So how much does cataract surgery cost you ask? Mrs Happy's Grandma stayed at our humble cottage last night. She underwent cataract surgery and couldn't drive the 30 minutes home yesterday. Today Mrs Happy took grandma back for her follow up visit. Everything was great. The room was filled with people much older than grandma. All of them looked decrepit. Probably used a walker or a wheelchair. Perhaps a cane. None of them looked like they could break a sweat.
But a magazine on the rack caught Mrs Happy's eye. Runner's Worldmagazine. You see, I have recently been excited at the prospects of Mrs Happy's new devotion to running. This magazine had some excellent articles in it for the beginner. She wanted to take the magazine home. More on that in a little bit.
Mind you, this is an ophthalmologist office. An office lined from door to exam room with old 100% insured Medicare patients draining the full service Medicare National Bank of all its bankrupt glory. Perhaps a few minutes more or less checking off the mini H&P or reading the primary doc's H&P. A few minutes to gown and glove and the race begins. An army of nurses prepare the patient, dilate the eyes, fill out the paper work, the discharge work as the doctor roams from surgery to surgery at the speed of light.
It's a highly lucrative business, that cataract mill. Not to mention the facility fees you get from owning your own specialty hospital. CPT® codes 66982-66984, depending on which code is billed pays between 10-15 work RVUs. These are cataract extraction/lens implant codes. Here is how cataract surgery cost is determined as explained through RVUs. The current government rate is about $35 per RVU. I'm sure there are other codes that can be added on as well. This is a global 90 surgical period. It doesn't really matter however. The surgeon probably spent about 15 minutes operating perhaps another 5-10 dictating or talking with family. Perhaps a good 10 minutes answering and looking at the eye post op day #1. I would guess the total time spent was maximum, 45 minutes. For which they were paid 10-15 work RVUs. Not to mention practice expenses and malpractice. That's $350-$500 for physician work effort (work RVU) only. For 45 minutes of work. And no phone calls. No paper work. No busy work. No preauthorizations. No family medical leave forms. No disability forms. No complicated drug evaluations. No multiorgan failure.
Just to cut out a cataract. And move on. It doesn't get any better than that. Remember volume rules in the current payment environment. Pay for volume, get volume. It doesn't matter what you do with any reform, as long as volume rules. By the way, the cataract surgery cost used to be much higher. Now, let me put that in perspective for you. It's all relative. For me to generate 10 RVU's of critical care time (in work RVUs) , I am paid 4.5 RVUs for the first 30-74 minutes of a dying critically ill patient (CPT® 99291). The next 30 minutes could get me another 2.25 RVUs (99292). The next 30 minutes could get me 2.25 RVUs (99292).
In other words, to generate just under 10 RVUs, I would have to take care of a critically ill patient with multi organ failure for two hours and fifteen minutes. And I still wouldn't generate enough RVUs to equate to a 45 minute cataract surgery cost.
How about hospital follow up visits? The highest level hospital follow up visit pays 2.0 work VUs. I would have to see five of them to generate 10 work RVUs. This is the highest level of complexity for a hospital follow up visit. Here is how you meet the requirements. The AMA expects a CPT® 99233 to take 35 minutes. On a good day, I can maybe get five 99233 done in 30 minutes each. That's 2 1/2 hours of work to generate 10 RVUs.
Now, let me ask you, as a medical student, if you have the opportunity to slave away with complicated medical disease or do 10 or more cataract surgeries a day generating 3-5x the income, which would you rather do.
Now back to the original story at hand. Mrs Happy found this running magazine in the office full of old blind Medicare patients who couldn't walk without a walker, let alone take up running. So Mrs Happy asked the front desk if she could take the magazine home with her, thinking it may as well get some good use out of it.
Thinking the asking was only a formality, she was shocked to learn that not only is the waiting area "low on magazines" (which no one can read anyway), but they asked she bring it back next week. Almost offended that someone would even ask. How about that. I find good humor in it all. An office raking in the dough like a blind puppy mill filled with senior citizens who can't see, let alone run. And yet they can't seem to find enough cash to stock their front office with magazines. And when they do, they pick a magazine that will find no use amongst the blind and disabled and find annoyance that someone would ask to take it home. Most people would have just taken it. That's what makes Mrs Happy special.