Providing Ophthalmic Services in a Contracting Environment

Abstract

purpose of this symposium is to heighten your awareness about the most serious issue facing ophthalmology today-our access to patients. intent of this symposium is to provide a clearer understanding of the issues. Academy and ophthalmologists will then be in a better position to sharpen the focus of our efforts to ensure our access to patients. We plan to address some actions which you, as individual ophthalmologists, and the Academy should take to help ensure the public's continued direct access to ophthalmologic services. We also will present principles which should guide us as we approach the future. Each panelist will approach the issue of access from a different perspective, with the aim of painting a realistic and complete picture of the impact of alternative delivery systems (ADSs) on ophthalmology and the provision of ophthalmologic services. Today, we will use ADSs as a generic term to mean any system of payment that is other than the traditional fee for service. Many will find the following portrayal of reality grim and the suggestions anathema to our usual way of thinking and of approaching our practices. Times have changed, and the situation is such that things once unthinkable are not tomorrow's nightmares but today's realities. If your anger begins to surface when listening to this symposium, please do not reject the message or make efforts to sacrifice the messengers, for as Shakespeare so eloquently stated in Henry IV The first bringer of unwelcome news hath but a losing office. I urge you to think beyond what has been customary or familiar before rejecting anything out of hand. Above all, I exhort you to be realistic and to begin to deal with what we are facing. It is only by dealing with reality that we will be successful. For a long time, we have been talking about the effects of prepaid health plans (health maintenance organizations [HMOs], individual practice associations [IPAs], competitive medical plans [ECMPs], and preferred provider organizations [PPOs]) on the practice of ophthalmology, and the changes that might occur in the way we deliver ophthalmologic services. We have tried to envision what