Ophthalmologists are facing profit hurdles because of payer prior authorization requirements and declining reimbursements.
Howard Katzman, MD, an ophthalmologist operating from a freestanding ASC in Salt Lake City, spoke with Becker's ASC Review on how payers are increasing barriers to reimbursement.
Editor's note: This interview was edited lightly for clarity and brevity.
Question: What are the three biggest challenges facing ophthalmology?
Dr. Howard Katzman:
1. The first challenge facing ophthalmologists is the progressive bundling of procedure codes by Medicare and commercial carriers. They pay for fewer things. They just bundled them into one procedure.
2. The second is declining reimbursements grossly disproportionate to the amount of risk and responsibility of what is being offered at ophthalmology facilities.
3. Third is the outrageous disparity of the difference in facility-fee reimbursement between hospital-based ASCs vs. freestanding.
Q: Many ophthalmologists have cited payers' prior authorization requirements as an obstacle to care. Have you had any trouble with prior authorization requirements?
HK: It depends upon the carrier. The most egregious carrier is UnitedHealthcare. They throw more stones in your path and more obstacles in securing prior authorization than any other carrier.
Their reimbursement for cataract procedures for freestanding ASCs has dropped so low that it's insane. If it wasn't for elective procedures — such as premium lenses, multifocals, astigmatism-correcting lenses and toric lenses — I don't think ophthalmologists could make a meal out of it.
It's crazy to go back and compare their reimbursement from 10 years ago to today. It's disheartening. I think they'll squeeze as far as they can to get physicians down.