January 16, 2014
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Patient quality of life outweighs bottom line in treatment decisions, speaker says

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PHILADELPHIA — Treatment decisions should be based on patient quality of life, not just the financial bottom line, a speaker told colleagues here.

“Patient value always trumps financial value when we only talk about finances when two interventions are the same. Then the cheapest one is typically the preferred one. We never go for money first. We always go for patient value,” Gary C. Brown, MD, MBA, said at Macula 2014. “We believe it’s important for you, the physicians, to be out there getting involved and particularly give the soft sell to some of our non-ophthalmologic colleagues because they have no idea what you do and no idea how much it helps patients.”

Patient value is improvement in length of life and/or quality of life, Brown said.

“There’s another thing called financial value gain, which includes cost-effectiveness and also the financial return on investment,” he said.

Cataract surgery in the first eye costs an average of $2,600 but yields a return of $121,000.

“That’s a 4,500% return, huge,” Brown said. “[Glaucoma therapy] gives more than a 4,000% financial return. And ranibizumab: It’s not as high as those, but it’s a 450% return, which is huge.”

Vision loss also has a profound effect on patients’ potential future income, Brown said.

Patient value will play a critical role as physician reimbursement moves to a pay-for-performance model from a pay-for-service system, he said.

Disclosure: Brown has an ownership interest in the Center for Value Based Medicine.