UPFRONT

Change is Coming

JASON S. SLAKTER, MD

As we heard on the evening of February 24, President Obama has made it clear that, in spite of the current economic crisis, healthcare reform remains a priority of the new administration. Already, Congress is moving forward to allocate billions of dollars to evaluate and eventually restructure the mechanism by which healthcare is delivered in the United States. I remain optimistic that the promised involvement of physicians and other healthcare personnel in the decision-making process for these reforms will result in changes that would be both meaningful and positive for patients and providers alike.

In looking at potential changes to the US health system, there is no doubt that improved efficiency of healthcare delivery, as well as quality/outcomes-based therapeutic approaches, will be emphasized going forward. To remain viable, and possibly even flourish, during this evolutionary process, it is critical that members of the retinal community remain aware of what is happening on the regulatory and reimbursement fronts, as well as position themselves to be adaptable to the potential changes in their practice patterns. For this reason, we have devoted a great deal of this issue of Retinal Physician to topics that relate to practice management.

One of the key components of any retinal practice today is the surgical management of vitreoretinal diseases. The movement toward ambulatory surgery center–based surgical services continues, and a thorough discussion on how a retinal surgeon can take advantage of new opportunities that exist for these outpatient procedures is nicely presented by Pravin Dugel and Mike Romansky. Given the changes that we may expect to face here in the United States, it is also wise to look outside our borders to see what physicians operating under alternate healthcare systems have done to improve their practice efficiencies. Dr. Didier Ducournau discusses his own novel approach to high-throughput surgery while maintaining the highest quality of care in an outpatient setting. His perspective is quite unique, and there are many things that we may learn from his approach to managing outpatient retinal surgery.

It is important that we take Dr. Ducorneau's comments within the context in which they are presented and understand that they might not be directly applicable to current US physician practices. It is also critical that we clearly indicate that improvements in operating room efficiency should not minimize the delicate nature of these surgical cases, as well as the need for highly skilled and experienced retinal surgeons to perform these complicated procedures.

Without question, change is coming to US healthcare. It therefore behooves us to keep an open mind about alternative approaches to healthcare delivery, both at home and abroad. By providing a forum for the discussion of these different approaches, as well as their potential advantages and disadvantages, we hope Retinal Physician will continue to serve our community as we move forward in these uncertain times.