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Cover Focus | July/Aug '19

An Open Mind: Part 1

Physicians recount experiences that emphasize the importance of open-mindedness in ophthalmology.

Richard S. Davidson, MD

One of the things I love about my practice is that a homeless person may be sitting in one room and a billionaire may be sitting in the next room, and they will both receive the same high-quality care. In 2005, when ophthalmologists first received permission from CMS to charge patients for premium services, I was not sure how this would affect my practice. Nowadays, when I lecture on premium services, surgeons often tell me that their patient population is not interested in and/or cannot afford premium services.

I work in a university setting, where my payer mix is approximately 65% Medicare and 12% Medicaid, and the remainder is commercial insurance. In the beginning, I wasn’t sure how to market premium services and was afraid I would have very few takers. However, I could not have been more wrong. No matter their demographic, most patients are willing to pay for premium services because they improve their quality of life. Now, my premium services acceptance rate ranges between 25% and 30% of all of my cases, and I believe there is still significant room for growth.

The lesson here is: Don’t assume patients are not interested in or will not pay for premium services based solely on their insurance status. Many will, and they will be some of your most grateful patients.

Richard S. Davidson, MD
  • Professor and Vice Chair for Quality and Clinical Affairs, University of Colorado Eye Center, Aurora, Colorado
  • richard.davidson@ucdenver.edu
  • Financial disclosure: None

R. Luke Rebenitsch, MD

One of the first tasks I received during fellowship was to read the book Blue Ocean Strategy. At first, I naively wondered what a business book had to do with ophthalmology, but I soon realized that it applied perfectly to our rapidly evolving specialty. The premise of the book is that, to have a successful business—or in our case, practice—one needs to continually differentiate by creating new offerings that don’t already exist. This strategy certainly applies to ophthalmology, and our patients benefit greatly from it.

Take, for example, the concept of a dry eye clinic. In years past, dry eye disease was not often discussed and was difficult to treat. Now, however, it is one of the fastest growing and most exciting areas of ophthalmology. If we were not open to ideas such as this, our practices would stagnate over time. As such, physicians at my practice make a concerted effort to attend meetings, to visit other practices, and to research new technologies whenever possible. These are exciting times for physicians and patients alike.

R. Luke Rebenitsch, MD
  • Owner and Medical Director, ClearSight Center, Oklahoma City, Oklahoma
  • dr.luke@clearsight.com
  • Financial disclosure: None

Ashley Brissette, MD, MSc

When my practice first purchased a femtosecond laser for cataract surgery, I was excited to use the technology for some upcoming white cataract cases. Before starting out, I reached out to a few colleagues across the country for their tips on managing these complex cases with the femtosecond laser.

In turn, I received a variety of responses related to the “ideal” capsulorhexis size, energy settings, and docking setup (plus one suggestion not to use the laser at all in these cases). In the end, I learned a few different strategies and tried a new technique for complex cases. This experience reminded me that, although we may all have slightly different approaches, it is ultimately most important to ensure that you do what is best for your patient and for yourself as the surgeon.

Ashley Brissette, MD, MSc
  • Assistant Professor of Ophthalmology, Weill Cornell Medicine, New York
  • Attending Ophthalmologist, New York PresbyterianHospital, New York
  • asb9040@med.cornell.edu
  • Financial disclosure: None
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