Patients who see news stories about Medicare financial disclosures may ask questions about payments to you or your practice. To help you form your responses to inquiries you may receive from your patients (and potentially the news media), the Academy suggests the following talking points.
Medicare Payments
- Ophthalmology supports CMS’ efforts to promote transparency and accountability. However, efforts in the past have been undermined by layman users’ inability to discern accurate information from raw data. Medicare data are incredibly complex, and analyzing the information requires a good amount of understanding of its context, including medical specialty practices, and the medical coding and reimbursement process.
- Ophthalmology has one of the highest percentages of elderly patients among medical specialties.
- Common and expensive ophthalmic diseases occur in elderly patients, including cataract, diabetic retinopathy, age-related macular degeneration and glaucoma.
- The data include the costs of Medicare Part B drugs, which are a significant factor as to why ophthalmology is so prominent in the CMS database.
- Some of the costliest drugs used by ophthalmologists are the Food and Drug Administration (FDA)-approved anti-VEGF drugs used to treat the more severe “wet” form of age-related macular degeneration (AMD), the leading cause of blindness among older Americans. Anti-VEGF drugs are also used to treat diabetic retinopathy, which is one of the most common causes of severe vision loss in Americans. They have been found to be particularly effective in the treatment of diabetic macular edema.
- Ophthalmologists must purchase these anti-VEGF drugs in advance from the manufacturers, and Medicare then reimburses the physicians for these costs. The Medicare payments for these medications are essentially a pass-through back to the pharmaceutical companies.
- Before the advent of anti-VEGF drugs, about two-thirds of wet AMD patients could expect to be legally blind within two years of developing the disease. Today, there are three highly effective anti-VEGF options − two FDA-approved drugs (Lucentis and Eylea) and one off-label use drug, Avastin (a cancer medication). More than half of ophthalmologists choose the less expensive anti-VEGF Avastin, which costs approximately $50 per dose.
- The two anti-VEGF drugs − Lucentis and Eylea – that are FDA-approved specifically for treatment of wet AMD and diabetic retinopathy cost between $1,500 and $2,000 per treatment.
- Having multiple treatment options for diseases such as wet AMD and diabetic retinopathy is crucial to providing the best treatment possible, as individual patients respond differently to different drugs.
- Ophthalmologists support the availability of each of these medications as they collectively provide a highly effective arsenal against a disease that a few years ago always resulted in blindness for our patients.
- Ultimately, which drug is used is dependent upon a variety of factors. Among them are:
- Patient choice, in partnership with the physician;
- Individual response to medications varies from person to person; and,
- Restrictions in some states to the availability of compounded medications such as Avastin can make this option difficult in some instances, and sometimes prohibited by law.
Open Payments (Industry Relationships)
If you have any financial relationships with industry partners, explaining them to your patients could help clear up concerns about perceived conflicts of interest. According to the Academy Code of Ethics, physicians should disclose financial relationships to patients verbally or in writing.
When discussing vendor relationships with patients, consider the following:
- Does the relationship provide clinical benefit to patients? If you are helping to develop medication or a device that could help the public, and receive grant money or other payments related to that research, patients may want to be aware of that information.
- Explain training or educational opportunities. If company representatives’ visits to your practice are educational in nature, share that information with your patients. For example, you might explain that visits help provide training that can improve clinical care.
- Proactively disclose relationships to patients. Consider incorporating written notice of your disclosure in existing office documents, such as prescription sheets, office information booklets or referral forms.
Talking to the Media
The media in your city may contact you about specific Medicare or industry payment information. You may refer media inquiries to the Academy’s public relations staff if you are not comfortable speaking about the subject matter. Academy staff can only respond to general questions and cannot address questions regarding individual physicians’ payments or prescribing habits.
Forward media inquiries to media@aao.org or 415.561.8534.
In the event that you are contacted by members of the news media, the following suggestions are intended to prepare you and your practice for media queries.
- Alert staff that once the data are released, they may receive calls from the media.
- Provide your best availability to respond to media inquiries in a timely manner.
- Prepare staff to take note of the following: The reporter’s name, media affiliation, phone number, email address and deadline. In addition, staff should request the specific questions the reporter would like answered. This will help you prepare your response.
- Do not be pressured into making a comment on the spot. Reporters may be a bit pushy; however, it is common practice to ask for a few minutes to get your thoughts together before calling them back to respond.
- Instruct your staff to be courteous, while not making any type of comment about the data release such as “oh yeah, that stupid thing is out again.” Such a comment is in fact a statement that could be used on the record.
- There is no such thing as “off the record.” If asked, simply state that “I have nothing further to offer beyond what I’m happy to provide for the record.”
Resources
The Academy provides detailed guidelines for physicians on financial relationships.