Dr. Todd L. Jackson | Crain's

In this ongoing series, we ask executives, entrepreneurs and business leaders about mistakes that have shaped their business philosophy.

Dr. Todd L. Jackson


Dr. Todd L. Jackson started Prestige Laser and Cataract Institute five years ago. After merging with NV Eye Surgery, the new company now operates three offices in the Las Vegas area, along with a satellite office in Pahrump, and employs 48 people. Collectively the offices see about 2,000 patients per month. Jackson and his partner, Dr. Peter W. DeBry, pioneered office-based cataract surgery in Nevada, reducing the cost to patients and insurers while also decreasing the procedure time.

The Mistake:

I wish I had had a better understanding of the regulatory environment of Nevada when I started. If I knew then what I know now, I would have started working with the governor's office and legislators to change policies in Nevada to help revolutionize the healthcare system here and put the power back in the hands of those who have the most intimate and close relationships to the patients – the healthcare providers.

I made a mistake early on thinking, "Hey, you're a doctor, you can just go hang a shingle outside, there's going to be patients for you to see, insurance companies are going to pay you fairly. You're going to be able to interface with the healthcare system just like you did in Wisconsin and Texas. Things are going to be wonderful." That is not how it is in Nevada. Nevada ranks as one of the worst places in the country to practice medicine.

There is a shortage of physicians in Nevada. You would think that would be a good problem if you're a physician because you would have plenty of patients to see, but because of the managed care environment of Nevada, if you are outside of the managed care system there is a scarcity of patients because most patients are being funneled into these managed care organizations that are controlled by these very large insurance contracts.

Most insurance companies are out to make money, which means they limit healthcare. They ration it, and they sometimes have very select providers, which means you have to wait a long time to see one.

Who has the best interests of patients in mind? The healthcare professionals. Yet if you ask physicians ... I think most physicians would say, "No, I feel very little power; I feel like I'm being dictated to by the insurance company."

For example, I take care of individuals with glaucoma. There are only four main classes of glaucoma medicines and two of the main drugs are on shortage right now. Insurance companies say, "Substitute it with this or substitute it with that." We can't even get one of four basic medicines to help people from going blind. What is this system coming to?

Who has the best interests of patients in mind? The healthcare professionals.

The Lesson:

What I would recommend to physicians or other healthcare providers who are going to be practicing in Las Vegas is to get involved on the state level right away. Understand the policies and what you can do so that we can be the best advocates for your patients.

There are some very simple solutions to revolutionizing healthcare in Nevada, and other states have already implemented some of these things.

There can be laws enacted that give physicians more of the power to make healthcare and spending decisions for their patients. For example, if an insurance company decides to delay their payment to me for 60 or 90 days, there is no law on the books that says that they have to pay a late fee.

Nevada wants more healthcare providers and physicians but we have some of the lowest reimbursements for healthcare providers in the country, and that has led to a shortage because why would you want to come practice in Las Vegas? If I didn’t have such deep roots in Las Vegas, I wouldn't be here.

So start working with the governor's office and state legislators and have a voice because you can make a difference. Sometimes you feel like you can't, but you're the one who is crying with the patient who has gone blind from a preventable condition. You can help lawmakers in Nevada be better.

Let's make Nevada one of the best reimbursement states for healthcare providers and let's put legislation in place that puts more power to help patients into the hands of providers and out of the hands of the insurance companies, and release the innovative power of thousands of healthcare providers who intimately care for and love their patients.

Photo provided by NV Eye Surgery

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