Quick Hits

Alphaeon to focus on self-pay services

New company says practices will benefit.

By Jerry Helzner, Senior Editor

Strathspey Crown, a private equity firm specializing in lifestyle healthcare, has established Alphaeon Corporation as an entity to promote the benefits of self-pay procedures to both patients and medical practices. Initially, Alphaeon will focus on ophthalmology, plastic surgery and dermatology, but may later expand to encompass cosmetic dentistry and wellness.

Daniel Durrie, MD, who operates an exclusively private-pay ophthalmology practice in Overland Park, Kan., and one of the founders of Alphaeon, has been named chief physician officer of the company.

“This is right up my alley” Dr. Durrie says. “Ophthalmology more than ever needs to look to expanding the private-pay area.”

Dr. Durrie asserts that, as a totally private-pay practice that accepts no government reimbursement, he does not have to deal with CPT codes, anti-kickback laws or timetables for implementing electronic health records.

“You can’t run the risk of defrauding the government if you don’t deal with the government,” Dr. Durrie notes. “Self-pay is about marketing, patient satisfaction and a high-level of staff performance. Alphaeon is already talking to about 30 companies and should have announcements of affiliations in about six months.”

He recognizes that the great majority of ophthalmology practices cannot become totally self-pay but, with help from a company such as Alphaeon, they can expand the percentage of self-pay procedures they perform.

Alphaeon has named William Link, PhD, as its chairman. Dr. Link and his company Versant Ventures were among the first to provide venture capital to fund new ophthalmic products and services.

Study confirms ASCs provide the most cost-effective care

HOPDs get 42% more for same procedures.

A new analysis by researchers at the University of California, Berkeley, finds that ASCs provide billions of dollars in reduced costs to Medicare and its beneficiaries, especially when compared to the same procedures performed in hospital outpatient departments (HOPDs).

The researchers found that ASCs cost Medicare $7.5 billion less than HOPDs from 2008 to 2011. The analysis estimated that ASCs have the potential to reduce Medicare costs an additional $57.6 billion over the next decade. The Ambulatory Surgery Center Association (ASCA) commissioned the study, Medicare Cost Savings Tied to Ambulatory Surgery Centers, and released results last month.

“With policy makers looking for ways to shore up Medicare’s finances and reduce health-care spending nationwide, our analysis suggests that ASCs offer a win-win for policy makers and patients,” says study coauthor Brent Fulton, PhD, MBA. “Encouraging patients to seek the care they need in ASCs throughout the Medicare system should be an easy decision.”

Because ASCs provide quality care at lower cost than HOPDs, Medicare reimburses ASCs at an average 58% of the HOPD rate. Key findings from the study include:

• ASCs reduced costs for Medicare and its beneficiaries $2.3 billion in 2011 alone.

• Medicare realized about $6 billion of the cost savings in the 2008-2011 study period. Medicare beneficiaries realized the remaining $1.5 billion in lower costs.

• Beneficiaries also stand to spend considerably less in future years. Because Medicare reimburses ASCs at a lower rate than HOPDs, patients also have a smaller insurance co-pay in an ASC. For example, a Medicare beneficiary would spend $148 less out of pocket by having cataract surgery in an ASC instead of a hospital.

“Unfortunately, the power of the price differential that produces these savings has limits,” says ASCA CEO William Prentice. “We are at or beyond that limit now. ASC growth has all but stalled, and some centers are being purchased and converted into hospital outpatient departments to take advantage of the higher fees that can be charged there.”

Despite law, ophthalmic drug shortages persist

Epinephrine shortage calls into question new FDA rules

By René Luthe, Senior Associate Editor

A shortage of nonpreserved epinephrine is posing a significant problem for cataract surgeons, says Brad

Black, MD, of Jeffersonville, Ind., one “far worse” than the Wydase (hyaluronidase injectable, Wyeth Pharmaceuticals) shortage that riled cataract surgeons around 12 years ago. “Many ophthalmologists are simply doing without epinephrine, not aware of using 4 or 5:1 dilute preserved epi, or turning to compounding pharmacies,” he says – all of which entail considerable risks.

Doing without intracameral epinephrine can complicate surgery in patients with intraoperative floppy iris syndrome, associated with use of systemic medications, among them tamsulosin (Flomax, Boehringer Ingelheim). Purchasing epinephrine from a compounding pharmacy is not ideal due to risk of contamination, the expense entailed in mixing drug “cocktails” to various surgeon’s specifications and a shorter shelf life.

The epinephrine shortage calls into question the effectiveness of the FDA Safety and Innovation Act, passed last year. It required manufacturers to notify the FDA as soon as possible upon becoming aware that production would be interrupted for a “life-supporting” or “lifesustaining” drug, and at least six months notice if such a drug would be discontinued.

According to Erin Fox, PharmD, director of University of Utah’s Drug Information Service, the act is a qualified success. “For what Congress can legislate, yes, it did help,” she says. According to the Drug Information Service, the 54 shortages it lists for the first four months of 2013 is well below the pace of 204 new shortages for 2012 and 267 in 2011.

But as Dr. Black points out, “It sure does not seem to be working for us.” However, while the FDA Safety and Innovation Act hasn’t solved the problem of drug shortages, Dr. Black says he is not sure the issue lends itself to legislative fixes. A shortage of critical drugs such as epinephrine pose a “double-whammy” for the surgeon, he says. “It prevents the surgeon from providing patients with the best care, and it places the surgeon in a position of liability.”

Questioning the residency selection process

Professor calls for relying less on traditional metrics.

By Bill Kekevian, Senior Associate Editor

Andrew G. Lee, MD, professor of ophthalmology at Weill Cornell Medical College in New York, set out in 2008 to update admissions standards for ophthalmology residencies when he released a report detailing their common flaws and his recommendations for improvement. Five years later, he’s still working to see those standards turned on their heads.

The report, published in Survey of Ophthalmology, proposed re-engineering the residency selection process to focus on skills Dr. Lee calls “nontraditional metrics” – leadership, empathy, compassion, professionalism and ethics.

“We’re still heavily dependent on traditional, intelligence-based metrics like test scores, grades and recommendations,” he says. “There’s a lot more to being a doctor than being smart.” Those traditional metrics do not account for particular, vital personality traits or “core values,” Dr. Lee says.

His report called for the use of non-traditional metrics that include “behavior specific” questions and developing a specialty-based consensus for the selection of traits specific to ophthalmology that might predict success. Dr. Lee has also advocated for the end of the traditional letter of recommendation, explaining that, due to fear of litigation, references are more likely to give honest evaluations over the phone.

So why haven’t Dr. Lee’s recommendations taken hold as he had hoped? “It’s multi-faceted,” he says, “but the biggest reason is, of course, money.” However, he says, while implementing change is always costly up front, the investment would be worth it.

“These are instruments that have been validated through their use in other fields,” he says. “CEOs and even sports figures get the full battery of psychological profiling and testing for leadership skills, but they have millions of dollars to accomplish this. We do not.”

REFERENCE

1. Lee AG, Golnik KC, Oetting TA. Re-engineering the resident applicant selection process in ophthalmology: a literature review and recommendations for improvement. Surv Ophthalmol. 2008;53: 164-176.

Children’s books that check their vision, too

Ophthalmologist pens series ‘as entertainment with a purpose.’

By Jerry Helzner, Senior Editor

Michael S. Korenfeld, MD, ACOS, is one of the regular contributors to this magazine’s “Ophthalmic

Innovator” column. As such, he offers advice to ophthalmologists who have novel concepts and ideas that they would like to bring to the marketplace. But Dr. Korenfeld does more than preach the basics of innovation, he also practices them in his own life.

Dr. Korenfeld’s latest concept – and a quite ambitious one – is a planned series of 23 children’s books (The Dilemma Series) that will teach children about “the empowerment of solving their problems, the value of working with others, and a little science along the way.”

Two added features make this series unique.

For one, the books are lavishly illustrated using ChromaDepth technology, a 3-D format that has never been used for book illustrations previously. With ChromaDepth, if you don’t have the 3-D glasses, the illustrations are attractive four-color images. But, with the 3-D glasses included with each book, the illustrations develop a foreground, mid-ground and background.

Secondly, each book in the series includes a collection of vision tests that have been reviewed by the FDA, which will allow parents to check their children’s vision in the privacy of their homes. The results of these tests will help parents determine if their children may need an eye examination.

Entertainment with a purpose

“Reading together with your children is a very intimate experience. This intimacy provides a perfect opportunity for parents to help their children take these Vision Tests and contribute to their children’s visual well being. I like to think of the Dilemma Book Series as entertainment with a purpose,” says Dr. Korenfeld.

In the first book in the series, Frank Fly has trouble reading signs and tells his friend Frederick Frog that Frederick cannot go to the beach because the sign reads “No Frogs Allowed.” Actually, Frank Fly has misread the sign “No Dogs Allowed” because he needs eyeglasses. When Frank Fly gets his eyeglasses, he reads the sign correctly, and now he and Frederick go to the beach together.

In the books, Dr. Korenfeld tells children that if they find things are hard to see or their friends can see things better, they should tell their parents and have their parents help them with the Vision Tests in the back of the book.

Dr. Korenfeld, a practicing ophthalmologist, owns Comprehensive Eye Care Ltd. in Washington, Mo. The books are available at www.dilemmaseries.com. OM