Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why cataract surgery is more complicated than it should be

Brian C. Joondeph, MD
Policy
April 9, 2018
Share
Tweet
Share

Eye surgery is a delicate business. It involves operating within an orb the size of a large marble to remove a cataract or repair a retinal detachment.

Not only is superb eye-hand coordination a must, but also an awareness of the myriad other medical issues in the elderly population most in need of eye surgery.

Traditionally, patients undergoing cataract surgery had a preoperative medical evaluation, including blood work, chest X-ray, and EKG, to determine their suitability for surgery. This is a remnant from the days when cataract surgery was a long operation with a week of hospitalization and bed rest.

Today, it’s a much quicker procedure, performed with minimal anesthesia. Patients return home an hour after surgery. It’s no surprise that researchers from the University of California, San Francisco found that routine preoperative testing before cataract surgery is neither necessary nor cost-effective.

Case closed, right? Not so fast. Enter the bureaucrats. The Joint Commission and Centers for Medicare and Medicaid Services require all patients undergo “A comprehensive history and physical assessment” prior to their surgery — including for post-cataract YAG laser procedures that take only minutes to perform. This usually means a referral to another doctor. But even worse, the bureaucracy mandates that the preoperative physical be performed “No more than 30 calendar days prior to date the patient is scheduled for surgery in the [ambulatory surgery center].” Also, it must be done then “Regardless of the type of surgical procedure.” This means that a healthy 68 year old, who had her annual physical six weeks ago, needs to repeat the process in order to have a two-minute laser procedure.

Note that if the same patient were undergoing a molar extraction or a root canal — both longer and far more invasive surgeries — needs none of this.

Why all this bureaucratic red-tape? It’s called “defensive medicine.” If an elderly patient happens, by timing and bad luck, to have a critical medical event during the few hours they are at the surgery center, the surgeon will be blamed for not knowing this would happen and not taking appropriate measures to prevent it. The tort lawyers will feast on his practice. Hence the excessive evaluation and testing, just in case.

Still another group of bureaucrats, insurance companies, have also nosed into eye surgery. Anthem’s new policy decrees, “It’s not medically necessary to have an anesthesiologist or nurse anesthetist on hand to administer and monitor sedation in most cases.”

Says who? The suits in the corner office at Anthem think they know better than surgeons. Meaning that when the surgeon is intently focused on the delicate task at hand, and the patient’s blood pressure drops or their heart rhythm starts dancing, the surgeon is expected to notice this and manage it appropriately while at the same time performing intricate microsurgery on the eye. How might that work out?

I wonder how many Anthem executives would let their mother with high blood pressure have eye surgery without an anesthesiologist monitoring Mom’s vital signs?

Bureaucrats and surgery just don’t mix. On the one hand, they mandate costly and unnecessary preoperative testing. On the other, they cut corners by refusing to pay for appropriate patient monitoring during actual surgery. They strain out the fly and swallow the camel.

And we wonder why medical care in the United States is so costly without outcomes that reflect this high cost. Because the bureaucracy thinks it knows better. It requires low-value preoperative testing, while at the same time casting patient safety aside in a misguided attempt to save a few dollars.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor. This article originally appeared in the Washington Examiner.

ADVERTISEMENT

Image credit: Shutterstock.com

Prev

I experienced trauma working in Iraq. I see it now among America’s doctors.

April 9, 2018 Kevin 7
…
Next

First date with a medical student

April 10, 2018 Kevin 7
…

Tagged as: Ophthalmology, Surgery

Post navigation

< Previous Post
I experienced trauma working in Iraq. I see it now among America’s doctors.
Next Post >
First date with a medical student

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Brian C. Joondeph, MD

  • Ophthalmology in the era of COVID-19

    Brian C. Joondeph, MD
  • An ophthalmologist analyzes Joe Biden’s red eye

    Brian C. Joondeph, MD
  • When medical science becomes fake news

    Brian C. Joondeph, MD

Related Posts

  • Please change the culture of surgery

    Anonymous
  • The necessity for the globalization of surgery and its barriers

    Jeremy Goodwin
  • Robotic surgery’s impact on training the next generation of surgeons

    Barry Greene, MD
  • Women in surgery: a tweet to action

    Sarah Shubeck, MD and Arielle Kanters, MD
  • The paths to homelessness are more complicated than we think

    Max Bergman
  • Americans and Canadians use more post-surgery opioid pain pills

    Julie Appleby

More in Policy

  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • A surgeon’s late-night crisis reveals the cost confusion in health care

    Christine Ward, MD
  • The school cafeteria could save American medicine

    Scarlett Saitta
  • Native communities deserve better: the truth about Pine Ridge health care

    Kaitlin E. Kelly
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Expert Q&A: Dr. Jared Pelo, ambient clinical pioneer, explains how Dragon Copilot helps clinicians deliver better care

      Jared Pelo, MD & Microsoft & Nuance Communications | Sponsored
    • Why the words doctors use matter more than they think

      Erin Paterson | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • How the CDC’s opioid rules created a crisis for chronic pain patients

      Charles LeBaron, MD | Conditions
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
  • Recent Posts

    • Expert Q&A: Dr. Jared Pelo, ambient clinical pioneer, explains how Dragon Copilot helps clinicians deliver better care

      Jared Pelo, MD & Microsoft & Nuance Communications | Sponsored
    • The lab behind the lens: Equity begins with diagnosis

      Michael Misialek, MD | Policy
    • Venous leak syndrome: a silent challenge faced by all men

      Elliot Justin, MD | Conditions
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Expert Q&A: Dr. Jared Pelo, ambient clinical pioneer, explains how Dragon Copilot helps clinicians deliver better care

      Jared Pelo, MD & Microsoft & Nuance Communications | Sponsored
    • Why the words doctors use matter more than they think

      Erin Paterson | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • How the CDC’s opioid rules created a crisis for chronic pain patients

      Charles LeBaron, MD | Conditions
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
  • Recent Posts

    • Expert Q&A: Dr. Jared Pelo, ambient clinical pioneer, explains how Dragon Copilot helps clinicians deliver better care

      Jared Pelo, MD & Microsoft & Nuance Communications | Sponsored
    • The lab behind the lens: Equity begins with diagnosis

      Michael Misialek, MD | Policy
    • Venous leak syndrome: a silent challenge faced by all men

      Elliot Justin, MD | Conditions
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why cataract surgery is more complicated than it should be
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...