White Papers to Prepare Practices for the Baby Boomers
In the United States, the aging of the Baby Boomers will affect ophthalmology disproportionately relative to many other medical disciplines, as many diseases of the eye are specific to aging.
Considering that the number of ophthalmologists in the United States is not expected to increase over the next 20 years, industry observers forecast a significant shortfall in the profession’s ability to keep up with the growing ophthalmic needs of society, perhaps as soon as early next decade.
As a result, ophthalmology must prepare appropriately in order to avoid being overwhelmed by future demand. This may be accomplished best by improving practice efficiency and plugging preexisting gaps in the delivery of care.
To this end, the Academy has released a series of white papers about “high–patient throughput” practices. The three white papers each discuss a specific practice model: physician only, physicians with technicians and physicians with technicians and optometrists.
As these models demonstrate, ophthalmologists may need to consider working with additional technicians and optometrists in order to practice more efficiently. Eye M.D.s may also need to consider modifying their practices to account for variables particular to their practice, including the pace at which the ophthalmologist likes to work, geographic variables such as population density, physician saturation and state legal constraints, and other issues, which the white papers address.
To view the white papers, visit www.aao.org/practice_mgmt/boomer.cfm.
Ask the Ethicist: Expert Witness Testimony
Q: I’ve been asked to testify as an expert in a malpractice case. The attorney would like me to testify to “X,” but, after reviewing the case, I believe objective testimony really should be “Y.” What do I do?
A: The expert witness is critical in helping juries understand the medical technicalities of a malpractice suit. Testimony from experts establishes the standard of care. Then the jury determines whether departure from this standard caused harm to the patient.
To qualify as a medical expert, one should hold a valid medical license and actively practice in the relevant clinical area.
Expert testimony is considered an obligatory part of a physician’s job responsibilities, and it is governed for all Academy members by the Academy’s Code of Ethics. Rule 16 of the Code states, in part, “False, deceptive or misleading expert witness testimony is unethical.”
Experts should be reasonably compensated for their time. This compensation, however, has the potential to create a sense of duty to the party that issues the check. This conflict of interest must be recognized and appropriately managed. Regardless of who is paying, an expert must remain completely objective in his or her testimony, even when truthful answers to questions are damaging to the designating attorney’s case.
Thus, it is your responsibility to inform the attorney that you cannot in good conscience testify to “X” if you know that doing so would result in false, deceptive or misleading testimony. If the attorney persists, you should withdraw and document your reasons for doing so.
In every deposition and trial, the question is asked, “Do you swear to tell the truth, the whole truth and nothing but the truth?” Keeping this promise will ensure your testimony is within the ethical standards of the Academy.
For more information on expert witness testimony, visit www.aao.org/about, click “Ethics” and “Ethics-Related Articles.” To submit a question, contact the Ethics Committee staff at firstname.lastname@example.org.
Ophthalmic Purchasing Program
The SimplifEye Ophthalmic Purchasing Program is a benefit available exclusively to Academy and American Academy of Ophthalmic Executives members.
It features a special formulary designed to provide the best possible prices on medical, surgical and front office supplies.
For more information, visit www.aao.org/simplifeye or call 800-772-4346 (toll-free in the United States).
Academy Exhibit at Hong Kong Meeting
If your plans take you to the World Ophthalmology Congress from June 28 to July 2 in Hong Kong, be sure to stop by the Academy’s booth (#N13–N14) and see the latest products from the Academy.
Revised Eye Fact Sheet
The Academy’s eye fact sheets reduce the time it takes to explain common problems to patients.
In the revised Laser Iridotomy Eye Fact Sheet (#057156), illustrations of the eye show how laser iridotomy creates a new passageway and what this passageway accomplishes.
It includes discussion of closed-angle glaucoma as well as the risks and side effects of the laser procedure.
Eye fact sheets come in packages of 25 and cost $9 for members and $11 for nonmembers.
To place an order, visit www.aao.org/store.
What’s New With BCSC 2008–2009
The new edition of the Basic and Clinical Science Course is out this month. Nine volumes have undergone minor up-dates, and four have undergone major revisions:
- Section 10, Glaucoma (#0280108) includes the epidemiologic aspects of glaucoma; hereditary and genetic factors; IOP and aqueous humor dynamics; clinical evaluation; and medical management of and surgical therapy for glaucoma. This edition contains updated tables and revised images, as well as new images illustrating both disease entities and surgical techniques.
- Section 11, Lens and Cataract (#0280118) reviews the anatomy, physiology, embryology and pathology of the lens. It also covers the epidemiology of cataracts and their evaluation and management in adults. In addition, an overview of lens and cataract surgery is provided, complications of cataract surgery are discussed and cataract surgery in special situations is explored.
- Section 12, Retina and Vitreous (#0280128) reviews basic anatomy of the retina and examines diagnostic approaches to retinal disease. It also examines disorders of the retina and vitreous, including retinal vascular and choroidal disease, focal and diffuse inflammation, hereditary dystrophies, peripheral abnormalities and posterior segment manifestations of trauma. Laser therapy and vitreoretinal surgery are discussed, as well.
- Section 13, Refractive Surgery (#0280138) reviews the underlying concepts in refractive surgery, including its scientific basis, the role of the Federal Drug Administration and the importance of patient evaluation. Specific procedures are discussed in detail, and the use of refractive surgery to treat presbyopia is examined. A new chapter discusses international perspectives.
Each of the 13 BCSC volumes provides up to 30 or 40 category 1 CME credits. The complete set (#0280958) includes all 13 volumes, plus a free copy of the Master Index.
The BCSC CD-ROM (#0282008) and BCSC Online (#0284008) are also available to order.
To place an order or find out about pricing information, visit www.aao.org/bcsc or phone the Academy Service Center at 866-561-8558 (toll-free in the United States) or 415-561-8575.
Member At Large
Scholarships Awarded in Ophthalmology
Dennis W. Jahnigen Career Development Scholarships have been awarded to Milam A. Brantley Jr., MD, for research on the association of genetic polymorphisms with AMD and Jacque L. Duncan, MD, for research on cell death in aging and AMD.
The scholarship provides a two-year award designed to support young faculty in the surgical subspecialties, including ophthalmology. It is intended to allow individuals to initiate and sustain a career in research and education in the geriatrics aspects of their discipline.
For more information, visit www.americangeriatrics.org.
Ellen R. Strahlman, MD, MHSc, vice president of worldwide business development at Pfizer, has been selected as an industry representative to the Dermatologic and Ophthalmic Drugs Advisory Committee of the FDA’s Center for Drug Evaluation and Research. Dr. Strahlman is an active Academy member and a member of the Academy Foundation’s advisory board.
Eve J. Higginbotham, MD, has been elected to the board of directors for the National Space Biomedical Research Institute (NSBRI). “Dr. Higginbotham is a highly respected and accomplished physician who will be an asset to NSBRI’s program to protect astronaut health during long-duration spaceflight and improve health care on earth,” said Bobby R. Alford, MD, NSBRI board chairman.
Why the Conversion Factor Goes Up and Some Payments Go Down
In the waning hours of 2007, Congress passed a temporary 0.5 percent Medicare fee update that runs through June 30, replacing a 10.1 percent reduction. Even with a 0.5 percent improvement to the conversion factor, some doctors have noticed a Medicare reimbursement decrease. This is because the conversion factor is just one component of Medicare’s resource-based relative value scale, which is used to determine physician payment. Other components include work relative value units (RVUs) and practice expense RVUs. CMS made changes to both of these areas effective in 2008, and this impacted payments. The decreases experienced by ophthalmologists were due to the Five-Year Review of work RVUs, to changes in practice expense policy and to the requirement for budget neutrality.
Work RVUs are developed based on surveys of physicians who perform a procedure. The RVUs take into account physician time, mental effort and judgment, technical skill, physical effort and psychological stress involved. Medicare law requires that changes in RVUs in one year may not exceed $20 million of what they would have been without changes. If changes to the RVUs exceed this amount, CMS must make adjustments to preserve budget neutrality. For example, in 2008, a major adjustment to payments for anesthesiology from the Five-Year Review of work RVUs negatively impacted all other payments.
In 2007, CMS applied a 10.1 percent budget neutrality adjustor to work RVUs in order to bring changes in RVUs below the $20 million threshold. CMS deferred some proposed work RVU changes to 2008, which again triggered budget neutrality, resulting in work RVUs for all codes being adjusted downward by approximately 11 percent for that year.
Practice expense RVUs, which account for the direct and indirect costs associated with performing a procedure, began a four-year phase-in of a new methodology to calculate practice expense RVUs with new data that are unfavorable for ophthalmology. These changes will result in a 4 percent total reduction in practice expense payments to ophthalmologists by 2010 compared with 2006, implemented through an annual 1 percent cut. This is unacceptable to the Academy.
What you can do. The Academy is partnering with the AMA on the Practicing Physician Information Survey to ensure that ophthalmologists’ higher practice expenses are appropriately recognized. Watch for the survey. It is an important vehicle for positive change in Medicare reimbursement.
The Academy is partnering with the AMA to ensure that ophthalmologists’ higher practice expenses are appropriately recognized.