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8 Factors Affecting Ophthalmologist Compensation

Mark Kropiewnicki, JD, principal attorney and president of Health Care Law Associates, vice president of The Health Care Group and regular presenter at the annual meetings of the American Academy of Ophthalmology, discusses eight trends and factors affecting compensation of ophthalmologists.

1. Blend of primary care and specialty practice. According to Mr. Kropiewnicki, the practice of ophthalmologists combines primary care and specialty surgery in an interesting way. "Many ophthalmologists take care of people on a regular basis [in the way an optometrist would], and in some cases they act as primary care physicians as far as doing yearly visits and providing vision care," he says. "As those patients age, they start seeing the physician for things like cataract surgery and other specialist procedures."

He says the combination of these two types of practice means several sources of income for ophthalmologists. An ophthalmologist who treats patients for yearly eye check-ups can serve as his or her own referral source for surgeries. In addition, the ophthalmologist can receive referrals from optometrists in the community for surgery.

2. Use of ophthalmic technicians to lower cost.
When ophthalmologists are faced with negative income changes, Mr. Kropiewnicki says they can generally make small changes in their practice to compensate for a decrease in revenue or reimbursement. "I love to see practices where they use a lot of ophthalmic technicians to do testing," he says. Since the physicians are only doing the procedures that need physician supervision, and lower-paid ophthalmic techs are performing the other tests, the practice can save a lot of money.

3. Use of scribes to increase efficiency. According to Mr. Kropiewnicki, ophthalmologists are unique among specialists in that they use scribes to record operative notes. "Instead of the ophthalmologist writing in the chart, you've got another person to do it, and that makes them more efficient," he says. He adds that as EMR becomes more prevalent in ophthalmology practices and ASCs, scribes may be used to write notes on the computer as well. He says the use of scribes increases the speed at which an ophthalmologist can perform procedures, meaning more patients and cases and therefore more revenue.

4. Aging patients.
As the patient population ages, Mr. Kropiewnicki says ophthalmologists will benefit from an increased demand for cataract surgery and other age-related surgeries. "We're all getting older, and at some point, we're going to need cataract surgery," he says. "There's going to be an awful lot of us needing some aspect of eye care, which means an awful lot of work for ophthalmologists to do."

He says this trend will particularly impact younger ophthalmologists, who will take the place of aging physicians as they retire. According to Mr. Kropiewnicki, many ophthalmologists are currently nearing 60, meaning there will soon be a wave of retirements in the eye care community. "As some of the older guys start retiring, there will be a need for more people coming up behind them, and the salary ranges will probably go up," he says.

5. Increased ease of cataract surgery.
While cataract surgeries used to require a long recovery time and several hours to complete, many ophthalmologists can now perform the surgery in less than 30 minutes. "There are relatively few complications, and more people are aware of [the surgery]," Mr. Kropiewnicki says. "I think we get a lot more of them now because patients are much more aware of the need for it."

He says some ophthalmologists are choosing to build their practice and income by using premium or accommodative lenses, which are different from traditional static lenses in that they allow the eye a range of motion and more ability to focus. The accommodative lens is paid for out-of-pocket rather than by Medicare, which means physicians do not have to worry about decreasing Medicare reimbursements when adding the technique.

6. Decreasing popularity of LASIK surgery. Three or four years ago, Mr. Kropiewnicki says LASIK surgery was a profitable enterprise for many practices. "It's a different model of operation because it's very dependent upon a lot of advertising and hand-holding, and a lot of marketing dollars get thrown at it," he says. "It requires relatively expensive equipment to do that, and the whole business went to hell in a hand basket when the economy [started to fail]." While he expects LASIK surgery to experience resurgence in the next five years, he says the surgery is currently not terribly popular among cash-strapped patient populations.

LASIK surgery is the one true elective ophthalmology surgery, though Mr. Kropiewnicki points out that some ophthalmologists perform ocular plastic surgery, which is also elective.  

7. Option to invest in a surgery center.
As many ophthalmology procedures, particularly cataract surgery, are performed in the ASC setting, ophthalmologists have the option of investing in a surgery center and increasing their revenue through ASC distributions. These physicians may be particularly well-suited to invest in an ASC because so many of their cases are performed outside the hospital.

8. Proposed Medicare physician fee cuts.
With proposed fee cuts for physicians on the horizon, ophthalmologists are concerned that their reimbursement will suffer significantly due to the large percentage of Medicare patients they treat. "If we see a 20 percent pay cut, you start getting into situations where doctors are not going to participate in Medicare," Mr. Kropiewnicki says. Since cataract surgeries are generally performed on Medicare patients, Mr. Kropiewnicki says ophthalmologists will have to consider whether the decreased reimbursement is feasible for the financial health of their practice.  

Learn more about Mark Kropiewnicki.

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