"The pharmaceutical world has become almost bimodal. Smaller ... companies provide the seed for innovation and then the larger companies often step in for the development mode and are able to provide a more global reach for the products."
–Jane Rady

In the current health-care environment, ophthalmologists are being challenged to deliver quality care to more and more patients at reduced cost. That means practices have to approach new technology acquisition very carefully.

“In a sense, physicians are operating in a socialist environment in terms of our income, but a capitalist environment for our expenses, said Lisa Arbisser, MD, clinical adjunct professor at the University of Utah’s Moran Eye Center. “That leaves a tremendous gap in our ability to invest in new technology.” Dr. Arbisser and others quoted here spoke during a panel discussion hosted by Ophthalmic Women Leaders and Women in Ophthalmology during the 2014 American Academy of Ophthalmology meeting in Chicago.

Cost concerns aren’t just about maintaining physician income, Dr. Arbisser said. “We also have to make sure we are providing a good livelihood for all the people who support us.” The first time she operated during an international charitable trip, Dr. Arbisser said she realized just how dependent her own productivity is on her staff and their protocols for moving patients, sterilizing equipment and breaking down operating rooms between cases.

To ensure that she is able to maintain that infrastructure, Dr. Arbisser said she tries to make careful judgments about when the time is right to jump on a new technology bandwagon. That could mean passing up the chance to be an early adopter in favor of waiting for more evidence that something new truly carries advantages. It also means she needs to keep her knowledge base current to understand the physiology of a new technique or the impact of advanced technology. “For me, it’s been a matter of seeing myself as a patient advocate first and foremost,” she said.

Industry’s Role

“Early adopters do take a little more risk, but they provide valuable input that helps us continue to improve products for their patients,” said Nick Tarantino, OD, chief global clinical research and regulatory affairs officer for AcuFocus. Of the medical device industry, he said, “We understand that we need to be able to demonstrate a favorable risk-benefit ratio, and often, the best way to do that is by assessing the benefit to patients through patient-reported outcomes.”

Such evidence of clinical benefit is not only key to convincing physicians of the value of new technology but also in justifying its cost to hospitals, ambulatory surgery centers and payers.

“Industry also plays an important role in supporting physicians through patient and staff education,” noted Candace Catanese, senior cataract account manager for Alcon. Additionally, she said, the affordability of new products is about more than just the price. “Sometimes the gains in efficiency or in outcomes make even an expensive new product affordable.”

“It really does ‘take a village’ to provide the kind of care that all of us in health care want to provide,” said Jane Rady, divisional vice president, business development at Abbott Medical Optics, OWL board member and moderator for this panel. “There are many opportunities for physician, staff, health-care policymakers and executives, and industry to work together to achieve the common goal of better patient outcomes,” she said.

Pressure to Standardize

“Large provider networks in the health-care system are eager to standardize care,” said Linda Christmann, MD, MBA, regional chief medical officer for Universal Health Services and president elect of WIO. She cites the cost efficiencies to be gained when networks are able to evaluate and approve bundles of equipment for a surgical procedure.

Ophthalmic Women Leaders
Ophthalmic Women Leaders promotes and develops diverse leadership to advance ophthalmic innovation and patient care. The organization’s mission includes working across ophthalmology to provide professional and personal development and create opportunities for collaboration. OWL regularly hosts discussions and speakers on topics, like the one featured here, that are of compelling interest to its members and stakeholders. For more information about OWL membership and upcoming educational and networking programs, visit owlsite.org.
Women in Ophthalmology
Women in Ophthalmology works to empower the aspirations of its ophthalmology and related members. The organization provides leadership training, networking and continuing medical information opportunities at its annual August meeting. The group partners with international and U.S. chapters to further career development of its members. They create collaborative relationships with industry through OWL and sponsorships to meet the needs of women in academia, practice and ophthalmic businesses. See wioonline.org for more details.
“That doesn’t work very well for me as a surgeon,” said Dr. Arbisser. “I try to determine, in a fact-based way, what are the best products to use for my patient.” That might mean she chooses an intraocular lens from company A, a phaco machine from company B, and drops or instruments from company C. Additionally, what works best in her hands might not be exactly what works best in another surgeon’s hands. “Best” might be defined differently from one patient to the next. “So while increased uniformity may lead to greater cost-effectiveness, I’m not convinced it will truly provide the best value,” she said.

Large ophthalmic companies would certainly like to be able to provide a hospital or surgery center with nearly every product needed for a surgical procedure. “I try to bundle the majority of the products, but when it comes to specialty products like IOLs, no company can satisfy everyone. I wish there was one lens for every patient out there, but there isn’t,” said Ms. Catanese. She said she tries to satisfy clinical needs by providing data and trial experience, but sometimes she has to take the surgeon’s guidance back to the company for further research and development. “Competition is healthy,” she acknowledged. “Good products by other companies force all of us to stay on our toes.”

Innovative new ideas and great single products often come from smaller companies. “The pharmaceutical world has become almost bimodal,” said Ms. Rady. “Smaller, venture-backed companies provide the seed for innovation and then the larger companies often step in for the development mode and are able to provide a more global reach for those products.” That trend is happening in ophthalmic devices, too, although there is still a deep well of innovation in larger companies.

Come Armed

Dr. Christmann said that hospitals and ASCs are looking for an 80 percent solution. “No matter how much we want to standardize, we do understand that patients aren’t widgets,” she said. She encouraged surgeons to be open to using what they can in common with other surgeons when it makes sense for their patients. But when it doesn’t make sense, ophthalmologists must advocate for themselves and their patients.

“In the United States right now, we are poised to tip the scales in health care from a focus on vÂșolume to value,” Dr. Christmann said. But value, she emphasized, doesn’t necessarily mean the cheapest option. “We need for physicians to speak up and to speak from evidence, including evidence of the costs of bad care. Hospital CEOs can’t factor that into their decision-making if they don’t know what the true costs are.” When it comes to purchasing expensive new surgical devices that can reduce complications, for example, that may mean coming to the table armed with facts about the incidence of complications and the financial impact of those complications. “We all need to champion the best care for patients,” she said.

Dr. Arbisser agreed. “As long as we always keep the patients’ best interests at the forefront of our decision-making then we can’t go too far wrong,” she said. “I am very excited to see more collaboration, more vertical integration and more careful thought now going into how we can go forward to take care of our population properly.”  REVIEW

Ms. Beiting is past president of Ophthalmic Women Leaders and principal of Wordsmith Consulting, in Cary, N.C. Contact her at (919) 363-3727 or jan@wordsmithconsulting.com.