What are your thoughts on the proposed 2020 fee schedule?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

OphthoApplicant04

Full Member
7+ Year Member
Joined
Oct 13, 2014
Messages
80
Reaction score
11
Copied below from the AAO announcement. A 15% cut to phaco in one year seems brutal.



Member Alert
The Centers for Medicare & Medicaid Services today released its proposed physician fee schedule for 2020. Here are the highlights, based on the Academy's early analysis. Because this is a proposed rule, the Academy will work with CMS over the next few months to ensure a final version that is fair to ophthalmologists.
Academy, ASCRS Secure Equitable Cataract Reimbursements

The Academy partnered with the American Society of Cataract and Refractive Surgery in an exhaustive effort to retain reasonable cataract reimbursement for our profession.

CMS today agreed to the rate that the American Medical Association's Relative Value Scale Update Committee (RUC) submitted. Although this is a decrease, the rate is equitable relative to payments of other physician services of similar time and intensity. It is a recommendation to which the Academy and ASCRS agreed.

The RUC is a unique multispecialty committee dedicated to describing the resources required to provide physician services which CMS considers in developing Relative Value Units (RVUs).

In a process that began last year, the Academy and ASCRS negotiated with the RUC for a rate that is based on our members' survey data.

This extensive survey delivered to the RUC a robust data set culled from practicing ophthalmologists. It was combined with careful, sustained negotiations with the RUC. CMS accepted this recommendation for its proposed fee schedule for 2020.
The proposed cataract fees for 2020 are as follows:
  • 66711 (Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens): 513.55, down from 658.79
  • 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation): 765.82, down from 813.04
  • 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation): 557.58, down from 654.47
Additionally, CMS is recommending Medicare Administrative Contractors set their own prices for new, combined cataract-and-ECP codes.

Despite the decrease, cataract surgery remains valued at the very top of the scale when compared with procedures of similar length. This is an acknowledgement of intraocular surgery's unique intensity and complexity.

Ophthalmoscopy Reimbursements
CMS is also making cuts to ophthalmoscopy fees. This is a very high-volume procedure, with very low-paying codes. Reimbursements for these codes will be even lower next year because now they will be bilateral instead of being billed on each eye. Physicians will no longer be paid for the initial ophthalmoscopy, only the extended procedure. Codes currently used to bill these procedures will be deleted.
The proposed ophthalmoscopy fees for 2020 are as follows:
  • 92X18 (Ophthalmoscopy, extended; with retinal drawing and scleral depression, of peripheral retinal disease (e.g., for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral): 23.45, down from 28.11.
  • 92X19 (Ophthalmoscopy, extended, with drawing of optic nerve or macula (e.g., for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral): 15.15, down from 28.11
The 2020 Conversion Factor
The proposed 2020 conversion factor is 36.0896, which would be up from 36.0391. There is a 0.14% budget-neutrality reduction.

The 2020 conversion factor for ambulatory surgical centers (documented today in a separate proposal) would be 47.827 for facilities that meet quality-reporting requirements, 46.895 for those that do not.
CMS' E/M Proposal
Last year, CMS permanently changed how E/M is reimbursed, collapsing the current five payment levels to just three. This change won't take place until 2021.
At this time, CMS is proposing to replace the impending changes to E/M with a plan put forward by the AMA on guidelines and descriptors in order to place more emphasis on the time required. The proposal would significantly increase the payment for these services in a budget-neutral manner that also negatively affects ophthalmology.

CMS is also proposing not applying these E/M adjustments to post-operative surgical visits that are built into ophthalmology's procedures.

Overall Effect
Because of the change to E/M and cataract and ophthalmoscopy codes, ophthalmology would experience one of the largest decreases among all medical specialties.
Quality Payment Program/MIPS Changes
The Merit-Based Incentive Payment System is getting harder. Physicians would need 45 points to pass, up from 30 points, thereby avoiding a 9% penalty. CMS also proposed increasing the cost category weight to 20%, up from 15%, along with fewer exclusions.

The Academy's IRIS Registry remains ophthalmologists' best tool for success in MIPS.
More Analysis Forthcoming
The Academy is reading and analyzing this massive, 1,704-page document (PDF, 7.6 MB). Make sure to visit the 2020 Medicare Fee Schedule page and read Washington Report Express in the coming weeks for more information on how this fee proposal will affect our profession.

Members don't see this ad.
 
Sucks. The ophthalmoscopy issue for us retina docs is a big hit as is the E/M reduction. We knew it was coming but always painful when the actual figures come out.
 
Near 20% cut to cataract surgery? That's a huge loss. The average cataract surgeon is going to lose $30-50k.

I would like to see by how much the Omidria and Durezol prices were negotiated down. Oh wait.
 
  • Like
Reactions: 1 users
Members don't see this ad :)
Doctors are sheep with little lobbying power. Thank god I'm not an ophtho grad coming out into this mess.
 
  • Like
Reactions: 2 users
Jeez a 13.6% cut in 2013 and now a 15%, I just can’t help but feel defeated. As an upcoming grad with over $300k in loans, I just feel sick to my stomach.


Any uplifting words for us scums?
 
Jeez a 13.6% cut in 2013 and now a 15%, I just can’t help but feel defeated. As an upcoming grad with over $300k in loans, I just feel sick to my stomach.


Any uplifting words for us scums?

Perhaps you'll get more cataracts now that it pays less and take more effort than seeing several patients.
 
I haven’t seen what actually ended up going through over the years but it seems like a common tactic. CMS proposes some outrageous cuts and then after the stupid comment period you end up settling for a smaller cut and only to come back and do the same thing next year. CMS saves money and you are relieved not to have a catastrophic loss to your practice.

I wonder if certain practices just lose “interest” in seeing the Medicare cataract. Probably not though latest medscape survey says nope I need all payors.
 
Be happy for now. In 2021, when the new President signs the Medicare for All law, reimbursements will be cut 25% or more.
 
  • Like
Reactions: 1 users
You can do the good ol' pop in for 1 second and smile routine and then onto the next patient. That 1 second counts as a face-to-face interaction and you can bill a visit while the medical assistant or middle level provider does the actual exam. Then take on extra days at other places. The healthcare in the USA is a mess because government got involved.
 
Ahh the old saw about make it up in volume.

What I meant to the young ophthalmologist is perhaps the old guys will retire or otherwise stop operating early. For better or worse, there are insufficient cataracts in the big cities to go around so this will not be made up in volume. Make it up by getting real good at selling femto ora LRIs toric multifocals optos migs ecp amt; if you can sleep at night.
 
It is a proposal....will change and will go to a 2% cut and everyone will cheer.

What to be scared about it the idea of the government running healthcare.

Get ready for incomes to be capped!
 
I wish I could be optimistic about this proposed cut being reduced but the way AAO is spinning it as a fair cut makes me worry it’s as good as done
 
Members don't see this ad :)
I wish I could be optimistic about this proposed cut being reduced but the way AAO is spinning it as a fair cut makes me worry it’s as good as done

Sounds like most prof orgs these days. Just going with the flow.

The only way this changes is if beneficiaries start to feel the effects. Until then Cut away!
 
All the more reason why you need to SAVE a big nest egg and diversify your income streams!
 
  • Like
Reactions: 1 users
Or just gtfo out of medicine.
Not many of us have the skill set to generate high income in another industry. Most of us are trapped in this rat race.
 
  • Like
Reactions: 1 user
Not many of us have the skill set to generate high income in another industry. Most of us are trapped in this rat race.

Very true. Gotta diversify those skill sets. Easier said than done though
 
Not many of us have the skill set to generate high income in another industry. Most of us are trapped in this rat race.
Not true. You made it through college, med school, a brutal residency and maybe fellowship. You’re educated, intelligent, hard working and disciplined. That skill set can apply to any industry. The difficult part is making the pivot. Most successful business people have many pokers in the fire, hoping one will take off. If investing one wouldn’t let it ride on a single stock, it’s best to diversify. Not saying give up medicine completely, but don’t be afraid to try other things
 
  • Like
Reactions: 2 users
Not true. You made it through college, med school, a brutal residency and maybe fellowship. You’re educated, intelligent, hard working and disciplined. That skill set can apply to any industry. The difficult part is making the pivot. Most successful business people have many pokers in the fire, hoping one will take off. If investing one wouldn’t let it ride on a single stock, it’s best to diversify. Not saying give up medicine completely, but don’t be afraid to try other things
I always find it interesting with the "new docs" coming out of school. As you said they work hard throughout undergrad. Get into prestigious medical schools, work grueling residency and fellowship schedules, perform complex surgeries. But if you asked most to be a business owner and do mundane things like hire a secretary they say no thanks. Too hard or too much work.
 
  • Like
Reactions: 1 user
Not many of us have the skill set to generate high income in another industry. Most of us are trapped in this rat race.

Is that really your goal in life? To generate high income? Of course you're going to be unhappy in medicine if that's why you're in it.

I disagree with you. Many of us could leave and start a business and be successful in other avenues. The reason we don't is because taking care of patients is highly rewarding. I would much rather be doing this than anything else.
 
  • Like
Reactions: 1 user
Is that really your goal in life? To generate high income? Of course you're going to be unhappy in medicine if that's why you're in it.

I disagree with you. Many of us could leave and start a business and be successful in other avenues. The reason we don't is because taking care of patients is highly rewarding. I would much rather be doing this than anything else.
I’m happy in medicine, don’t put words into my mouth. A lot of us have student debt and mortgages and require a high income to pay back.

Lol at “many of us could start a business...” show me and I’ll believe you.
 
  • Like
Reactions: 5 users
Is that really your goal in life? To generate high income? Of course you're going to be unhappy in medicine if that's why you're in it.

I disagree with you. Many of us could leave and start a business and be successful in other avenues. The reason we don't is because taking care of patients is highly rewarding. I would much rather be doing this than anything else.
Money shaming is not helpful and a bit disingenuous. Physicians are in a unique situation where we are supposed to be completely altruistic and in the service of others and somehow that "work" is not supposed to be monetized. Like getting paid for what we do is somehow unethical. I'm all for people getting paid for an honest days labor and I think its ok to make that a consideration in terms of choosing a career, speciality etc.

I do agree that we have the skill set necessary to do well in any field, we simply lack the knowledge and sometimes the motivation. No doubt we could do well in just about any arena with the right set of circumstances in place
 
  • Like
Reactions: 1 users
There are attorneys who are highly skilled and not litigators. They have a special skill. Those type of lawyers get paid well. $450/hour is common. $1200/hour does exists. When they think of the case, those are billable hours. If you look up PubMed about a patient, that is pro bono (free) work. Physicians do not have to be completely altruistic. If that were the case, doctors would go the area of greatest need. For oncologists, that is the country of South Sudan where there are zero oncologists. A far (but considered nearby) country of Kenya has only 35 oncologists, who see over 10 times the number of patients that US oncologists see. The ability for the average South Sudenese to pay is minimal.

Fair compensation, at least fair to some extent, is the way American society works or should work. The problem is doctors have no lobbyists. Big Pharma, hospitals, insurance companies all have lobbyists and can work against doctors. The public thinks the AMA is a powerful lobbying organization. No, the AMA is a powerful seller of CPT coding.
 
  • Like
Reactions: 1 user
Completely agree. The difference is that lawyers (and quite frankly other high income earners) aren’t held up to the same high standards and ethical considerations that physicians seem to be held to. When you hear a lawyer or businessman making tons of money on a deal or whatever no one raises an eyebrow. When a doctor makes a lot then it raises all kinds of red flags and discussions about the ethics of the doc and so on. I think if you have spent a lot of time and money to acquire a skill and offer a unique and highly skilled service then you deserve high compensation. It works that way in the market and this should be no different.

Not only do we not have a great lobby but most docs have very little interest in politics and thus allow this to happen without much input. Who wants to give up medicine to serve in Congress or senate? To become a professional lobbyist? Or pay large sums of our income to have others do it for us? Too little
 
  • Like
Reactions: 1 user
Money shaming is not helpful and a bit disingenuous. Physicians are in a unique situation where we are supposed to be completely altruistic and in the service of others and somehow that "work" is not supposed to be monetized. Like getting paid for what we do is somehow unethical. I'm all for people getting paid for an honest days labor and I think its ok to make that a consideration in terms of choosing a career, speciality etc.

I do agree that we have the skill set necessary to do well in any field, we simply lack the knowledge and sometimes the motivation. No doubt we could do well in just about any arena with the right set of circumstances in place

I wasn't money shaming, I was responding to the comments about "gtfo out of medicine" and "its not possible because we're dumb and cant and stuck in this rat race."

I completely agree that we need to be paid an honest amount for our time, skill, and investment. I don't think it's an easy parallel to draw between doctors and businessmen/lawyers. In the second case you have someone willing to pay $450 per hour to a lawyer for whatever function they need. If they don't pay they won't get the contract reviewed, so be it. But what should an oncologist say to a patient with newly diagnosed cancer? "I can cure you, but my billing starts now and I require $500 per hour. The doctor is always going to have power over the patient due to this dynamic. That part is unique to physicians compared to other fields.
 
  • Like
Reactions: 1 user
I’m happy in medicine, don’t put words into my mouth. A lot of us have student debt and mortgages and require a high income to pay back.

Lol at “many of us could start a business...” show me and I’ll believe you.

This is just as poor of a generalization as "show me all of the failed physician businesses and I'll believe you."
 
This is just as poor of a generalization as "show me all of the failed physician businesses and I'll believe you."
There is zero evidence that is a large percentage of physicians that can start and run a successful non-medical business. If there is, please show us.
 
It would probably be helpful for us to learn from our veterinarian collegues...

You can make your work a labor of love and not get paid super well (ie like being a veterinarian) OR you can work your ass off, perform assembly line medicine and make the "doctor wage" but probably burn yourself out in the process. Obviously, there is a path somewhere in the middle, but many vets have a better sense when they got into the field that their future is not lucrative and are less motivated by the money, but they love what they do. I think this is the new reality we're headed towards in medicine. If money is an important motivator, than it's going to be a rough/disappointing future.
 
  • Like
Reactions: 1 user
There was
It would probably be helpful for us to learn from our veterinarian collegues...

You can make your work a labor of love and not get paid super well (ie like being a veterinarian)

There is a little logic in this but we have to be aware of the classic film "Bridge over the River Kwai", the story of British and American prisoners of war held by the Imperial Japanese Army during World War II. They were forced labor to build a bridge. The Imperial Japanese Army colonel told them in a speech "Be Happy in Your Work!".

In Nazi Germany's Auschwitz death camps, where Jews were gassed to death, the gate read "Arbeit macht frei" or loosely translated "work will make you free" or "be happy in your work!"

When doctor pay drops too low, the ability of people applying to med school will drop. The quality of medical care will suffer. Already, college students are considering being NP's, where often the hours are 8-4, no call or nights and where it is very easy to change "specialties" from ortho to derm to rheumatology in a matter of weeks or a few months. Being a NP specializing in derm and getting bogus NP board certification, you are consider more of an expert than a recent dermatology MD graduate who is not yet board certified.
 
  • Like
Reactions: 1 users
The abysmally low salary of many pediatricians gives some idea of just how low salaries can go and smart people will still make huge sacrifices of time and money to go to medical school to do it. Unfortunately, I’m not optimistic about the long term unless doctors can strengthen their political action committees.
 
  • Like
Reactions: 3 users
A critical point will hit where Opthalmology will simply see the doctors shift from Participating Medicare status to being a Non-Par status.

If cuts continue to take place or bureaucracy is too much, they will switch from Non-Par and completely opt out of Medicare entirely.
 
Not all markets.
Private insurance also doesn't have requirements for MIPs and other meaningful use issues for EMRs
Private insurance doesn't have the extra rules that CMS has attached with it.

Private insurance will and does eventually follow medicare. In my area for example medicare is the highest payer.
Private insurance has every reason to cut rates to medicare levels and even lower. Their number 1,2,3,4,5, goal is Profit Margin.

Medicare for all gives private insurance ceo's nightmares. They will lobby till their last breath to prevent that from happening.


Now that amazon, walmart, and every other pharmacy has their own "minute" clinic. Its only a matter of time before they all hire armies of NPs, PA's etc and they'll just pay their way to have independent practice in all 50 states for them. This isn't a joke. No one would have imagined the role of NP's and such 20 years ago in healthcare and now look at the situation. The next move is taking over via subspecialist Nps..... Some are already doing GI scopes if I am not mistaken its only a matter of time.. tick tock. Thank god I work hard and invest heavilly. I would not want to be a med student or resident these days.
 
  • Like
Reactions: 1 user
Private insurance will and does eventually follow medicare. In my area for example medicare is the highest payer.
Private insurance has every reason to cut rates to medicare levels and even lower. Their number 1,2,3,4,5, goal is Profit Margin.

Medicare for all gives private insurance ceo's nightmares. They will lobby till their last breath to prevent that from happening.
Too bad they shot themselves in the foot and decided to shift so much of cost of care onto patients. There is no greater way to lose all political support when people are paying $6000 individual deductibles and each doctor visit brings on multiple bills.

Medicare for all is an inevitability at this point. The private system has become an anathema to most people.
 
  • Like
Reactions: 1 user
As a private practice solo OD owner, may I suggest that the PACs of both Optometry and Ophthalmology come together and fight for better reimbursements? Optometry and Ophthalmology have some of the strongest lobbies and most of that money is spent fighting each other. I saw a chart a few years back that I cannot find currently, detailing how much different health care providers donate to their political organizations and OD and Ophtho were the highest and overly represented compared to all other physicians/providers. I bill medical heavily and the extended codes being cut hurt me quite a bit. Divide and conquer is an excellent tactic to weaken any organization and if we don't start looking at the bigger picture then both of our professions will suffer in the long run. What do you guys think?
 
  • Like
Reactions: 5 users
Private insurance will and does eventually follow medicare. In my area for example medicare is the highest payer.
Private insurance has every reason to cut rates to medicare levels and even lower. Their number 1,2,3,4,5, goal is Profit Margin.

Medicare for all gives private insurance ceo's nightmares. They will lobby till their last breath to prevent that from happening.


Now that amazon, walmart, and every other pharmacy has their own "minute" clinic. Its only a matter of time before they all hire armies of NPs, PA's etc and they'll just pay their way to have independent practice in all 50 states for them. This isn't a joke. No one would have imagined the role of NP's and such 20 years ago in healthcare and now look at the situation. The next move is taking over via subspecialist Nps..... Some are already doing GI scopes if I am not mistaken its only a matter of time.. tick tock. Thank god I work hard and invest heavilly. I would not want to be a med student or resident these days.


That's awful if Medicare is your highest payor. Not sure what area you live but I have to assume it's a bigger city.

We are in a more rural area (with a very large draw) so we have great rates with all of the private carriers that far surpasses the Medicare rates. We had one that tried to offer us below Medicare rates and we just said "no thanks". And we have not had a problem with the private carriers following whatever changes Medicare makes.

The bigger cities may be overrun with cataract docs scratching for cataracts but not in the more rural areas. Guys in my neck of the woods are doing 20-30 per OR day week after week.
 
At present, the constant-dollar payment for cataract extraction with implant is 17% what was paid when Part B Medicare was established in 1967. Cutting further is really nothing more than an economic and social experiment to see what breaks first. I suspect access will be hit first: practices doing close to the maximum in safely feasible volume will ration convenience in the interest of maintaining adequate cash flow. Patients having procedures with cash-paid enhancements, multifocals, all-laser, LASIK plus cataract, torics will get scheduling priority over patients having basic extractions with implants. Some patients may be waiting much longer for their surgeries than in the past. The proponents of cutting who admire other countries' insurance systems don't consider that element of those systems, that access is limited and delays for non-emergent procedures like cataract extraction can be substantial.

If cuts get to the level of non-viability, and some of the proposals to eliminate higher level office encounter codes for outpatient care are threatening that, you will see practices closing Medicare panels and going non-par or dropping Medicare entirely. That will be unprecedented and I can't imagine that will go un-noticed. In fact, it could be a very serious impeachment to the federal government's credibility as an administrator of the Medicare program. Mandating prices that do not respect costs or fair payment for risk and time has never worked anywhere. The so-called formulas for payments, RBRVS and multipliers, along with naked across-the-board cuts to fit budgetary reductions, have been manipulated such that they are not credible. Congress presumes that Part B is unbreakable. It isn't.
 
Last edited:
  • Like
Reactions: 2 users
I predict 5-10 yrs from now, patients who only want basic cataract surgery will only be able to get it done at residency programs. I think most practices will stop doing it bc it wont be financially worth it. And ophthos who are not comfortable with premium lenses or cataract refractive surgery will be co-managing with ophthos that are good at it as well.
 
I predict 5-10 yrs from now, patients who only want basic cataract surgery will only be able to get it done at residency programs. I think most practices will stop doing it bc it wont be financially worth it. And ophthos who are not comfortable with premium lenses or cataract refractive surgery will be co-managing with ophthos that are good at it as well.

They say that with every reimbursement cut but residents and ophthalmologists are still clamoring to do cataract surgery. The main thing my residents seem to care about is their cataract numbers. I try to train them to diversifying their skill-set (medical retina, glaucoma..) but for most of them it's all about the cataract numbers. Many of the ophthalmologists I know don't seem to know how to do anything else besides cataracts. And so many of the residents still want to do cornea fellowships -- which, IMO, is the least useful fellowship. Any ophthalmologist can learn to put in a premium lens or do refractive -- whether it's the right thing for the patient is a different story.
 
  • Like
Reactions: 1 user
They say that with every reimbursement cut but residents and ophthalmologists are still clamoring to do cataract surgery. The main thing my residents seem to care about is their cataract numbers. I try to train them to diversifying their skill-set (medical retina, glaucoma..) but for most of them it's all about the cataract numbers. Many of the ophthalmologists I know don't seem to know how to do anything else besides cataracts. And so many of the residents still want to do cornea fellowships -- which, IMO, is the least useful fellowship. Any ophthalmologist can learn to put in a premium lens or do refractive -- whether it's the right thing for the patient is a different story.

As a first year resident, I was wondering what do you think would be the most useful fellowship?
 
At present, the constant-dollar payment for cataract extraction with implant is 17% what was paid when Part B Medicare was established in 1967. Cutting further is really nothing more than an economic and social experiment to see what breaks first. I suspect access will be hit first: practices doing close to the maximum in safely feasible volume will ration convenience in the interest of maintaining adequate cash flow. Patients having procedures with cash-paid enhancements, multifocals, all-laser, LASIK plus cataract, torics will get scheduling priority over patients having basic extractions with implants. Some patients may be waiting much longer for their surgeries than in the past. The proponents of cutting who admire other countries' insurance systems don't consider that element of those systems, that access is limited and delays for non-emergent procedures like cataract extraction can be substantial.

If cuts get to the level of non-viability, and some of the proposals to eliminate higher level office encounter codes for outpatient care are threatening that, you will see practices closing Medicare panels and going non-par or dropping Medicare entirely. That will be unprecedented and I can't imagine that will go un-noticed. In fact, it could be a very serious impeachment to the federal government's credibility as an administrator of the Medicare program. Mandating prices that do not respect costs or fair payment for risk and time has never worked anywhere. The so-called formulas for payments, RBRVS and multipliers, along with naked across-the-board cuts to fit budgetary reductions, have been manipulated such that they are not credible. Congress presumes that Part B is unbreakable. It isn't.

Physicians will blink first. We always blink first. We will find ways to do more with less, (mid levels, using cheaper standard lenses, no viscoelastic, no disposable instruments, slow to update outdated technology, etc).
 
As a first year resident, I was wondering what do you think would be the most useful fellowship?


I'm retina, so I'm biased, but I'd say either glaucoma or peds would be the most beneficial fellowships. Mainly because there's a big need for both, especially glaucoma. And the different ways to treat glaucoma sees to be expanding all the time. Of course, oculoplastics would be very useful as well. From my experience, retina and oculoplastics are the only two sub-specialties where you'll most likely be practicing 100% of your sub-specialty once in PP. Almost all of the other fellowship trained ophth will be practicing a combo of their fellowship and cataract surgery when in PP
 
  • Like
Reactions: 1 users
They say that with every reimbursement cut but residents and ophthalmologists are still clamoring to do cataract surgery. The main thing my residents seem to care about is their cataract numbers. I try to train them to diversifying their skill-set (medical retina, glaucoma..) but for most of them it's all about the cataract numbers. Many of the ophthalmologists I know don't seem to know how to do anything else besides cataracts. And so many of the residents still want to do cornea fellowships -- which, IMO, is the least useful fellowship. Any ophthalmologist can learn to put in a premium lens or do refractive -- whether it's the right thing for the patient is a different story.
It is the one surgery number that matters in job seeking for those not going on to fellowships. Even for those who are, the numbers build confidence.
 
They say that with every reimbursement cut but residents and ophthalmologists are still clamoring to do cataract surgery. The main thing my residents seem to care about is their cataract numbers. I try to train them to diversifying their skill-set (medical retina, glaucoma..) but for most of them it's all about the cataract numbers. Many of the ophthalmologists I know don't seem to know how to do anything else besides cataracts. And so many of the residents still want to do cornea fellowships -- which, IMO, is the least useful fellowship. Any ophthalmologist can learn to put in a premium lens or do refractive -- whether it's the right thing for the patient is a different story.

With all due respect, you are probably not a cataract refractive surgeon. To say everyone can learn to put in a premium lens or do refractive when you have patient expectations of seeing 20/15 and J1+ downplays how challenging it can be to do perfect cataract and refractive surgery for these patients. It is that mindset that gives poor outcomes and unhappy patients.
 
With all due respect, you are probably not a cataract refractive surgeon. To say everyone can learn to put in a premium lens or do refractive when you have patient expectations of seeing 20/15 and J1+ downplays how challenging it can be to do perfect cataract and refractive surgery for these patients. It is that mindset that gives poor outcomes and unhappy patients.

True. But do you need a cornea fellowship to learn those skills? The main thing cornea fellows seem to care about are their transplant numbers. (Granted the best fellowships are probably balanced...just like the best residencies)
 
That will be unprecedented and I can't imagine that will go un-noticed.

Which is probably why it won't happen. Unfortunately, cuts are nothing new. Practices with high volume ASCs are still going to make out okay. I hate it as much as anyone else but medium to large practices dropping medicare is simply not going to happen given the demographics of cataract surgery.
 
With all due respect, you are probably not a cataract refractive surgeon. To say everyone can learn to put in a premium lens or do refractive when you have patient expectations of seeing 20/15 and J1+ downplays how challenging it can be to do perfect cataract and refractive surgery for these patients. It is that mindset that gives poor outcomes and unhappy patients.

When you place a toric and get that 20/15 vision, realistically how long does it last? Every patient I've seen (including from high volume refractive experts) ends up needing correction after ~3-5 years. Do you LASIK/PRK q5 years? I've never seen someone avoid reading glasses beyond the 5 year mark for multifocals, either.
 
  • Like
Reactions: 1 user
Top