of an optical shop.
Does medical ophthalmology vs surgical only.
Does/does not offer certain premium IOLs/femto/etc
Upgrade rates and whether the optometrists can participate in premium IOLs financially
Optometry "friendly" (does not talk **** about the local ODs, refer to them as doctors, etc)
Relationship building / OD visits / dinners / CEs / etc

Presence/absence of an optical shop is #1. Those cataract surgeons without an optical shop will get the bulk of O.D. cataract referrals, for obvious reasons.

 

[Bgladney]

Can someone explain to me how PE firms will be able to afford the generous salaries they have offered?

I understand "upselling", but even with a 50% conversion rate, it will be difficult to maintain their profit margins, or am I wrong?

I just see the game of "hot potato" ending abruptly.

 

[eyeeye_captain]

Can someone explain to me how PE firms will be able to afford the generous salaries they have offered?

I understand "upselling", but even with a 50% conversion rate, it will be difficult to maintain their profit margins, or am I wrong?

I just see the game of "hot potato" ending abruptly.

If you’re able to let us know what offers are looking like, it would be helpful and appreciated.

 

[Slide]

Can someone explain to me how PE firms will be able to afford the generous salaries they have offered?

I understand "upselling", but even with a 50% conversion rate, it will be difficult to maintain their profit margins, or am I wrong?

I just see the game of "hot potato" ending abruptly.

Because it is a game of hot potato. The initial salaries are used to lure in new associates but come with major strings or conditions, often with your future salary pulled forward. The firms don't care because someone else is going to hold the bag when it crashes.