0 Case Study Conflict of Financial Interest Billing for Unnecessary Procedures

ACADEMY OF OPHTHALMOLOGY Case History  80-year-old female  POH significant for: Amblyopia OD with vision of 20/400 Wet AMD OD Cataracts OU  Status post anti-vegf OD and has no other ocular complaints.

ACADEMY OF OPHTHALMOLOGY Case History  Patient is referred to Doctor Kutsalot Cataract specialist with large referral network Performs 3000 CE each year Relies on his ODs to do all the pre and post operative care.

ACADEMY OF OPHTHALMOLOGY Case History  Doctor K advises the patient: She has a dense cataract Most cataracts this dense are removed The CE surgery is simple and only takes 10 minutes Medicare will cover the cost of the surgery Most of his patients get a MFIOL because that gives them “their best vision”

ACADEMY OF OPHTHALMOLOGY Case History  Doctor K does not advise the patient: Her prognosis for improved vision in the right eye is poor She will continue to need anti-vegf in the right eye. The wet AMD could complicate her surgery.

ACADEMY OF OPHTHALMOLOGY Case History  The patient has an uneventful CE procedure  Her BCVA on POD #1 is 20 /800  The patient is started on steroids and seen again in one week with no improvement.

ACADEMY OF OPHTHALMOLOGY Case Discussion  What ethical issues, and corresponding Rules of the Code of Ethics, are involved in this case?

ACADEMY OF OPHTHALMOLOGY Case Discussion  Applicable Rules of the Code of Ethics: Rule 2. Informed Consent Rule 9. Medical & Surgical Procedures Rule 10. Procedures and Materials

ACADEMY OF OPHTHALMOLOGY Case Discussion Ethical Issues Rule 2. Informed Consent  The performance of medical or surgical procedures shall be preceded by appropriate informed consent.

ACADEMY OF OPHTHALMOLOGY Case Discussion Ethical Issues  Rule 2. Informed Consent Accurate description of Dr K’s expectations for improvement Should include discussion of amblyopia, wet AMD and MFIOLs.

ACADEMY OF OPHTHALMOLOGY Case Discussion Ethical Issues  Rule 9. Medical and Surgical Procedures An ophthalmologist must not misrepresent the service that is performed or the charges made for that service.

ACADEMY OF OPHTHALMOLOGY Case Discussion Ethical Issues  Rule 9. Medical and Surgical Procedures Did Dr. K give a truthful, accurate description of procedures?  Should avoid giving the patient the perception that she should do this because other patients do it.

ACADEMY OF OPHTHALMOLOGY Case Discussion Ethical Issues  Rule 10. Procedures and Materials. Ophthalmologists should order only those laboratory procedures, optical devices or pharmacological agents that are in the best interest of the patient. Ordering unnecessary procedures or materials or withholding necessary procedures or materials is unethical.

ACADEMY OF OPHTHALMOLOGY Case Discussion Ethical Issues  Rule 10. Procedures and Materials. Was there a reasonable explanation given for the MFIOL? Did Dr. K’s profit from the lens upcharge cloud his judgment?

ACADEMY OF OPHTHALMOLOGY What Do You Think?  What issues should Dr. Kutsalot have discussed with this patient with such a poor prognosis?  Did financial matters affect his judgment?