UPFRONT

State of Siege

JASON S. SLAKTER, MD

Over the last several years, it seems to many of us that the practice of medicine as we know it has been under attack. The assault has come from several fronts — from the influx of managed-care organizations, as well as from government regulations on billing practices and documentation. Over time, more and more of our days are spent trying to adhere to the regulations instead of focusing on the care of our patients.

As we enter the summer of 2008, 2 major events are unfolding that will profoundly affect the way we practice. The first is the proposed 10% cut in Medicare fees that are currently on the books to take effect as of July 1, 2008. As I write, we are just 24 hours away from a Senate vote to forestall what could be a devastating reduction in income to many retinal practices. Even if this vote is successful in halting the planned fee reduction, additional attempts to cut Medicare are inevitable, and eventually some may succeed. We may then be forced to accept a significant reduction in the overall income to our practices and battle just to keep our practices in operation in the face of these cutbacks.

THE FLORIDA FRONT

Remarkably, while we struggle with this dilemma of maintaining the highest quality of patient care in the face of rising costs and reduced revenues, we are faced with a new and even more serious threat. Optometrists in Florida are pushing forward potential legislation that would permit them to perform intravitreal injections. This move is based upon a 2007 Florida legislature decision that allowed pharmacists to perform flu shots in spite of opposition by organized medicine. Amazingly, the optometric groups argue that an intravitreal injection of an anti-VEGF agent for the treatment of AMD is analogous to "immunizing" the patient against macular degeneration. This would be laughable were not such a frightening concern for the quality of care of patients and for the continued viability of retinal practices in Florida and elsewhere.

It is truly remarkable that, while the government has instituted physician quality review processes to ensure that patients receive standardized levels of care when treated by ophthalmologists, individuals who lack the training, knowledge, and expertise to properly care for conditions as complex as AMD may be allowed to treat patients. The specialty societies within the retinal community and the AAO have all asked for our support for the Florida ophthalmologists and their fight against this legislation. In the past, doctors as a group have tended to be passive or genteel in their responses to situations such as this. Those days must come to an end! We must, for the sake of our patients' health and our own survival as physicians in the retinal community, mobilize to fight this and other threats that we face today. It is critical that we donate the money and time needed to oppose the expansion of optometric practice, as well as to inform our legislators of the critical role that physicians play in the health of our nation.