UPFRONT

Commoditization of Care?

Peter K. Kaiser, MD

A patient came to my clinic the other day very unhappy. He simply could not live with his 20/20 floaters. It was ruining his life. To make matters worse, he had paid several thousand dollars for YAG vitreolysis by a doctor in Falls Church, VA, who had performed thousands of laser treatments “without a complication.” After the laser, the patient felt things had gotten much worse. He then proceeded to beg me to perform a vitrectomy in both of his eyes (at the same time) to fix this.

I asked him why he thought that this would be a good idea. He said he had gone to another retina specialist after the laser who said he had performed more than 20,000 floaterectomies and would operate on both eyes on the same day because the procedure was so minimal.

Moreover, it would only take 10 minutes per eye. I thought I performed many surgeries, but even doing 500 surgeries a year, that would take 40 years! (To be clear, I do not want to make this column about the pros and cons of floaterectomies.)

What concerns me is that there are many “retina” doctors who are starting to sound like refractive surgeons who perform phaco in 10 minutes, saying they can perform a vitrectomy in 10 minutes with no sutures and minimal complications and overinflating their numbers and skills.

Certainly, microincision surgery has been a huge evolutionary step in our surgical ability, efficiency, and safety. However, the greater risk to our field is commoditization of our bread and butter surgery. If it truly only took 10 minutes, then the relative value units (RVUs) would dramatically drop, and we would all be all be very unhappy.

Apple and many other companies have minimal advertised prices. They never commoditize their products, and as a result, their products retain value better than competing products. That is the space in which our field needs to be. We need to highlight the many years it takes to perform the delicate surgery we perform, the years of practice to acquire the knowledge to avoid and fix complications, and the expense required to have the necessary equipment to do this all safely. Retina surgeons should require a “minimal advertised skill” level.

In this issue, we have several articles discussing better visualization, next-generation vitrectomy systems, and the benefits these devices will bring to our field, all of which are important for surgeons who want to remain at the top of their game. Performing a vitrectomy in 10 minutes is not one of them.

In the end, I refused to operate on this patient and suggested he think twice about being treated by a surgeon who operates on both eyes in one day and perfoms 10-minute vitrectomy. I also told him to make sure his laser doctor counts him as a failure in his FDA study of YAG vitreolysis — times two. I’m sure Wiley Chambers at the FDA will have a field day evaluating that submission.