The year was 1975, and an American rock band called the Talking Heads, known for pioneering post-punk and new wave music, was discovered in New York City. Of their three musical hits that made the Rock and Roll Hall of Fame’s top 500 songs that shaped rock and roll, “Once in a Lifetime” is one of the most memorable among baby boomers and maybe even recognizable by millennials.
In ophthalmology, there are many “talking heads,” or key opinion leaders (KOLs), who help drive many of eye industry’s directions in terms of pharmaceuticals, surgical devices, diagnostic testing, clinical studies, surgical techniques, marketing strategies and, ultimately, ways to optimize patient care and outcomes. Whether it be in the form of formal advisory boards, round table sessions, smaller regional meetings or larger national eye meetings such as the American Society of Cataract and Refractive Surgery and American Academy of Ophthalmology, or just simple one-to-one discussions in the hallways or at mealtimes, KOLs have paved the way for present and future success for both eye care professionals and their patients. I look at eye care professionals as a whole as talking heads, leaders among themselves and their private, group and/or academic practices and their patients. Every day in the slit lamp trenches of clinical eye care or surgical suites or scientific laboratory settings, we are all leaders in trying to achieve the best for our patients, which stems from the fact that “Once in a Lifetime” we all did take the infamous Hippocratic Oath.
Unfortunately, with the recent ongoing legislation of the Affordable Care Act, the push from ACOs and other managed care organizations, the demand to meet Meaningful Use criteria with electronic health records, the transformation to ICD-10 diagnostic coding, and the oversight by the government on physician-industry relationships via the Sunshine Act, PhRMA and AdvaMed guidelines, the desire to continue as talking heads for our patients has become progressively more cumbersome and saddening. Many eye care professionals are retiring earlier than predicted, while others are selling their practices and moving to states with less stringent state regulation of health care policies and lower malpractice rates. The overhead costs to us talking heads continue to rise despite an environment of reduced insurance reimbursements, which adds to the conflict of whether to play in the eye game any longer. The good news is there have been CMS rulings to allow for additional reimbursement opportunities in cataract surgery with presbyopia-correcting IOLs, astigmatism management and femtosecond cataract laser digital imaging. The AIM Act is before Congress to even pave a path for additional ease in the pressure in enforcement of such rulings. The bad news is trying to abide by that Hippocratic Oath taken “Once in a Lifetime” as it becomes more challenging with all these additional governmental regulations.
My personal story has succeeded thus far as a solo private practice for 23 years in suburban Illinois north of Chicago, and much of my success has been my desire to be a talking head not just for my patients but for my staff, my family, my friends, my community and my referring doctors. I can only praise all the premium surgeons who have survived the changes over the last 2 to 3 decades and still be able to continue as a talking head. As we approach this year’s AAO meeting in Las Vegas, I encourage all of the talking heads to look past all the governmental regulations and headaches and focus on what matters the most: finding better ways to treat and care for our patients. In the end, no matter what happens this year at AAO, I challenge all the talking heads to each give me a pen (that the guidelines took away from me) so I can jot down that pearl of knowledge you will give me to help improve the care of my patient, the efficiency of my practice, or just the betterment of myself as a talking head.
- CMS Ruling 05-01. Determining payment for insertion of presbyopia-correcting IOLs. https://www.cms.gov/Regulations-and-Guidance/Guidance/Rulings/downloads/cmsr0501.pdf. May 3, 2005.
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: firstname.lastname@example.org.
Disclosure: Jackson reports no relevant financial disclosures.