Government picks up tab for foldable lenses
Eye surgeons will lose additional revenue from markups they have been charging patients
Eye surgeons will no longer be able to charge patients for the foldable lenses implanted during cataract procedures under a new policy that took effect Monday. The change will cost government up to about $ 15 million a year.
Foldable ( as opposed to rigid) monofocal lenses will now be provided by health authorities at no charge to more than 50,000 cataract patients a year.
The provincial agency called Health Shared Services will purchase all lenses for patients in bulk buying agreements with suppliers. Previously, patients paid out of pocket for lenses purchased from many surgeons or medical clinics at prices ( up to $ 500) that represented 100- per- cent markups.
The charge for the lenses was in addition to the $ 500 fee for service that ophthalmologists were paid by government to do the outpatient procedure on each eye.
During cataract surgery, the cloudy natural lens is removed and an intraocular plastic lens implant is inserted. Cataracts develop as a process of aging.
The surgery itself has been a medicare benefit for decades but the foldable lens has been an extra charge. That’s because the government covered only the less expensive, rigid type, even though the modern flexible lens has been the preferred choice of patients and surgeons for at least 10 years because of the smaller incision required and speedier recovery.
Dr. Fred Mikelberg, head of ophthalmology for Vancouver Coastal Health and the University of B. C., said some ophthalmologists have been able to generate “significant income” from charging “inappropriate” markups on lenses and he’s heard “through the grapevine” that there are now some unhappy doctors who will lose that income stream. At the same time, the practice of being a medical provider and retailer simultaneously has long been a contentious issue across Canada. So too has the fact that the government was only covering the cost of lenses long considered obsolete.
“Rigid lenses haven’t been the standard of care for about 10 years,” Mikelberg said, adding that while long- term results were about the same between hard and soft lenses, shortterm advantages for flexible lenses meant that they’ve been the preferred choice in 95 per cent of cataract procedures.
While some B. C. ophthalmologists have charged as much as $ 500 per lens for the flexible types, at the Vancouver Coastal Health Eyecare Centre, surgical daycare patients were charged $ 350 per lens, in what Mikelberg described as a small ($ 100) markup on the cost from the supplier.
The premium went to a trust fund that was tapped for research and capital equipment. “Our surgeons did not benefit,” said Mikelberg, a glaucoma expert who does not perform cataract surgery.
“We will lose this stream of income for research and will need to make it up by future fundraising. Nevertheless, this is a good progressive step and provides patients with appropriate care at no extra personal charge.”
Ryan Jabs, a spokesman for the Health Ministry, said the change recognizes the shift in the standard of care for cataract surgery. It’s expected a minority of cataract patients ( 20 per cent) will decide they want even more advanced multifocal lenses so they’ll be able to shed their need for glasses after the surgery. In those cases, patients will be asked to pay the difference between the standard — and insured — monofocal lens and the specialty lens cost, which may be hundreds of dollars.
Dr. John Blaylock, an ophthalmologist who operates at Chilliwack Hospital a few days a month but does most surgery in his private facility, said the change will cause a significant loss of revenue for surgeons who have used the money to pay for their overhead.
“I can see why the government is doing this, because it will win them brownie points with the public, but it has to work on paper. Surgeons can’t subsidize patient care,” he said.
At the same time, he recognizes there’s been a potential for conflict of interest since selling lenses meant there was a financial incentive for doing surgery that may not always be absolutely necessary. He doesn’t include himself in the category of surgeons doing unnecessary surgery.
Blaylock, who billed the Medical Services Plan $ 1.035 million last year ( before paying overhead costs) said his take- home pay is “very modest” relative to the hours he works. But he concedes there’s little sympathy for bigbilling eye surgeons, even among other doctors. He also warned that the unintended consequence of all the changes may be that fewer eye surgeons do cataract surgery and that’s a concern, given population demographics and what it means for the everincreasing numbers of patients needing cataract surgery.