The field of ophthalmology is in the midst of tremendous change. Hyper-evolving technology, a veritable tsunami of patient demand for services with increasing expectations, a significant consumer element added to the physician patient relationship and an uncertain reimbursement environment work together to create a landscape that is ripe for creative destruction.
‘Creative Destruction’ is a phrase introduced by Joseph Schumpeter in his work entitled “Capitalism, Socialism and Democracy” (1942) to denote a “process of industrial mutation that incessantly revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one.”
Creative destruction happens when something new kills something older. An example of this is personal computers. The industry, led by Microsoft and Intel, destroyed many mainframe computer companies, but in doing so, entrepreneurs created one of the most important inventions of this century.
In his book, Schumpeter goes so far as to say that the “process of creative destruction is the essential fact about capitalism.” Unfortunately, while a great concept, this became a buzzword of the dotcom boom era, with nearly every technology CEO talking about how creative destruction would replace the old economy with the new.
In ophthalmology, this creative destructive force is the femtosecond laser for cataract surgery. Like many destructive forces, there are those who will deny its usefulness and say, “my manual procedure is just as good.” This is dangerous, short-term thinking.
The femtosecond (FS) laser for cataract surgery will continue to improve and will be the bulwark of cataract surgery within the next decade. I predict that those who deny this will suffer the same fate as the man with the fastest horse who denied that the automobile would ever be anything other than an entertainment vehicle.
The FS laser technology itself is a high “cool factor” for those who have used it. More importantly, I believe that the customized outcome and patient perception that it offers will be the driving force behind widespread acceptance in the market.
Does using the FS Laser offer a better outcome? That remains to be seen and this is the reason that most cite to continue the old, tried and true manual method of cataract extraction.
For those paying attention to the political (Medicare reimbursement) environment the recent denial by the United States Supreme Court to hear the challenge to the component of the Affordable Care Act known as the “Death Panel” by opponents is concerning. Mainly because the mission of this panel is not to control, or distribute, care as opponents to the program will claim. Its mission is to step-in when they believe a reimbursement level to physicians and facilities is in a position to impact the overall system.
The Baby Boomer population and the rapidly following Generation-X group are all moving into the system. As a result, the drain on Medicare for cataract surgery alone will continue to climb. Politicians will not be able to resist the urge to cut the reimbursement rate to surgeons. Maybe this is true because patient shared billing has created a shadow revenue stream that may portend a model for other specialties to follow?
Those who do not evolve their practices, thinking and surgical approaches to maximize the opportunity presented by patient shared billing will have change foisted upon them in a manner that may not be to their liking. The good news is that the ability to change is within anyone’s reach, it simply begins with an open mind.
Surgery is art. What’s also true is that surgery is a business. In the new era of ophthalmology, the successful surgeon tomorrow may not be the same as the leader today.
Is the one who can perform the most procedures in an hour the winner? Today’s reimbursement model supports, and even encourages, this type of thinking.
Or will the surgeon who can provide patients with an experience that makes them feel a connection to the process of visual rehabilitation the one who will prosper in the Ophthalmology 2.0? I believe that this is the case.
The hard part of this is that the system has placed the surgeon and her staff squarely in the middle of the storm and many are not equipped to find shelter. A difficult reality of this is that most have not asked to be in the position that they find themselves, that of what I call, a “reluctant seller.”
What if surgeons and patients begin to think of the Medicare reimbursement for cataract surgery as more of a subsidy and less of an entitlement?
Today’s patients are willing to supplement their care if they are adequately educated about their options and understand the value that they receive. That’s not selling, that’s building a connection.
The current third party reimbursement system (Medicare) implies to its providers by its actions that they are worth less and less each year. A provider in this system, after experiencing rate cuts long enough, begins to accept this implication and find ways to “make-do.” Some even prosper.
My prediction is that those who focus on creating an experience, establishing a connection and offering value to patients will enjoy the long-term opportunity to be artists in surgery. Those who say, “what I’m doing today is good enough,” will be victims of the creative destruction process and consumed by a beast-like reimbursement system whose appetite for lower costs is never satisfied.
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