Transcript Case Study Conflict of Interest - American Academy of Ophthalmology

Case Study
Conflict of Financial Interest
Billing for Unnecessary
Procedures
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.
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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.
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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”
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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.
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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.
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Case Discussion
 What ethical issues, and corresponding Rules
of the Code of Ethics, are involved in this
case?
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Case Discussion
 Applicable Rules of the Code of Ethics:
• Rule 2. Informed Consent
• Rule 9. Medical & Surgical Procedures
• Rule 10. Procedures and Materials
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Case Discussion
Ethical Issues
Rule 2. Informed Consent
 The performance of medical or surgical procedures shall be
preceded by appropriate informed consent.
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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.
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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.
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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.
AMERICAN ACADEMY OF OPHTHALMOLOGY
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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.
AMERICAN ACADEMY OF OPHTHALMOLOGY
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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?
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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?
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