From October 2016 North Bay Business Journal
Medicare began releasing records of reimbursements to doctors in 2013. That data revealed some numbers made doctors appear as they were making a lot of money when really the cost was pharmaceutical costs as the the data added those costs into the physician compensation.
In 2012, 151 out of the 344 doctors billed more than $3 million. An ophthalmologist in Florida topped the list with $21 million in reimbursements, according to records released by Medicare.Coming in second was hematology/oncology at $2 billion, followed by cardiology at $1.6 billion.The reason ophthalmology ranks so high is because of the cost of drugs used to treat wet age-related macular degeneration (AMD). AMD is a chronic eye disease that causes blurred vision or a blind spot in the visual field, generally caused by abnormal blood vessels that leak fluid or blood into the macula. It is a leading cause of vision loss in Americans 60 years of age and older, affecting as many as 11 million.The drugs are injected into the eye to limit leaking submacular vessels, prolonging patients’ vision, and preventing blindness.One drug, called Lucentis, costs $2,000 per treatment, and another drug, Eyela, is $1,850 per treatment.Ophthalmologists also use a third drug, called Avastin, to treat the condition, and its cost is $50 per treatment.The reason for the discrepancy in price is that Avastin, while FDA approved to treat colon and other cancers, is not approved to treat AMD. Before the advent of Lucentis and Eyela, Avastin was tried, it worked, and patients clamored for it.Avastin has proven to be effective, and numerous studies have concluded that there are minimal differences in risk between the three drugs, including those from the National Eye Institute and in reports from the American Academy of Ophthalmology.A 2014 study from Health Affairs, a peer-reviewed health journal, shows that Medicare, and American taxpayers, could save $18 billion over the next 10 years if physicians switched to Avastin.For doctors, however, the discrepancy is not just about cost.“Among eye doctors, it’s well known that there is a lot of broad brush data out there (about the drugs), but that’s not really a fine grained enough picture. There is a lot of variability of how patients respond to the drugs, with more subtlety involved. There is also a fine level of detail with a very clear difference between the drugs,” said Stephen Meffert, an ophthalmologist at Northbay Vitreoretinal in Santa Rosa.Northbay Vitreoretinal is one of the largest organizations in the area that treats AMC. In August, the office, among five doctors, performed 1,000 injections: 522 with Eylea, 429 with Avastin, and 130 with Lucentis.One drawback of using Avastin, Meffert said, is that it tends not to last as long for patients, about 4 – 6 weeks compared to 6 – 8 weeks with Eylea.For an elderly population, longer-acting drugs are advantageous in saving trips to the office for treatment, he said.For the doctors, the decision of which drug to use is also affected by how the drug is prepared and marketed. The more expensive Lucentis and Eylea are delivered to ophthalmologists as convenient eye injectables, usually stored in the ophthalmologist’s office and available for use whenever they are needed. Avastin needs to be compounded by a pharmacy, an extra step that also carries a small degree of risk of contamination.