Eyeballing the Eye Doctors
There is an unsung hero among Southern California’s ophthalmologists, and he wants to keep it that way. He is the surgeon who blew the whistle on a computer programming error that was feeding tens of thousands of unearned dollars to doctors performing cataract surgery. He, alone among the doctors receiving the unexpected 20% overpayments, reported it to the state, returned the money and set in motion the correction of the error.
Not to worry. The state has now corrected the computer program and is preparing to go back over its records to collect the overpayments by docking the other doctors.
The error was understandable. The fact that only one doctor stepped forward is a bit harder to comprehend. Since then, at least two other doctors have sent in money, according to the California Assn. of Ophthalmology. State officials said that they had no record of receiving the additional payments. The association is now suggesting that all doctors check their books but hold up payments until formally advised by the state to avoid further confusing what the association says is an already confused situation.
Cataracts are big business for the medical profession, perhaps the most common operation, with estimates of as many as a million operations a year nationwide. As new technologies have supplanted old, there has been a trend--one professor of ophthalmology called it a stampede--to do the work on an outpatient basis. This has been hastened by Medicare, the national insurance for persons 65 and older, which discourages the surgery in the usual inpatient hospital setting and encourages outpatient work by paying 100% of the cost in certified clinics.
The computer error involved payments for only a small portion of the cataract surgeries--those cases involving low-income patients also eligible for Medi-Cal coverage. These so-called cross-over cases were overpaid by at least $250,000, perhaps as much as $1 million.
Dr. Sherwin H. Sloan, president of the California Assn. of Ophthalmology, is convinced that the doctors did not know about the overpayments. Clerks handle billings in the offices, he explained, and often are confused by the reports. But state officials said that the payments are clearly marked and that it would be hard not to notice such substantial overpayments.
The failure of the doctors to notice the huge overpayments is evidence itself of the megabucks dimensions of this procedure. The publicity that accompanied the discovery of the computer error inevitably will focus attention on those fees. Medicare pays surgeons the same for inpatient hospital or outpatient operations--an average, in Southern California, of $2,028, according to federal officials. Some of the most active surgeons do 20 or more operations a week. The actual surgery rarely takes more than half an hour. The outpatient facility is paid an additional $375, in contrast to the $2,100 that Medicare would pay for inpatient hospital care. Medicare also covers up to $500 for an anesthesiologist, and $400 for an assisting surgeon, in the outpatient clinic. And an increasing number of the outpatient facilities are free-standing--that is, not associated with a hospital and often owned by the surgeon.
