Thursday, February 6, 1997
HEALTH CARE:
Reductions could mean low quality care, less time for research,
educationBy Hannah Miller
Daily Bruin Contributor
Doctors usually don’t have much time for political activism. So
when the leading trade association for eye doctors recently
demanded that "Ophthalmology must speak with one voice," it
heralded a major crisis in the industry.
Medicare, the federal government’s health care plan for people
over age 65, faces cuts of up to 63 percent in eye-care
reimbursements. And because the profession of ophthalmology
primarily serves the elderly, facilities like the Jules Stein Eye
Institute (JSEI) would be particularly hard-hit.
Dr. David A. Lee, chief of the Glaucoma Division at JSEI,
estimates that "70 percent of our patients are on Medicare."
"Most of the diseases we treat are diseases of age," said Tom
Foerstel, JSEI’s chief administrative officer. "Seven years ago, we
used to get reimbursed $2,300 for cataract surgery. Now it’s down
to $1,000."
Administrators and doctors are scrambling for solutions. "The
primary thing we’re doing," said Lee, "is to make it up in volume.
We don’t have a choice."
And as Lee and his colleagues are realizing, their research and
educational responsibilities might have to fall by the wayside.
According to assistant professor of clinical ophthalmology Dr.
Kevin Miller, the targeting of eye care is a carefully considered
choice. "They cut where they’re spending money," he explained.
Therefore, the most widespread and necessary procedures take the
hardest hits.
Miller’s specialty is in cataract surgery, the single
most-requested surgical procedure for patients over 65. True to his
prediction, this procedure will also be cut by 39 percent if the
proposed changes go through, one of the most stringent cuts.
Such effects have been felt even with the failure of the
Republican 104th Congress to cut Medicare during last year’s budget
fights. And the issue is still alive: the balanced-budget amendment
currently under debate in Congress would slash Medicare by another
half.
If the fee cuts currently proposed by the Health Care Financing
Administration (HCFA) pass through Congress, they will become law
on Jan. 1, 1998. "It is politically expedient right now to cut
Medicare," commented Dr. Steven Schwartz, the JSEI’s director of
Diabetic Eye Disease and Retinal Vascular Center.
Meanwhile, the doctors themselves are trying to cope with the
changing workload. "In my specialty, I deal with very scared people
who are about to go blind," said Schwartz. "Spending time with the
patient is a very important part of medicine."
"What you’ll see are mills turning out a high volume of
patients," speculated Miller. "That’s unfortunate, because a lot
less care will be rendered."
The other effect, Miller said, will probably be a drop-off in
research and development, due to a crunch in both money and
time.
Eye-care practitioners would probably have to see more patients
to avoid a drop in salaries, leaving less time for research and
education.
In addition, privately funded research on eye care could dry up
if there were no profits to be gained from innovation.
"Private research is almost dead in this area," said Miller.
"We’ve enjoyed the first place in medicine for the last 30 years.
That is about to change."
Even worse, speculated Miller, those with cataracts and other
age-related diseases will have trouble finding quality treatment.
"People will simply stop doing the work," he said.
When Medicare reduces reimbursements, the effect is felt
throughout the health care system. HFCA’s formula for determining
reimbursements (as they differ by procedure) is usually taken as an
industry standard by managed care organizations.
For example, Healthnet, one of UCLA’s employee-benefits HMOs,
reimburses at 70 percent of Medicare’s rate for certain procedures.
"Medicare pays peanuts, but now we’re getting a percentage of
peanuts," said Miller. Other HMOs, including UC Care, pay as low as
60 percent of what Medicare pays.
In light of the possible cuts, the Eye Institute is trying to
better balance its budget, but ophthalmology department Chair
Bartly Mondino said that no definite plans have been made yet to
remedy the situation.
"We might have to maximize other revenue strains," Mondino said,
"such as our managed care patients, our self-pay patients, and our
foreign patients."
Foerstel explained that the JSEI may become increasingly
dependent on cash-only procedures. "Refractive surgery, like radial
kerotomony and laser eye-surgery is not covered by Medicare," he
said.
But, as Foerstel expressed, strictly fee-for-service procedures
are seen as diverging from UCLA’s educational mandate.
"A lot of faculty feels that this is not what an academic
facility should be about," he said. "But what else can we do to
keep up?"