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Dr. Aizuss Speaks Out
"An Issue of Quality"
Featured in the Southern California Physicians Magazine 2009
As we monitor the battle over health care reform and pay heed to the proposals of President Obama and the Congress it is important that we continue to pay attention to ongoing government oversight of medical practice. Many physicians including me feel that health insurance reform is critically needed to ensure the wide availability of medical insurance to our patients without excluding individuals for insignificant preexisting conditions. On a daily basis I have patients asking me to write letters on their behalf seeking to overturn health insurance exclusions of future medical care for their eyes because they had a single episodic eye problem, for example a contact lens associated acute infection or an incipient cataract that may take forty years to mature or an episode of ocular inflammation. However, we must also be vigilant to monitor current government initiatives to restrict our patients’ access to care under the guise of cost containment.
Recently, the Center for Medicare Services (CMS) contracted with Optimal Solutions Group, LLC which in conjunction with the Oklahoma Foundation for Medical Quality, a Medicare quality improvement organization developed a cataract outcome measure that would require hospital outpatient departments and ambulatory surgery centers to determine whether a patient planning to undergo cataract surgery would achieve a 20% improvement in vision and if not, disallow the procedure. First, arbitrarily pulling the standard of “a 20% improvement in vision” out of the proverbial hat has no epidemiologic or evidence based support. Why 20% and not 30% or 15%? Nor can I as an ophthalmologist even know what that means. Is it a 20% improvement in snellen acuity? Is it a 20% improvement in contrast sensitivity? Is it a 20% improvement in visual tasks that affect activities of daily living and if so, how do we as clinicians measure this? The CMS based their proposal on two studies both over 15 years old. Neither paper cited methods of cataract surgery employed and even if they had, they become irrelevant since techniques in use today bear little semblance to those used 15 years ago. Instrumentation, intraocular lens implants and patient expectations are very different than they were over a decade ago.
Interestingly, 20 years ago Medicare required preauthorization for cataract surgery in an effort to reduce costs and surgical volume. That program failed when the cost of monitoring for unnecessary surgery turned out to be far greater than the savings accrued from preventing such supposedly unnecessary surgery!
As President Obama and Congress hope to pay for health care reform from so called Medicare savings, we all expect such savings will come from reduced physician fees and strictures on purported unnecessary procedures and medical care. We must be vigilant that CMS does not impose restrictions now without factual evidence-based studies that demonstrate how savings can be achieved without diminishing our patients’ care or access to care.
David H. Aizuss, M.D.
Past President, Los Angeles County Medical Association
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