EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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98 EW MEETING REPORTER February 2012 Reporting live from the 2012 Hawaiian Eye meeting EyeWorld launches new video-based Meeting Reporter for Hawaiian Eye Monday, January 16 What's new in 2012 Kevin J. Corcoran, C.O.E., C.P.S., F.N.A.O., a top ophthalmology con- sultant, reported that cataract sur- gery is no longer the number one ophthalmic procedure. Intravitreal injections have taken over the top spot, according to a review Mr. Corcoran's firm did of 2010 Centers for Medicare & Medicaid Services (CMS) data. The number one designation is not exactly good news for injections, which have been rapidly increasing in numbers, catching the eye of CMS. "Two things always happen: Reimbursement goes down, scrutiny goes up," Mr. Corcoran said. Mr. Corcoran reported several code and fee changes for 2012, as well as administrative changes and changes to incentive bonus pro- grams. The need for ophthalmic services continues to grow, and there will be more scrutiny of the Medicare program integrity, he added. He also advised surgeons to take advantage of three government in- centive programs: the Physician Quality Reporting System, e-pre- scribing, and the HIT program. "The first two are becoming in- creasingly easy to do," he said. "For 2012 you should be doing them. And you at least ought to be taking a look at health information technol- ogy, even if you're not in a big hurry to do it." E-prescribing only requires that Watch videos from Hawaiian Eye on your smartphone or iPad using your QR code reader. (Scanner available for free at your app store.) Or view the video at http://www.eyenewstv.com/hawaiimr Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2012 Hawaiian Eye meeting, Maui. physicians do 10 prescriptions elec- tronically in the first 6 months. "E-prescribing has a 1% bonus this year," Mr. Corcoran said. "If you don't do it, there will indeed be a penalty next year." Key practice drivers John B. Pinto, president, J. Pinto & Associates Inc., San Diego, spoke about the importance of optimizing revenue, not only containing costs, in a practice. "From a business per- spective, this is the key driver: What's the profit you are making per hour of your time," he said. "It is driven by four key items: individual energetics and productivity, utiliza- tion of surgical and testing services, appropriate coding, and cost con- tainment—in that order. Profit en- hancement is more a matter of revenue enhancement than cost con- tainment."Mr. Pinto said there was some "good" news, including the "market demand to not go blind." Ophthalmology has a high ben- efit-to-cost ratio, he added. "Passive income opportunities will still abound with dispensing, ASCs, labor substitution, automation, and opto- metric providers in owned delivery networks," Mr. Pinto said. He added that other good news includes the practice possibilities that stem from an aging population. Over the course of the next 10- 20 years, the growth rate for seniors is expected to be around 50%."That's 20 million more sen- iors in just 15 years. When you con- sider that seniors spend about 10 times as much on eyecare, you're going to be doing very well in that department," he said. "That's a rea- son, acknowledged or not, that many surgeons have been backing off their refractive practice and get- ting into the senior space." Tuesday, January 17 Aberrometry cuts enhancement rates "On-the-table enhancement with real-time aberrometry in the operat- ing room has reduced my need to perform post-operative enhance- ments by 80%," said Mark Packer, M.D., clinical associate professor, Oregon Health & Science University, Portland.Dr. Packer said he has been using aberrometry at the time he performs corneal relaxing incisions for the past 3 years. Dr. Packer meas- ures the residual astigmatism using wavefront aberrometry right in the operating room after he performs the lens implant and the corneal relaxing incisions. "I know from experience that if that residual astigmatism is 0.5 D or less, I'm home free," he said. "How- ever, sometimes I don't get the result I intend, even though I've cut accord- ing to the nomogram to the right depth and right location. For some reason or another, some corneas don't respond the same way." Dr. Packer said when he takes the measurements and discovers he has more than 0.75 D of residual astigmatism still on the table, he will enhance his relaxing incisions by extending the arc. "I've already cut to 90% depth," he said. "I don't deepen; I extend the arc. In addi- tion, if the axis is rotated, I will ex- tend the arc symmetrically if we have a clockwise rotation." Dr. Packer said by doing this, he has reduced his post-op enhance- ment rate to 3%. He presented an expansion of a study published in the Journal of Cataract and Refractive Surgery where he showed that he de- creased his enhancement rate (per- forming LASIK after multifocal lens implantation) from 16% to 3%. "Today, the expanded treatment group is up to 70 eyes, and the en- hancement rate, I'm pleased to say, is holding steady at 3%."