Show Summary

In this special Mailbag episode, John Kitchens, MD, and Scott Krzywonos take listener questions on cash-pay diversification, exploring whether concierge retina models could emerge in certain markets and what services like photobiomodulation might look like outside traditional insurance billing.

The conversation then turns to how payers may respond to high-cost emerging therapies — including tyrosine kinase inhibitors and gene therapy — and whether step therapy policies are likely to shift as these treatments approach the market.

The episode closes with a practical discussion on technology adoption, examining how practices weigh ROI, efficiency gains, and declining surgical reimbursements when deciding whether to invest in new surgical or imaging equipment.

Topics Covered

Cash-Pay Diversification in Retina

• Listener question from Jed Assam, MD (VRA Vision, Sioux Falls, South Dakota)

• Whether concierge retina could work, and whether VIP-style care models might translate to retina practices

• Potential cash-pay services such as photobiomodulation (PBM) therapy

• Operational considerations for scheduling concierge visits separately from standard clinic flow

• Geographic limitations for cash-pay models in smaller markets

Future Therapies and Insurance Coverage

• Listener question from Deepak Sambhara, MD (Eye Clinic of Wisconsin, Wausau, Wisconsin)

• How payers may respond to upcoming therapies such as tyrosine kinase inhibitors and gene therapy

• The likelihood of step therapy policies changing

• Pricing challenges for long-duration treatments

• Economic implications of one-time gene therapy approaches

Technology Adoption in an Era of Declining Reimbursement

• Listener question from Priya Vakharia, MD (Retina Vitreous Associates of Florida, Tampa, Florida)

• How practices decide when to adopt new surgical technology

• Cost pressures from declining surgical reimbursement

• Evaluating investments in surgical and imaging equipment

• The potential role of AI-driven analysis in improving efficiency and clinical decision-making

Key Takeaways

Concierge-style retina care may be viable in affluent metropolitan markets but remains niche. Insurance economics will strongly influence how quickly new therapies reach patients. Practices increasingly rely on ROI analysis and efficiency gains when deciding whether to adopt new technologies. Artificial intelligence may help practices manage growing data complexity, though its financial model remains uncertain.

Have a Question for the Next Mailbag?

RetinUp listeners can submit questions by sending a voice memo to info@retinup.com, leaving a comment on YouTube, or connecting with John and Scott on LinkedIn. Sign up for the newsletter at RetinUp.com.