If a hole existed into which money were flowing down the drain, would that hole be repaired? Maybe yes and maybe no, and understanding why we act the way we do when it comes to money is one of the basic tenets of behavioral economics. My contention here, and something that is supported by looking at conversations in online social forums such as Vision Therapy Parents Unite, or VTODs on Facebook, is that any discussion of neuro-optometric rehabilitation, optometric vision therapy, or behavioral optometry in general is incomplete if it doesn’t take behavioral economics into account. Considerations in behavioral economics aren’t unique to our field. They have become part and parcel of the way healthcare is practiced in many circles.
One of the more open and honest discussions of behavioral economics from the practitioner’s perspective that I have read in a long time is contained in a thought-provoking book authored by a family physician, Dr. Matthew Hahn. In its introduction, Hahn notes: “More and more, doctors and nurses fight not against disease, but against a rule-crazed administrative system hell-bent on wasting their time and denying patients care. They are being driven away from and even out of patient care, forced to focus instead on compliance with an ever-expanding universe of pointless rules and harmful regulations devised by bureaucrats and administrators who have no idea what they are doing and have little regard for the consequences of their actions. The practice of medicine, providing care to patients, has been shoved aside, replaced by a sea of distractions.”
If you’re more of a video viewer than a reader, you can glean highlights of the book through this C-Span interview. Most of the failing health care reform principles that Dr Hahn references emanate from CMS, the Center for Medicare and Medicaid Services. One of Hahn’s least favorite was the so-called “Meaningful Use”, a carrot-and-stick program designed to force practices away from paper files and into EHR (Electronic Health Records). The fact is that this program was more of a “Meaningless Use” of time and effort, but instead of organizing and challenging the program, most physicians complained but complied.
So-called Meaningful Use was phased out in 2016 and phased into further carrot-and-stick incentives that rewarded physicians for complying with these arbitrary data measures in a dizzying array of alphabet soup programs. One of them is MIPS, or “Merit-Based Incentive Payment”. God bless our colleagues who get turned on by chasing after these incentives, and here is a snapshot of MIPS, from which most optometrists will thankfully be exempt:
I made the financial decision when all of this was beginning to remain outside the system for all of these governmental reward-and-punishment schemes. It made no fiscal sense to rush to comply with the hassle of doing something for which you’d be rewarded with a percentage point or two of income, or penalized by a point or two for not following the herd. You’d have to reward or penalize a practice alot more than that before the extra overhead for playing this game would more than pay for itself.