At the Bethesda offices of eye doctor Mark E. Whitten, the influence of government regulation is pervasive but barely noticed. It's even evident in the placement of the lunch area, well removed from all sterile equipment. Yet for the most part, regulations fade into the background as office procedures become routine. These are things we do anyway.
Some requirements are more conspicuous than others.
Whitten performs laser eye surgery at the TLC Rockville Laser Eye Center, where he is participating in a federally regulated clinical trial of an experimental laser. The surgeon must take care to inform patients about the experimental equipment, and he must monitor their progress to help the Food and Drug Administration assess the device's safety and effectiveness. Medicare, the federal health insurance program for the elderly and disabled, covers many of the patients, and fulfilling its billing requirements can be a chore. To avoid trouble with the government, the doctors must thoroughly document the services they perform. When claiming reimbursement for a comprehensive exam, Whitten said, doctors ask patients about their smoking history and alcohol intake even though those questions may be irrelevant to the treatment at hand.