Improve Vision, Make Money

American Academy of Ophthalmology 2013

Melissa M. Brown, MD, MN, MBA


November 26, 2013

Editorial Collaboration

Medscape &

In This Article

Improving Vision Makes Money

When we look at financial value, we consider several things, one of which is the direct medical cost. The direct medical cost is what Medicare and the other third-party insurers pay. That is money out of their bank, and it is what people look at. That is what the government looks at. That is what our policymakers look at. How much money does it cost to have cataract surgery in this country, in a patient, over what period of lifetime? I am suggesting that we also look at our societal gains: not just what Medicare has to pay for cataract surgery, but what does Medicare get back?

From the good work of Javitt[3] and Schmier,[4] we find out that when we look at the societal aspect, there is less depression, fewer injuries and nursing home admissions, lower caregiver costs for the patient, and increased wages from the standpoint that someone with better vision can keep a better-paying job or keep a job at all. This will surprise you; the doctor's fees probably won't, but the societal return on investment (ROI) for that $2600 cost for that patient is $121,198. That is a 4567% gain. Not a 20% gain in QOL. It is huge. It doesn't have to pay very much for an amazing return, which is increasing visual acuity. It tells us how important vision is to the future of our patients.

Let's look a little bigger. For cataract extraction surgery, the total direct medical cost in 2012 was $4.8 billion. The ROI for cataract surgery over 13 years is $123.5 billion. That is because there is less depression and fewer injuries. This is all money in the bank to Medicare, Medicaid, and our third-party insurers. To the patients, there are lower caregiver costs, which is a huge part of that savings on $123.5 billion. Increased wages go back into the gross domestic product. The money that goes back into Medicare is much higher than the amount that goes out to pay the direct costs.

In summary, cataract surgery has great patient value; it has outstanding financial value, and the ROI from cataract surgery (unilateral and bilateral) is phenomenal.

The take-home for patients, putting all of these numbers aside, is understanding how important cataract surgery is. Patients need to understand that their QOL is going to be greatly enhanced [with surgery] if they do have cataracts that are visually disabling.

I would suggest to our policymakers that improving vision enhances your constituents' QOL and it makes money. In fact, it "mints money" in the process of spending a lot less.

The take-home point for physicians is to be sure that you do a great service to your patients and to your government and society. We have good data that support that bilateral cataract extraction is very cost-effective and helpful to your patients. Find out who your federal representative is. Become a resource for that person. Stay involved because they really need us. Understand how important it is, believe that you are doing a great job, and spread the word around.