One river many streams

Michael Mair FRANZCODirector Timaru Eye ClinicHealth Leaders ConferenceWellington NZ 04.05.07

Uniprice Public and Private funding for Ophthalmology

One set of equipment, one team, one building, one process

One price for clinic assessments Ideally, one surgical process Many funding streams The process managed, audited, monitored by Houston

Ophthalmology software.

http://www.houstonm.com/index.php?option=content&task=view&id=139

Funding for Timaru Eye Clinic

Public Inter District Flow (IDF) volumes ACC War Pensions Private insurance Police reports Private discretionary funds ?other

Eye Clinics in New Zealand working to this model Timaru Tauranga Rotorua New Plymouth

The problem: providing expensive care with limited resources Glaucoma, Cataract and Retina are the

‘big three’ in Ophthalmology

Glaucoma incidence and demographics in New Zealand 2% over 40, 10% over 80 have glaucoma Treating it costs $30 M per year in NZ It generates about 25% of FU attendances and 15% of

new patient referrals patients with early-stage or suspected glaucoma use

approximately $623 per year in health care resources, while patients with end-stage disease consume approximately $2,511.

Efficient Treatment is Equipment intensive

Treating Glaucoma Early Lowers Economic Burden,

……….. but the equipment is expensive

‘Perfect care’ might be unmanageable!

Current standards of care call for treatment of all patients who have glaucoma. .

We now treat individuals with glaucoma who have no field loss and no elevations in IOP, but do have characteristic optic nerve or nerve fiber layer loss.

such a treatment protocol could potentially place upward of 15 million Americans on treatment for Glaucoma, and about 200,000 NZ…

One river many streams

Use of ancillary staff Triaging screening

Age Related Retinal Disease

200620062050205021502150

1 in 10 are 60 years or over1 in 10 are 60 years or over

1 in 5 will be 60 years or over1 in 5 will be 60 years or over

1 in 3 will be 60 years or over1 in 3 will be 60 years or over

2006 100,000,000 Chinese 65 or over2006 100,000,000 Chinese 65 or over

IncreaseIncrease

%%2025 2025

AMDAMDPrevalencePrevalence

%%2000 AMD2000 AMD2000 50+2000 50+CountryCountry

30303,564,7503,564,75014142,735,5002,735,50019,429,00019,429,000UKUK

2525574,500574,5001414460,625460,6253,236,0003,236,000SwedenSweden

77772,711,5002,711,50014141,534,5001,534,50010,825,00010,825,000SpainSpain

72722,008,7502,008,75014141,165,8751,165,8758,563,0008,563,000PolandPoland

1616939,625939,6251616808,125808,1254,935,0004,935,000HollandHolland

5252385,2125385,212514142,530,6252,530,62517,997,00017,997,000ItalyItaly

105105200,375200,3751414107.500107.500761,000761,000IrelandIreland

21215,492,1255,492,12513134,441,5004,441,50033,559,00033,559,000GermanyGermany

42423,780,0003,780,00014142,653,2502,653,25019,046,00019,046,000FranceFrance

3737329,375329,3751515240,500240,5002,300,0002,300,000FinlandFinland

-13-13323,450323,4501313371,875371,8752,803,0002,803,000BulgariaBulgaria

3939668,000668,0001414481,500481,5003,476,0003,476,000BelgiumBelgium

6161535,875535,8751414322,875322,8752,377,0002,377,000AustriaAustria

AMD & European Union (EU)AMD & European Union (EU)

EU - 28 Million AMD PatientsEU - 28 Million AMD Patients

UK - 1 Million Pounds for every 145 UK - 1 Million Pounds for every 145 Treatable AMD PatientsTreatable AMD Patients

EU - 10’s of Billions of Euros overEU - 10’s of Billions of Euros over next 2 Decadesnext 2 Decades

20042004

20252025

How are we going to address this?

Rationalized high cost care No duplication of resources One river many streams…

Cataract – 80% of people over 80 have it Prioritization has shown wildly different

point score levels through out NZ 20 in Timaru, near 40 in some places A population generates approx 500 per

100,000 per year Efficient process is equipment intensive

The New Alcon Infinity Phaco Machine costs

over $120,000, the training for the people to use it much, much

more

Cataract is too expensive to duplicate resources One river, many streams Regularize the point score across DHB

boundaries Send the work where the capability exists

to do the work Local care for local people!! `(the elderly are frail….)

The Present Public/Private split

Ophthalmologists and their equipment are expensive

Present system depends on hypocrisy The public system pretends to deliver an

adequate service, the Docs clean up in private! A single process with different funding streams

allows for efficiency, sincerity, and planning

Inter District Flow Funding for Ophthalmology (Public Sector)

First assessment 153.11$ 157.93$ Follow up 112.69$ 127.77$ Argon laser 178.07$ 193.76$ Minor procedures 177.41$ 173.37$ Fundus screening 82.41$ 80.69$

2006/7 2007/8

The Houston Software generates any number of audits and reports Produced by The NZ Software Corporation Developed initially in the Timaru Eye Clinic A few token examples…

TIMARU EYE CLINIC CATARACT AUDIT 1

Cataract Operations•Total Number of Cataract Operations: 178

Left Eye: 73Right Eye:105

•Average Pre-op Acuity: Snellen 6/30Logmar 0.21 (6/6 = 1.00)

•Average Post-op Acuity: Snellen 6/9 Logmar 0.60 (6/6 = 1.00)

•Average improvement in Acuity 190.28%

•Change in Corneal H Shape 0.67%

•Change in Corneal V Shape 1.4%

•Capsule Ruptures 2.25% (4)

Anterior Chamber Diagnosis Incidence Breakdown

Iridoschisis

After-cataract, obscuring vision

Ocular laceration with prolapse or exposure of int

shallow

Cysts of iris, ciliary body, and anterior chamber

Scleritis and episcleritis

Other disorders of iris and ciliary body

Anterior scleritis

Posterior synechiae

Rubeosis iridis

Herpes zoster iridocyclitis

Recurrent iridocyclitis

Hyphaema

Primary iridocyclitis

Chronic iridocyclitis, unspecified

Recession of chamber angle

Operated Eye for Public CataractJan - Dec 2000

Right Eye59%

Left Eye41%

Operated Eye For Private Cataract Jan - Dec 2000

Right Eye53%

Left Eye47%

process

The Record

Meeting

Process

Parting

•Can this ever happen?

Can this ever happen? Can this ever happen? Can this ever happen? Can this ever happen? Can this ever happen? Can this ever happen? Can this ever happen Can this ever happen? Can this ever happen?

Thank you very much for your attention