He saw flecks first. Tiny, gray things drifting around his vision like cockroaches scrambling for cover under the kitchen light. Annoying sure. Not urgent though. Or so he thought.
Seven days later the curtain fell. His left eye went dark, piece by piece, like a shade dropping over a window. A retina was peeling off the back of his eyeball
He had hours. Maybe less. Experts call it “before the sun rises again” kind of time. Any good eye doctor would jump on that case. Immediately. Unless that doctor answers to a private equity firm.
Then it gets tricky.
Private equity doesn’t buy practices to lose money. They buy them to make money, fast and cleanly. So they look at the ledger. They see that retinal detachment surgery costs about $8,000 to perform but Medicare pays them less than $4,000 for the trouble.
That’s a $4,000 loss per patient.
Most solo ophthalmologists shrug this off. They get paid over $400k a year anyway. The losses on the emergency cases get balanced out by the generous reimbursements on elective stuff like cataract surgery or Lasik. It’s a trade-off. Things work out in the end.
But private equity hates losing money. Even on the small stuff. Even when the big stuff pays well.
They direct clinicians to perform lucrative procedures while cutting or eliminating unprofitable ones
The math is simple to them. Stop doing the thing that loses you four grand.
And so they stop doing it.
About 50,000 people face retinal detachments every year. It’s urgent. You lose your vision forever if you wait. Yet studies show that retinal practices owned by private equity firms perform 20% fewer of these surgeries than their independent counterparts.
Twenty percent. Gone.
Is there a fix? Sure. Make Medicare pay more for the retina tears. Easy. But then they’d have to charge less for the other stuff to keep the system balanced.
Here’s where the wheels fall off.
Ophthalmologists love their high fees on non-emergency work. They lobby hard to keep them high. Ask them to cut the cash on the easy stuff to subsidize the emergency stuff, and watch the resistance mount. Powerful lobbyists don’t like seeing their margins shrink, even if it saves a few eyeballs.
The logical path is a revenue-neutral tweak. Fix the prices so the emergency surgery makes sense to perform and the elective work stays profitable without exploiting the system. Ophthalmologists can keep their six-figure salaries. Patients get saved. Everyone breathes a sigh of relief
But will anyone build it?
