When we all set out to become surgeons, I bet none of us thought we would end up spending so much time talking to patients about money. However, as the treatment landscape for retinal diseases becomes increasingly complex with novel drugs, biosimilars, step therapy, changing reimbursement, and OR access issues, money is a big factor in our practices these days.
Nothing has made this clearer than the dwindling funding for copay assistance programs such as Good Days. Patients who never spent a dime on their anti-VEGF agents are being hit with bills—and they are confused. Our practices have been absorbing not only their emotions, but the long conversations that come with them. Now, physicians and staff are tasked with educating patients on various insurance plans, explaining what copay assistance programs are, and why patients have lost coverage.
To help, we sat down with Michael M. Lai, MD, PhD, to discuss what happened with our copay assistance programs, how it has affected our practices, and what we can do about it. He notes that the onslaught of patient education has paid off for his practice; his patients are better informed, and many are better equipped to manage their health care finances.
A nice companion article to that is our Practice Management column, which highlights the various issues with the prior authorization process for anti-VEGF therapies and potential solutions. If you want more on the economics of practice, we have an excellent article in the May/June issue of Retina Today that provides an update on the anti-VEGF step therapy process by Jennifer Adeghate, MD, PhD, and her team at the Medical College of Wisconsin.
When you’re ready to focus on your own finances, check out Coding Advisor, which provides helpful tips for properly coding E/M and eye visit codes to maximize your reimbursement. Lastly, we have an article on life insurance to help you stay on top of important long-term goals.
We became retina specialists to save patients’ vision. While we may not have expected so many financial hurdles to reach that goal, it’s worth the effort to ensure patients get the care they need in a timely manner.
