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A Case for Balance Billing 

I enjoyed reading “Is It Time for Balance Billing?” (Feature, November/December) in which several experts commented on Dr. David Chang’s argument for this billing in Medicare. I applaud Dr. Chang’s insight and courage in bringing this to another professional forum.

My belief is that allowing physicians to balance bill for Medicare charges will preserve the federal government’s ability to fund Medicare, allow physicians to continue to see Medicare patients and help control utilization of medical services.

Another way to look at balance billing is to say that current Medicare reimbursement is inadequate. None of the experts commented on this fact. In my town, primary care physicians no longer accept Medicare patients because the reimbursement is below that which is necessary to cover their overhead. Medicare does not work if doctors don’t see patients. Any contractual relationship must be beneficial to both parties; otherwise, the process will not be sustainable.

This problem will be exacerbated in the future as the Medicare budget shrinks and money is pulled out of physician reimbursement. I can envision a day when a legal mandate is the last step in forcing physicians to see and care for Medicare beneficiaries. Balance billing—setting a fair price for physicians’ services and allowing them to receive it—can prevent this doomsday scenario.

Robert E. Tibolt, MD   
Salem, Ore.   


How Green Is Green? 

I dutifully boarded a flight back home after last year’s Annual Meeting with considerably more papers in tow than I had on the outgoing flight. I had acquired the printed version of the Final Program (1 pound, 15.8 ounces) replete with descriptions of the posters, papers and all activities. In addition, I had received Subspecialty Day programs (1 pound, 1.7 ounces), as well as a slimmed-down version of the Pocket Guide (5 ounces). I read with amusement the description inside the latter’s back cover regarding how the Academy had saved some 186 trees and 17,683 pounds of greenhouse-gas emissions as a result of publishing this tome on postconsumer recycled fiber.

As the ESPN football pundits would say, “C’mon man!” The weight of these three volumes tipped the digital scales at just over 3 pounds. They will reside comfortably on my bookshelf until I get back from the next Annual Meeting when I will dispose of them—likely in a nonrecyclable manner. I suspect that I am not the only attendee who left their registration bag in their hotel room hoping that someone on the hotel staff would be able to use it.

Maybe the Academy should allow Annual Meeting participants to opt out of receiving these materials.  ARVO has gone to a CD-ROM format for the program booklet, and I see no reason why the Academy could not follow suit. Perhaps there could at least be a paper recycling bin on the premises to assure that the recently printed programs will be recycled and live to see another day with the Academy.

Richard K. Parrish II, MD   


Treating Pterygium With Laser 

After reading “Management of Pterygium” (Pearls, November/December), I would like to recommend argon-laser photocoagulation of active pterygium blood vessels. It has been described previously in the medical literature. 1,2

Argon-laser photocoagulation is a valuable but overlooked adjunct to treating both primary and recurrent pterygia. It is also far simpler than an analogous approach—photodynamic therapy with verteporfin (Visudyne).3

Robert G. Smith, MD   
Madison, Wis.   


1 Smith, R. G. Surv Ophthalmol 2004;49(3):376.
2 Hirst, L. Surv Ophthalmol 2004;49(3):376.
3 Fossarello, M. et al. Cornea 2004;23(4):330–338.


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