• Opinion

    Thriving in the Shadow of Big Business Health Care

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    Ruth D. Williams, MD

    By Ruth D. Williams, MD, Chief Medical Editor, EyeNet

    My hometown of Chicago is a favorite annual meeting location for many of you. In the past, visitors would venture north to the Water Tower, but now the center of Chicago is in Millennium Park. Cloud Gate—the modern, shiny kidney bean–shaped sculpture that begs for a selfie—has become Chicago’s new icon. Millennium Park has many enticing features, including the Frank Gehry–designed band shell, the lovely Lurie Garden, the “spitting fountains,” the skating ribbon, a climbing wall, and the wildly creative chil­dren’s playground. This is now the heartbeat of Chicago.

    Looking north from the park, you’ll see another symbol of the modern world rising up: the Blue Cross Blue Shield Tower. This impressive 57-story skyscraper of glass and steel signifies the massive power of health care business; togeth­er, insurance companies, pharmacies, drug companies, and health systems have become a juggernaut.

    Headlines in 2015 announced a whirlwind of acquisitions and mergers in the health care space. In March, Actavis com­pleted the Allergan acquisition (and adopted the Allergan name), only to announce months later that Pfizer would acquire Allergan to become the largest biopharma firm in the world. In July, Anthem revealed plans to acquire Cigna for $54 billion, and Aetna to acquire Humana for $37 billion, leaving only 3 large national health insurance companies. The pharmacy business also consolidated, as CVS bought the Target pharmacy and clinic business for $1.9 billion, and Walgreens hopes to acquire Rite Aid for $9.8 billion.

    However, ophthalmologists are most directly affected by the consolidation of local health systems. Becker’s Hospital Review reports that at least 100 hospital mergers occurred in 2014, and the trend toward ever-larger integrated health sys­tems continues. Large multispecialty physician groups often align with one health system, and many physician practices have been acquired by the local hospital.

    How can ophthalmology practices survive, let alone thrive, alongside such behemoths?

    One advantage is that ophthalmology is small. Many of the integrated health systems are absorbed in the tasks of vertically integrating with their primary care providers, creating seamless EHR and IT systems, developing internal quality measures, and reviewing the cost data from the first years of running an accountable care organization. Most health systems haven’t yet studied their eye care costs.

    Also, ophthalmologists can function quite effectively as independents. Unlike cardiologists, orthopods, or internists, we are often self-contained, with our own offices, testing, lasers, and ambulatory surgery centers. Furthermore, we are ultra-efficient. Most of us have fine-tuned patient flow in our offices and operating rooms. It would be difficult for a health system to run our practices better.

    Another advantage is that ophthalmology is indispens­able to population health. Primary care physicians are dependent on ophthalmolo­gists to meet HEDIS measures. Any good network needs to provide subspecialty eye care, and too-narrow networks come under fire.

    What steps can an independent oph­thalmology practice take to function as a small business in the shadow of Big Business health care? We must show up and be heard. A partner from the ophthalmology practice should be on the board of the local physician network. We must attend hospital staff meetings, participate on hospital committees, and have working rela­tionships with health system executives. We can develop our own internal quality measures—then offer to help develop quality measures for the emerging ACO or network.

    We may think of ourselves as independents, but we are inter-dependent. We must view ourselves as part of the health system and diligently work with the larger organizations that need our services. There has always been a place for smaller business; let’s use that to ophthalmology’s advantage.

    But our most important advantage is that eyesight is so precious. For our patients, the center of the health care uni­verse is where a competent and compassionate ophthalmolo­gist has restored their vision. Here, we do our daily work.