Ophthalmology Business

APR 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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Facing the challenges of stinging cuts by Enette Ngoei Contributing Writer Ways that practices can continue to thrive and achieve high-quality patient satisfaction despite reimbursement decreases A ll over the U.S., the Medicare reimbursement cuts detailed in the 2013 Medicare physician fee schedule will affect ophthalmology practices, large and small. The 13.6% reduction in reimbursement for cataract surgery and the 26.5% reduction in physician reimbursement are particularly stinging. On March 1, the automatic sequestration of federal spending was triggered. The sequester was originally scheduled to take effect on Jan. 1 under the provisions of the Budget Control Act of 2011, which charged a Joint Select Committee on Deficit Reduction (the so-called "Super Committee") to develop a comprehensive proposal to reduce the federal debt. Sequestration was put into place as a backup plan and reduces the overall debt through automatic, across-the-board spending cuts. Medicare FFS claims with dates-ofservice or dates-of-discharge on or after April 1 will incur a 2% reduction in Medicare payment, according to the Centers for Medicare and Medicaid Services. Still, there are several ways that practices can tackle these changes, said Eric Donnenfeld, MD, founding partner, Ophthalmic Consultants of Long Island, and clinical professor of ophthalmology, 6 New York University Medical Center, New York, N.Y. "The partners, the associates, the staff, and the management in the practices have to realize that these changes in healthcare are occurring, and they have to change or adapt to meet the challenges of the cuts in Medicare and at the same time deliver quality ophthalmic care in the new healthcare environment," he said. Reducing expenditure One of the first things practice owners can do is look at their expenses and see where they can make cuts, said Derek Preece, MBA, BSM Consulting Group, Orem, Utah. "Part of reducing expenses is making sure the processes within their office are as efficient as possible," he explained. Having a budget in place generally helps to reduce expenses, he added. Charles Heaton, MD, Heaton Eye Associates, Texas, said his prac- Ophthalmology Business • April 2013 tice had the chief financial officer run different scenarios to see what it would mean for a certain percentage cut in reimbursements. For example, in a 20% reimbursement cut, they would cut capital expenditures by delaying buying equipment, putting off non-essential consulting agreements, cutting back to some degree on staffing with a hiring freeze, and basically cutting immediate expenses such that the partners might face a 15% cut in their personal income, he said. Once the reimbursement cuts get up to 40%, they would get into structural changes in the practice and probably 25-30% cuts in partner reimbursement levels, Dr. Heaton said. Private practice owner Ken Miller, MD, California, said he and his partner met about a month ago and went through each item on their profit/loss statement from last year in anticipation of the reimbursement cuts. "We're looking at everything," he said. In fact, Dr. Miller and his partner met with their IT company

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