Viewpoint

Bigger boats and larger toolboxes

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

Do we have too many tools in the toolbox?

If you haven’t been paying attention to all the tools that are out there, let me help fill in the gaps.

Outfitting a basic exam room costs about $20,000. Then add in visual fields, autorefractors, keratometers, IOL optical biometers, aberrometers and corneal topographers. We have YAG, argon and SLT lasers. We’ve got lasers for LASIK, flaps and even cataracts. Let’s not forget the OCTs: adaptive optics, Fourier-domain, (spectral and swept-source), and the older time-domain. On the horizon is SSADA (read about it on page 57).

KEEPING UP

For many of our peers, it’s exceedingly difficult to financially keep up with these advancements. A mega-practice might, but even its partners must draw the line somewhere. How does a small or solo practice decide what or what not to get? Some things the practice wants could be helpful, but not enough to justify the expense. Other things are not quite as critical but reimbursement is good and therefore justifiable.

Constant model updates come next. You’re told you need to spend lots to get the new one because your old one isn’t as effective. And even if you decide to rough it out, you can’t because your equipment doesn’t integrate with mandated electronic health records.

For those of us with more than one location, there are other headaches. If you want all offices equipped the same way, then it’s no problem—as long as you can afford it. For me, my main office has an SD-OCT, but two others have older TD-OCTs and one none at all. Sometimes patients must go to a different location for certain tests.

UP ON THE ROOF

One consultant we know says if the technology gets too expensive, physicians won’t buy. But physicians feel forced to buy, and equipment prices aren’t going down. OCTs now cost $60,000, and the new ones may be even more expensive.

Just to be clear, my rant has nothing to do with choosing between patient care and a fatter wallet. Many of the articles in this issue talk about early detection of eye disease. That takes high-tech, and I’m all for it.

But practically speaking, even if you can afford it — where is the solo practitioner or small practice going to put all this equipment? They must be performing some procedures on their roofs.

As a beloved Amity Island police chief once said, we’re gonna need a bigger boat. OM