From the Editor

Anger, Oath, and Action

WILLIAM J. FISHKIND, MD, FACS
CHIEF MEDICAL EDITOR

I have been pondering the myriad of obstacles we encounter in providing patients with the medical care they deserve. After all, we did vow to uphold the Hippocratic Oath to provide care, and we are bound by our promise. In the oath it is written, “I will remember that I do not treat a fever chart, a cancerous growth but a sick human being.” But, in the reality of practicing medicine in today’s complex environment, our aspirations to provide care can be severely compromised by misguided government regulation.

A New Challenge

A few months ago, for example, CMS announced Draconian cuts in payment for glaucoma treatments, including glaucoma surgery and glaucoma laser treatments. These slashes in remuneration make it challenging to perform tube shunts, requiring tissue grafts to protect the tube, in the ambulatory surgery center. The payments for the surgical fee and tissue graft have been bundled into a single ASC facility fee. The consequence is that the new CMS reimbursement for the ASC facility fee, involving a tube shunt with tissue graft, may well be insufficient to cover the cost of performing the operation. Without adequate reimbursement, ASCs may elect not to perform this procedure, limiting the options available to patients and, in some areas, making the hospital operating room the only option.

The ASC environment is proven to deliver the best ophthalmic surgical outcomes, including patient convenience and experience, and at the lowest cost. So, how do we reasonably and ethically communicate to patients that our only alternative is to move them from the safe, effective, and patient-friendly ASC to the much less convenient and more costly hospital environment? And why should we, as physicians, have to make such a choice in this era of healthcare reform that is allegedly intended to enhance access, reduce costs, and improve quality?

Doing Our Part

This week’s episode of “Meet the Press” focused on anger in America, a consequence of the perceived loss of the “American Dream.” I can relate. It’s issues like this that anger me, too, when in a very specific way, a misguided payment policy interferes with our ability to act in the best interests of our patients.

I am reminded of the insightful words of Edward R. Murrow, American journalist and television and radio figure, who said, “A nation of sheep will beget a government of wolves.” As the ophthalmic ASC community, we must never succumb to the obedient, flock behavior of sheep.

Doing more begins with improving all within our control. In this month’s issue, we focus on a range of subjects, all addressing ways to improve our ability to serve our patients. Doing more also means translating anger into action when the misguided get in our way. ■

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.