As the New Year dawns in ophthalmology, cataract surgeons, unfortunately, are waking up to yet another cut to their surgical reimbursement from Medicare, this time to the tune of 15 percent.
Also unfortunately—this time for Medicare and its beneficiaries—this cut is a tone-deaf move that shows a lack of awareness of the various forces at work in the specialty. By making the cut, the agency appears oblivious to the fact that, by many estimates, there’s an impending shortage in the number of ophthalmologists in the United States: “In 2025, projected supply and demand for the 10 modeled surgical specialties show an overall deficit of 24,340 FTE surgeons, with nine surgical specialties displaying shortages. The greatest deficits are predicted for ophthalmology (6,180 FTEs), orthopedic surgery (5,050), urology (3,630 FTEs) and general surgery (2,970 FTEs).”1
Why would you want to cut reimbursement for a specialty’s bread-and-butter procedure at a crucial time when the number of prospective ophthalmologists may already be decreasing? Wouldn’t you want to attract physicians to the specialty, rather than drive them away? This doesn’t even take into account the incursion of private equity into ophthalmology: Why should veteran cataract surgeons suffer through more reimbursement cuts when they can just accelerate their exit from the specialty by selling their practices to PE firms (and, in turn, accelerate the pending shortage of physicians)?
CMS also seems to forget that, when pushed far enough, ophthalmologists have the option of opting out of Medicare altogether, making treatment even less available to patients who can’t afford concierge service. Though opting out is by no means an easy road, deep repeated cuts to cataract surgeons’ reimbursement make that road look more and more viable. It’s true that it can be a daunting task having to shift to a patient-pay structure and, in effect, “sell” patients on procedures, but in many ways it’s even more daunting to try to make ends meet with less and less revenue.
Granted, most physicians just want to focus on patient care, not have to pitch elective procedures to patients. However, if CMS continues to cut cataract surgery reimbursement, while at the same time impose layer upon layer of payment regulations and EHR mandates on physicians—each of which have a cost in their own right—what other choice might some ophthalmologists have?
In the end, CMS can cut cataract surgery reimbursement, but what it ultimately may be cutting is patients’ access to cataract surgeons.
—Walter Bethke, Editor in Chief
1. Health Resources and Services Administration. National and regional projections of supply and demand for surgical specialty practitioners: 2013-2025. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/surgical-specialty-report.pdf. December 2016. Accessed 19 December 2019.