Short term / long term outlook

[teleret]

Hi, everyone.
Just wanted to hear opinions on the possible scenarios for the next several years.
Given the 13.8 percent cut for cataract surgeries, are we in an anicipation mode for the similar cuts for other procedures, such as lasers, injections, OCT ( FA already had a cut for this year) or there is hope things will be more or less stable for the next 5-6 years.

And a bigger picture scenario. Do we find ACO and bigger scale organizations as our inevitable future or we , as ophthalmologists, see the potential for smaller practices?

I appreciate your opinions in advance.

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[Eyefixer]

 

[guttata]

Short answer: No one knows.

But, it is obvious that the current administration wants to push primary care salaries at the expense of specialists'. OCT was already cut by 50% a couple of year ago, so I don't foresee another cut soon. Unfortunately, the price of newer OCT machines are twice that of older models. Visual fields were cut by 20%, concurrent testing cut by 20% (meaning, if you do a visual field and OCT on the same day, you will be paid 20% less for the second diagnostic test even though it requires the same resources), intravitreals cut by 10%, FAs cut by 20%.

Anything that utilizes a fair amount of Medicare resources/monies will be subject to cut. The politicians do not care. They see what certain procedures are costing Medicare and cut the most 'burdensome' codes. Unfortunately, many private insurers base their reimbursement rates on Medicare rates, so it will only be a matter of time before private rates decrease.

Not many ACOs have been buying ophthalmology practices in my area. I suspect this is not isolated to my region. We do not generate much revenue for the hospital system. And, those who may generate a lot surgically already have ownership in their own ASCs, so there may not be incentive to join a large organization.

 

[teleret]

But, it is obvious that the current administration wants to push primary care salaries at the expense of specialists'. OCT was already cut by 50% a couple of year ago, so I don't foresee another cut soon. Unfortunately, the price of newer OCT machines are twice that of older models. Visual fields were cut by 20%, concurrent testing cut by 20% (meaning, if you do a visual field and OCT on the same day, you will be paid 20% less for the second diagnostic test even though it requires the same resources), intravitreals cut by 10%, FAs cut by 20%.

Based on our conversation, the majic number for everything that is going to be cut is close to 20 %.

 

[orbitsurgMD]

I don't think you can generalize that way. Some codes will be cut more than others. Cataract surgery, as the most common surgical procedure claimed in the Medicare program is always at the top of any list when it comes to cuts since the reductions are amplified by a factor of a couple of million. So far, the cuts have not reduced the quantity of cataract surgeries done or the availability of willing cataract surgeons. So further cuts may be expected until there is complaint from the beneficiaries that surgery is unavailable.

Other services, including office visits, are slated to see slight increases.

 

[Visionary]

I don't think you can generalize that way. Some codes will be cut more than others. Cataract surgery, as the most common surgical procedure claimed in the Medicare program is always at the top of any list when it comes to cuts since the reductions are amplified by a factor of a couple of million. So far, the cuts have not reduced the quantity of cataract surgeries done or the availability of willing cataract surgeons. So further cuts may be expected until there is complaint from the beneficiaries that surgery is unavailable.

Other services, including office visits, are slated to see slight increases.

Very true. Also keep in mind that this reduction in cataract reimbursement was driven by a survey of cataract surgeons regarding difficulty and OR time involved. In other words, we did this to ourselves! Sure, it's cool when you have few complications and can do a 5 min phaco, but that means the service is ultimately going to be devalued. There is such a thing as being too good for your own good.

 

[Adab]

Also for those in the job market or who have just signed: what range of starting salaries have you guys heard? And have you noticed a difference among large multiple medical specialty group (like Kaiser) vs eye groups starting salaries? I interviewed rather broadly and got the sense that a starting salary of 150-200 was normal (+ 25k for retina)--and lower in bigger, more saturated cities. And what about bonus? I've heard of ~ 30% above 2.5x to 3.3x salary. Is this in the typical range for folks?

 

[MR1]

Retina only. Seen most starting between 250-300. These are popular and unpopular areas but not SF or NYC. Bonus about right. Varies alot btw 2.5-3.2ish of gross. 25-30% of that. Obviously academic places often use RVU for bonus. Some w sign on bonus and/or moving costs. ~10-30k extra here.