Letters

Avoid EHR ‘Kool Aid’

■ I read your editorial in the March 2013 issue with interest (Viewpoint “Why EHR Hasn’t Delivered”). I have been resistant to, and quite frankly hostile, to the notion of EHR.

Years ago, myself and other like-minded people predicted the very results you’ve reported. It was so surreal to see everyone drinking the Kool Aid under the belief that this really had anything to do with patient care when, in fact, it was all about power, control and money. How is it we smart people in medicine bought this package of poop?

To say it is frustrating doesn’t begin to cover it. I realize it is a lost cause and my complaining achieves nothing, but I just can’t help it. I keep having this fantasy that our leadership will stand up for us and say “No.” Oh well, just had to send another e-mail to no avail.

— Kim Wise, MD, Norman, Okla.
kimwise23@yahoo.com

An Editorial Fit For All the News Fit to Print

■ I loved your editorial in the February 2013 issue (Viewpoint, “It’s Just One Man’s Opinion”) – your rebuttal piece regarding central planning. It should be submitted to The New York Times! Your publication is wonderful in many regards. This is just another example.

— Marguerite McDonald, MD, Lynnebrook, N.Y.

No Sugarcoating Cut in Cataract Fees

■ I usually find the articles in Ophthalmology Management refreshingly pertinent to practice in today’s most challenging times. When I read the article “Good, Bad News on Cataract Reimbursements” in the December 2012 issue, I became quite perturbed.

The article reported on a 13.5% (now 15.5% with the sequester) reduction in Medicare reimbursement for cataract surgery. However, the writer tried to put a positive spin on the crippling reductions, citing that the Centers for Medicare and Medicaid Services will not look at the value of the procedure again for another five years (by which time I will have stopped operating and likely have lost my solo private practice); that other government incentives will offset the surgery reimbursement reductions (those so-called incentives cited turn to penalties soon if not adhered to; and no increases in reimbursement), and that somehow it’s good news that femtosecond surgery will not be reimbursed any more than standard cataract surgery and “should follow the same rules.”

The writer also cited that time of surgery was a factor in determining reimbursement. Yes, time is valuable, but it takes a rocket eight minutes to reach orbit. Time isn’t everything value is based on. This so-called good news sounds like a sales pitch from a used-care salesman — at best, condescending. No matter how much you spice it up, rotten food will still make you sick.

It is enough that our profession has become the laughingstock of both government and industry. We are seen as pathetic pushovers who are willing to accept, at best, laughable reimbursements in the eyes of both medical insurance executives and Congress. At worst, our stature has garnered disrespect and contempt: We are seen as imbeciles when it comes to the business side of our profession — a perception that, sadly, is not far off.

With the 16% reduction in reimbursements, I receive a check from Medicare for less than $480 for intraocular eye surgery. As an ophthalmologist whose patient population is about 90% Medicare, this has a crippling effect on my solo practice. I actually lose money every time I go to the operating room. I would make more changing the tires of my patient’s car than performing delicate, highly specialized eye surgery.

I have reduced the number of days in the operating room, because I make more money just performing eye examinations in the office, and will likely completely give up surgery out of financial necessity. Consequently, I will be giving up a large part of what I am trained to do and what a relatively small number of people in this country are capable of performing.

The excuse that there simply is not enough money to go around does not fly. When hospitals get well over 20 times what the surgeon receives for surgical services in reimbursement from Medicare, and a single dose of 0.05ml of Lucentis that I inject monthly into patients’ eyes for the treatment of macular degeneration costs ($2,000/dose) more than four times eye surgery, and the artificial lens I implant is reimbursed to the hospital more than five times what I receive, it is obvious where the power and the money is going. We as physicians (and our patients) are humongous losers in the whole paradigm of health care.

Doctors have been giving up their private practices and becoming hospital employees in droves because they are facing the unthinkable: failing. As previously highly successful achievers in life, we are not used to that and we are embarrassed to admit that we are failing financial and looking bankruptcy in the face no matter how good we are as clinicians and caregivers.

What our profession needs, more than anything else, is to get the public to understand our plight. Much has changed since the 1980s when cataract surgery commanded more than $3,000 per case. Overhead has skyrocketed, and regulations and demands (e.g., EHR) have become a suffocating burden — a perfect storm to extinct our profession or, at best, reduce us to mere technicians and workhorses rather than true professionals. Our public has no idea of this. They have the perception still of the “rich doctors” when nothing is further from the truth. We must educate our public about the US physician’s plight.

It’s time to abandon the ivory tower and show us for who we really are — the most highly educated and skilled professionals who have devoted their lives to helping others, no matter their background, in the most profound and meaningful way imaginable — but professionals who are seriously struggling to survive financially. For the sake of our profession now and for the future, please stop belittling these devastating changes that are taking place and threatening our practices’ existence and our professional lives.

— Michael B. Mizoguchi, MD, Eureka, Calif. OM