The way providers so poorly manage diabetic retinopathy is a poster child for what's so wrong about our healthcare system.
This potentially blinding eye disease affects up to 45% of the 26 million Americans with diabetes. It is silent and gradually erodes vision in a way patients often don't notice until it's too late. Unless they're regularly screened for the disease.
It's also very expensive. The malady carries a $900,000 lifetime medical and societal cost per patient.
We could and should do better by these patients, but here's how we thwart efficient quality of care and allow the diabetes cost curve to soar:
We rely on referrals. We want primary care doctors to give their diabetic patients a referral to an ophthalmology retina specialist for annual eye screening, necessitating they make an appointment with yet another practitioner, who in remote or low-income areas may be hard to find.
We have long realized that about half of these patients never make it to the test, either because they can't afford it, live too far away, or just don't understand the urgency. In low-income populations only 10% of patients with diabetes are getting screened for eye disease.