From the Editor

One Step, One Punch, One Fight

On boxing and the ophthalmic ASC

WILLIAM J. FISHKIND, MD, FACS
CHIEF MEDICAL EDITOR

Boxing, although not usually a topic in my daily conversations, has been on my mind with the news of Muhammad Ali’s death. He was the real deal — a champion in and out of the ring. He stood up for what he believed in, even when those beliefs were controversial and difficult. His strong will helped change attitudes. One fight at a time, through his long, courageous battle against Parkinson’s disease, he influenced people around the world.

Fighting for what we believe in is hard work. It’s easy to drop our guard and lose our momentum. We all have fights to fight. As physicians, we fight for the ability to deliver quality care to our patients.

Medical Economics recently published an excerpt from the original 1965 Medicare Law: “Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services ...”

The author goes on to make the point that almost every act of Congress — and every Medicare rule that followed — is in violation of this important principle.

We now find ourselves in the unenviable position of fighting to deliver outstanding medical care to our patients and we have the Centers for Medicare and Medicaid Services (CMS) and government regulators as our adversaries.

Take office-based cataract surgery, for instance. Even as we have proven our ability to deliver the best, safest, and most cost-effective surgical outcomes in the ASC setting, CMS throws a corkscrew punch in the form of a proposal to explore the risky and economically nonsensical notion of reimbursing cataract surgery performed in unregulated office settings. And then there is the constant battle over fair reimbursement rates for ASCs and HOPDs, cost reporting, quality reporting measures, changes and ambiguities in sterilization policies, and pending regulatory reform legislation.

The fights are endless. How can we possibly win? For Sylvester Stallone’s Rocky Balboa, the way to victory was, memorably, “one step, one punch, one fight.”

There’s a lesson for us in that — and another lesson, as well, in Ali’s life. Outside the ring, some of Ali’s strongest opponents became his staunchest allies. After his death, the tributes poured forth. George Foreman, defeated by Ali in the 1974 “Fight of the Century,” mourned his friend, pronouncing, “the greatest piece of me is gone.”

The “main event” for us is, and always has been, quality care for our patients. Is it unreasonable to expect CMS to work with us, if not as actual allies, then at least as honorable adversaries who play off each other’s strengths? They have their job to do and we have ours, but our goal should always be the same: safe, quality patient care.

The next time you receive a call, a letter, or an email from OOSS, AAO, ASCRS or the ASC Association asking you to communicate with and support your governmental representatives, DO IT. We must keep fighting for quality patient care in the ophthalmic ASC — one step, one punch, one worthy fight at a time! ■

William J. Fishkind, MD, FACS, is Chief Medical Editor of The Ophthalmic ASC and past President of OOSS.
He is Director of the Fishkind, Bakewell & Maltzman Eye Care and Surgery Center in Tucson, Ariz.