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Statement by American Academy of Ophthalmology President Richard L. Abbott, MD, in response to the op-ed piece “Three Simple Ways Medicare Can Save Cost” by John C. Goodman in the Aug. 11 Wall Street Journal

08/19/2011   08:30:00 AM

SAN FRANCISCO, CA – In framing the debate for improving federal programs such as Medicare, nothing is more important than working from accurate data. Unfortunately, John Goodman, president and CEO of the well-respected National Center for Policy Analysis, fails in this regard. The American Academy of Ophthalmology is pleased to set the record straight.

Modern cataract surgery has increased the intensity and complexity of the surgery for the ophthalmologist. For the patient, these same advances translate to a shortened recovery time and fewer complications. That is as it should be. For Mr. Goodman to compare this surgery and its three months of follow-up examinations with a single office visit by another medical specialty goes far beyond an accurate and fair comparison.

Mr. Goodman compares payment for a 25-minute primary care office visit with that for a "10-15 minute" cataract operation. Using CMS National Payments and time data from CMS-approved surveys, a primary care office visit for a new patient in 2011 is paid $102 (not including the primary care only bonus of 10 percent this year) and cataract surgery is paid $742 based on 30 minutes (not 10-15) of surgery time.

For a true comparison, further adjustments to the data are needed. After practice expenses, malpractice costs and $222 for all postoperative office visits for three months after surgery are subtracted from the cataract payment, the ophthalmologist is paid $221 for 30 minutes of surgery. The primary care physician seeing office patients receives $51 (pre bonus) for 25 minutes of office work. One can debate whether this 4:1 ratio is proper, but it is not the 15:1 ratio that Mr. Goodman dramatically claims.

Nor do we feel that most patients would consider $221 to be an exorbitant charge for a technically challenging and ever-changing operation with remarkably high success in safely restoring vision and functional ability. In 1991 Medicare paid ophthalmologists about $1,500 for a cataract procedure that was not nearly as safe, predictable, effective or demanding as the surgery today. Now, 20 years later, advances in technology, drugs and surgical techniques have given Americans a more precise and safer procedure—and one for which the ophthalmologist is paid half as much.

We respect our primary care colleagues and appreciate the vital role that they play in improving the health of all patients. We will continue to work with them, as we have in the past, to develop physician compensation models that reflect a patient-centered, value-based approach for physician payment. We would strongly support payment reform that allows the patient a role in determining what a service is worth. Restoration of vision with modern cataract surgery is a high-value proposition. Just ask patients how much difference it makes in their lives. It is one of the most cost-effective major surgical procedures available today.

Media: Dr. Abbott is available for further comment.

About the American Academy of Ophthalmology
The American Academy of Ophthalmology is the world's largest association of eye physicians and surgeons—Eye M.D.s—with more than 30,000 members worldwide. Eye health care is provided by the three "O's" – ophthalmologists, optometrists, and opticians. It is the ophthalmologist, or Eye M.D., who can treat it all: eye diseases and injuries, and perform eye surgery. Find an Eye M.D. in your area.

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