In their presentation, "Ophthalmic Strategies and Top Five Initiatives for ROI," Max Reiboldt, CPA, Chairman, Coker, and Chad Eckhardt, Esquire, Frost Brown Todd, discussed the top five ophthalmic provider strategy initiatives for return on investment (ROI). Among the areas discussed were: Rural/community ophthalmic health-care coverage challenges; technology; indigent care and resultant stress on the health-care delivery system (and specifically ophthalmic providers); health-care choice and the patient as a consumer; and physician/health system/private/public investor affiliation.
"While there are certainly more than five initiatives these days, we have isolated those we have experienced in active advisory services. They are without question of regular, almost daily, concern," said Mr. Reiboldt.
1. Rural/Community Ophthalmic Health-care Coverage Challenges
In the session, Mr. Eckhardt said that there are going to be more challenges as it relates to rural care. “I see less and less ophthalmic care being delivered in the rural areas. I think we are going to see ophthalmic care move more into the urban and suburban areas,” he said.
He also noted that the way ophthalmologists are going to be providing access to care in the rural market is going to be driven a lot by technology.
2. Technology
Mr. Eckhardt noted that one of the struggles he sees with providers, especially larger providers in the ophthalmology space with technology is trying to convince those who are going to make decisions to invest in technology — given the struggle for reimbursements, other revenue streams. "I see this being a discussion point within the providers to really focus on what technology they can use to drive results and improve care but to also make sure it’s financial stable.”
In terms of where he sees technology going, Mr. Eckhardt added “I see the technology really moving into the direction of telehealth, better imaging and AI on top of that in order to help free up time for ophthalmologists to provide the surgical and specialized care that they really enjoy doing."
3. Indigent Care and Stress on Healthcare System
Mr. Reiboldt and Mr. Eckhardt pointed out that “free” care has always been a feature of our system of care. They noted that compassionate providers prevail, even those that are for-profit. In addition, they said, hospitals extend benevolence regularly, but typically limit their ophthalmic expertise. Notwithstanding these traits, they said, the stresses on the system for rendering free care are growing. Many patients who enter for their ophthalmic needs via hospital ORs/may wait for their problems to worsen before seeking care.
Some possible solutions/responses provided to the growing indigent population they noted include: Continued assumption of responsibility of the “haves” sharing the cost with the “have nots”; stricter regulations concerning requirements relative to immigration, those “gaming” the system, etc.; stronger rules governing Medicare/Medicaid fraud; asking more of corporate America; shifting to value-based (not volume-based) reimbursement; asking everyone to pay “something”; and more or less governmental involvement.
“I think that moving to a value-based proposition of health care ultimately will give us some opportunities to capture access to care for this population,” relayed Mr. Eckhardt.
4. Health-care Choice and the Patient as a Consumer
If patients are being viewed as consumers, says Mr. Eckhardt, they are going to start being more accountable for their own decision making. “The cost of care being shifted to the individual is going to make them be more frugal with their resources and they will make sure they get a return on that spend but at same time the patient as a consumer wants to have more available options for health care.”
5. Physician/Health System/Private/Public Investor Affiliation
According to Mr. Reiboldt, transactions among ophthalmic providers affiliation are at an all-time high and varied structures are under consideration among all sectors of eye-care services.
"Since the 1990s, we have moved from most ophthalmologists practicing independently to multispecialty, private equity, etc., to the vast majority existent as some sort of affiliated structure," he said.
He also pointed out that there are varied levels of affiliation, that all ophthalmic providers must have an affiliation strategy; and that it may be pluralistic, where there are numerous approaches.
According to Mr. Reiboldt, often the ultimate partner is private equity. “Private equity is interested in ophthalmology because there is still a fair amount of profit to be gleaned.”
Mr. Eckhardt also added that, “When it comes to private equity, one thing I know that a lot of ophthalmologists think about when they are considering this, is if there is some economic opportunities for them, as well as opportunity to shed some administrative activities."
If an ophthalmologist is going to be affiliated with private equity, he says, it is important to also think about the culture.
"Understanding that culture and what impact it will have on physicians, the clinical decision making, and making sure you have a good understanding of the culture for this affiliation is very important. I think this is one of the keys to making sure that this is successful and bringing the fruition of all the things we really want to see through the affiliation.”
