Business Spotlight: Single Focus

The journey for Missouri Eye Institute’s eighth staff doctor covered some 6,000 miles and two decades.

Soviet Union-native Dr. Alex Kartvelishvili joined the Springfield eye care specialists in late August to serve mostly retina patients, but his trek to Springfield dates back to 1992, when his family immigrated to New York City.

“The Soviet Union was collapsing at the time and the situation was very volatile,” Kartvelishvili recalls of his preteen years in the Republic of Georgia. “A war broke out where we were living.”

Upon fleeing to Brooklyn, Kartvelishvili was drawn to health care, and after 14 years of studies culminating with a two-year fellowship in south Texas, the 34-year-old was an in-demand retina specialist. A national physician recruiter contacted him last year with interest by the doctor-owners at Missouri Eye Institute.

“I wanted to come to the Midwest. That was one of my top choices,” he says. “I knew that doctors were needed here and New York City was oversaturated with doctors.”

He joins doctor-owners Francis “Chuck” Jansen, Daniel Osborn and James Bureman at the independent practice affiliated with CoxHealth. The board-certified eye surgeons perform thousands of cataract surgeries, more than 500 Lasik procedures, a couple-hundred eyelid surgeries and roughly 70 corneal transplants each year.

Osborn, a cataract and refractive surgeon, also was recruited to Missouri Eye Institute – by co-founder Dr. Don Beisner – but he only hopped two states over. Upon completing medical school and residency at Indiana University, Osborn started in 1996 and quickly succeeded the retiring Beisner.

At the time, the practice operated a single office on Fremont Avenue, near Battlefield Mall. Today, Missouri Eye Institute has 11 locations, with full-time staffing in Branson and Joplin and satellite offices from El Dorado Springs to Cabool.

The latest office is a retina practice that opened three months ago off South National Avenue at Lakewood Street. Kartvelishvili heads it up with Dr. Robert Benedett, and he also sees more than 30 patients in Joplin each Wednesday.

Ahead of the curve
In the age of federal and state health care reforms, Missouri Eye Institute was ahead of the curve for electronic medical records. Osborn says the doctors brought EMRs into action about five years ago, triggered by the expansion into Joplin.

“When we first opened, we were actually taking tubs with paper charts back and forth. It was not manageable,” he says, adding the federal Medicare program is beginning to penalize clinics for not using EMRs.

While Missouri Eye Institute is well-equipped for the technological reform, Osborn says other pending law changes for his practice are less clear.

“They’ve literally given us zero information – either they don’t know or they don’t want to tell,” he says, noting he doesn’t have a single mark on his calendar for a legal effective date coming down the pike.

He expects the talks about payment for performance, with fee levels tied to reports on surgery outcomes, to become effective at some point.

“Right now, that’s not being done. But we’ve set up our system to where we can provide that easily when the government finally does do that,” Osborn says.

One constant is the elderly population Missouri Eye Institute serves. Even so, Osborn says the average age has dipped significantly in the last 10 years – from a 78-year-old female as the average cataract patient to now an average age of 55.

“That trend is going to continue with baby boomers,” Osborn says, noting the generation generally has had more sun exposure and UV damage to their eyes, as well as some harmful medications and food preservatives. “The number of people who need services is growing.”

The demand curve is complicated by government program reimbursement rates.

Given Missouri Eye Institute’s typical patients, Medicare is a big factor in its business model. When Osborn came on board in the mid-1990s, the practice earned $1,200 per cataract surgery from Medicare. He says the reimbursement rate has since been cut in half.

Osborn says the practice performs nearly 4,000 cataract surgeries a year between four doctors.

He and other doctors nationwide are waiting for a Jan. 1 release of Medicare’s 2014 payment schedule.

“Right now, there is scheduled to be a 30 percent Medicare cut on Jan. 1, unless Congress fixes it,” Osborn says. “Nobody knows.”

He says on top of a 17 percent cut in Medicare payments this year, such a move could send large ripples throughout the industry.

“I predict a huge number of doctors in this area and the country will stop taking Medicare, if that cut goes through,” Osborn says. “We would be forced to stop taking it. That can’t continue.”

Mister fixer
Missouri Eye Institute also cares for Medicaid patients, a service Osborn considers more of a community responsibility than a business proposition.

According to a Kaiser Family Foundation report on Medicaid-to-Medicare fee indexes by state, Missouri’s Medicaid reimbursement rate was 59 percent of Medicare reimbursement in 2012. The national average was 66 percent Medicaid-to-Medicare fees, the report said.

“We’ve always felt like that was part of our community duty even though the state doesn’t feel like they should pay us anything reasonable,” Osborn says, noting the practice likely loses money on Medicaid office visits. “We never turn away Medicaid patients.”

Still, he appreciates the single focus of the eye care specialty.

“I like fixing things,” he says, comparing the role of an internal medicine doctor, who makes a diagnosis and recommendations. “You can’t make them lose weight. You can’t make them exercise. You can’t even make them take their pills. You get to manage chronic things, but you don’t always get to fix things.

“We have a very concrete problem,” he adds. “It’s fun to see the patients come in the day after surgery and they’re all excited because they haven’t been able to see in years. They didn’t even know how bad their vision was – then someone turned the lights on.”[[In-content Ad]]