EyeWorld Asia-Pacific June 2014 Issue

June 2014 20 EWAP FEAturE Ethical dilemmas with femtosecond cataract surgery by Ellen Stodola EyeWorld Staff Writer AT A GLANCE • There are very specific cases where patients can be billed for use of the femtosecond laser. These include using an imaging component for a premium IOL and for use in astigmatism correction. • There is a lot of debate over the actual effectiveness of the femtosecond laser and whether it is superior to other options; long- term data on the technology are not yet readily available. • Physicians should discuss all possible situations with patients, including when patients want the technology but can’t afford it or the physician doesn’t offer it. Femtosecond technology presents some ethical hurdles for surgeons T he femtosecond laser is a new technology that many are seeing the benefit of incorporating into surgeries; however, there are still issues to be ironed out with the technology, including the cost and the surgery time. Not all doctors have this technology readily available to patients, and in terms of cost, the extra fees for the femtosecond laser are specifically addressed under CMS guidelines, with the ability to charge only in certain circumstances. John Banja, PhD , Emory University Center for Ethics, Atlanta, Ga., U.S.; Richard Hoffman, MD , clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, Eugene, Ore., U.S.; and Kevin M. Miller, MD , Kolokotrones professor of clinical ophthalmology, Jules Stein Eye Institute, Los Angeles, Calif., U.S., spoke about the ethical issues surrounding femtosecond cataract surgery. Presenting femtosecond cataract surgery to patients Despite not having a femtosecond laser where he works, Dr. Miller thinks the presentation of the technology is fairly simple. “If it’s a cataract patient, you have to be doing a non-covered service to bill for the laser,” he said. The only non-covered service that makes sense is the astigmatism service. He said that using a femtosecond laser for astigmatism management is a safe harbor for use of this technology, adding that another partially safe place is offering the technology when performing imaging as a necessary preparation for implantation of a premium lens. The latter, while approved by CMS, doesn’t make much sense, thinks Dr. Miller, because the imaging is performed for the sole purpose of facilitating non-covered services such as the incisions, capsulorhexis, and lens softening. “You’re only safe if you’re offering astigmatism management as part of your non-covered package,” Dr. Miller said. “A premium IOL could be in that package, but you can’t price the premium IOL higher just because you want to use a femtosecond laser to make the incisions.” Dr. Banja said femtosecond technology should be presented to a patient only if his or her condition warrants it. Thus, using femto to “correct for astigmatism” in a patient who had only traces of it would hardly be ethically acceptable, not to mention the risk of that being discovered in an audit.