In late July, CMS issued a proposed rule that would, if enacted, result in an approximate 15% reduction in the professional fee component of cataract surgery, effective January 2020. This is the first significant rate change in cataract reimbursement in more than five years. Note that many commercial payers base reimbursement on a percentage of the Medicare Fee Schedule, so any cut in Medicare rates can have a larger impact on your practice.
Rather than react emotionally, as a practice leader it is important to thoughtfully consider how such a change in fees could impact the finances of the overall business. In addition, engage with your team to evaluate options to lessen the impact of the proposed rule while not compromising the integrity of the patient experience.
The good news is that ophthalmology can offer elective cash-pay services that bring tremendous value by enhancing patients’ vision and quality of life. These can “make up the gap” created by a fee reduction, while respecting the patient’s desire to be better educated about their clinical and surgical options.
Take thoughtful, effective steps
During the past 30 years, I have seen ophthalmology face significant challenges; however, one constant has been the ability of practices to address them in an effective manner. Here are a few suggestions to assist with this process:
- Measure the financial impact of the proposed changes.
- Meet with your leadership team to review the analysis and to discuss areas of opportunity to manage the economic impact on your practice.
- Focus on the following opportunities:
- Benchmark key production and efficiency metrics.
- Identify opportunities to enhance provider and staff production.
- Modify doctor schedules to enhance patient flow.
- Leverage your investment in staff and technology to drive increased production and efficiency.
- Enhance staff and patient education to improve lead capture and patient conversion to cash-pay services.
- Review operating expenses to eliminate costs that are not driving value to the practice.
The key to success is to take a thoughtful, disciplined approach in meeting the challenges that lie ahead. As a key member of your practice leadership team, look at this new challenge as an opportunity to re-examine how you do what you do to identify ways to improve efficiency. OP