Sunday, March 25, 2012

Cataract Surgery Evaluation Concern

Question: I feel uncomfortable and rushed in my cataract surgery evaluation. At the first visit with the cataract surgeon, I was seen by the doctor and an assembly line of technicians and given a diagnosis of cataract. At the second visit I was again, given a quick exam by the cataract surgeon and told I could be scheduled for cataract surgery in 2 days. At the surgery center which was in the same building there were only two people who did a medical exam and really only took my blood pressure. They PUSHED for lens implants that cost extra money. I feel uncomfortable & "rushed". Is it me, or is this how things are done today? I am 67 yrs old.

Answer: You are describing the unfortunate reality of an American healthcare system under government siege. Today's Cataract Surgeon-and MOST medical specialists-are under enormous pressure to cut costs of all aspects of the care they provide. Believe it or not, the surgeon's fee paid by Medicare for performing Cataract Surgery-a highly technical, highly complex intraocular surgical procedure that changes lives, is NOT much different than what you pay to get your car exhaust system replaced when you visit Midas® Muffler. Equivalent life value? Hardly!

But the decreasing reimbursements provided to Ophthalmologists has necessitated an acceleration of the "industrialization" of care whereby technicians are engaged to provide more and more of the testing and evaluation of patients. This should not be interpreted to mean that you are getting shortchanged on the quality of care as in most practices these technicians are well trained, highly skilled, certified and under the direct supervision of the Cataract Surgeon who makes the decisions with you about your care. However, stylistically it can very well be impersonal and seemingly disconnected from the Cataract Surgeon. This method of patient care is encouraged and required for physicians to survive under Obamacare-it has cut some $500 million in Medicare funding-this has to come from somewhere.

In addition, Medicare ONLY pays for barest minimum type of Lens Implant for Cataract Surgery and tells the Cataract Surgeon to charge the patient for the Lens Implant that can offer the best vision correction options. So, the Cataract Surgeon can either not bother to present you with the best vision correction option for your Cataract Surgery using advanced technology Lens Implants, or present you the options and get caught "selling" you something.

It is NOT appropriate to PUSH any type of Lens Implant-the choice of Lens Implant is entirely up to the patient-but they should at least hear the choices-albeit there are some practices which may very well "oversell" the Lens Implant options. The reality is that this cannot be a rampant problem, as less than 15% of the Cataract Surgery performed in the U.S. today actually uses advanced technology Lens implants that require private payment by the patient. The decision as to when to have Cataract Surgery is entirely up to the patient, unless there are some associated anatomical or medical issues-such as the potential for Narrow Angle Glaucoma or an inability to assess or treat Diabetic Retinopathy or Macular Degeneration-that make the urgency of scheduling a cataract extraction more acute. It is when the patient feels they are ready that THEY should schedule the Cataract operation.

So, unfortunately this is the state of affairs today in medicine. There are still a few Cataract Surgeons who survive in "high touch" personalized care consultative medical practices-but they are becoming far and few between as their economic survival is challenged. All Cataract Surgeons and Cataract Surgery Centers do their best to deliver high quality care-perhaps NOT the warmest or most patient friendly care-in a challenging environment. The patient has the right to decide if and when to have Cataract Surgery, which practice and Cataract Surgeon to have it with, and whether they wish to have an advanced type of Lens Implant. At the moment choosing the practice style that feels the best to each patient, is still within the patient control and choice, although-unfortunately this will be limited with the ongoing government control of healthcare. This may not be the answer you were looking for but unfortunately it is today's reality.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

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