To the Editor.
—In his Editorial1 discussing the results of a study that found cataract surgery to be performed twice as often in FFS settings when compared with prepaid ones,2 Dr Obstbaum certainly was correct in his conclusion that "[a]ny system... should comply with the published standards that reflect what is in the best interest of the patient." It should be noted, however, that the imprecision of current standards may, in fact, provide a likely basis for the difference found in the study.The primary indication outlined in the document Obstbaum cites3—ie, surgery should be performed "when cataract impaired vision no longer meets the patient's needs and the anticipated benefits of surgery exceed the risks"—is certainly a reasonable statement. Yet, by affording sizable discretion in surgical decisions, this indication actually facilitates the ability of financial incentives inherent in either system to act. If all decisions were "cut and dried,"
Kliger CH. Cataract Extraction Rates and Insurance Status. JAMA. 1997;278(18):1490. doi:10.1001/jama.1997.03550180040023