RetinUp Mailbag – Cash Pay Models, Emerging Therapies, and Tech Adoption During Reimbursement Reductions

Hosts:John Kitchens, MDScott KrzywonosShow SummaryIn this special RetinUp Mailbag episode, John Kitchens and Scott Krzywonos answer listener questions from retina specialists around the country about three issues: cash-pay diversification, the future of emerging therapies in light of payer realities, and how practices can realistically adopt expensive new technology as reimbursements decline.The conversation explores whether concierge retina models could emerge in certain markets, how insurers may respond to high-cost innovations like gene therapy and tyrosine kinase inhibitors, and what practical frameworks practices use when deciding whether to invest in new surgical or imaging equipment.Throughout the episode, a central theme emerges: innovation in retina continues to accelerate, but reimbursement pressure is forcing practices to rethink business models, technology adoption, and long-term sustainability. Topics CoveredCash-Pay Diversification in RetinaListener 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 practicesPotential cash-pay services such as photobiomodulation (PBM) therapyOperational considerations for scheduling concierge visits separately from standard clinic flowGeographic limitations for cash-pay models in smaller marketsFuture Therapies and Insurance CoverageListener 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 therapyThe likelihood of step therapy policies changingPricing challenges for long-duration treatmentsEconomic implications of one-time gene therapy approachesTechnology Adoption in an Era of Declining ReimbursementListener question from Priya Vakharia, MD (Retina Vitreous Associates of Florida, Tampa, Florida)How practices decide when to adopt new surgical technologyCost pressures from declining surgical reimbursementEvaluating investments in surgical and imaging equipment The potential role of AI-driven analysis in improving efficiency and clinical decision-makingKey TakeawaysConcierge-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 [email protected], leaving a comment on YouTube, or connecting with John and Scott on LinkedIn.Sign up for our newsletter at RetinUp.com.