Eyeworld

UPDATE 14 Quality Payment Program hardship exception applications, including Promoting Interoperability Small Practice Hardship Applications, due December 31 C MS has released two hardship exception applications for pro- gram year 2018 for payment year 2020 on the Quality Payment Program webpage (qpp.cms.gov), including: the Promoting Interoperability (PI) Hardship Application, which includes the small practice hardship for practices of 15 or fewer Medicare-eligible clini- cians, and the MIPS Program Extreme and Uncontrollable Circum- stances Application. Promoting Interoperability Hardship If you're participating in MIPS during the 2018 performance year as an individual, group, or virtual group—or participating in a MIPS Al- ternative Payment Model (APM)—you can submit a Quality Payment Program Hardship Application for the PI performance category, citing one of the following specified reasons for review and approval: • MIPS-eligible clinicians in small practices (new for 2018) • MIPS-eligible clinicians using decertified EHR technology (new for 2018) • Insufficient internet connectivity • Extreme and uncontrollable circumstances • Lack of control over the availability of certified electronic health record technology (CEHRT) An approved Quality Payment Program hardship exception will: • Reweigh your PI performance category score to 0 percent of the final score • Reallocate the 25% weighting of the PI performance category to the Quality performance category You must submit a hardship exception application by December 31, 2018, for CMS to reweigh the PI performance category to 0%. Extreme and uncontrollable circumstances MIPS eligible clinicians who are impacted by extreme and uncon- trollable circumstances may submit a request for reweighing of the Quality, Cost, and Improvement Activities performance categories. "Extreme and uncontrollable circumstances" are defined as rare events (highly unlikely to occur in a given year) entirely outside your control and the facility in which you practice. These extreme and uncontrollable circumstances would cause you to be unable to collect information necessary to submit for a performance category, or to submit information that would be used to score a performance category for an extended period of time (for example, 3 months unable to collect data for the Quality performance category). In your application, you must indicate the performance categories that were subject to an extreme and uncontrollable circum- stance and how the circumstance affected your ability to collect or submit data for the 2018 MIPS performance year. The application for extreme and uncontrollable circumstances must be submitted by December 31, 2018, for the 2018 MIPS perfor- mance year. EW Editors' note: Go to ascrs.org/node/32509 for the original announcement, complete with hyperlinks to related information and resources. From Washington Watch In the journal Intraoperative complication rates in cataract surgery performed by ophthalmology resident trainees compared to staff surgeons in a Canadian academic center Stephanie Low, MD, Rosa Braga-Mele, MD, David Yan, MD, Sherif El-Defrawy, MD In this prospective North American case series, investigators consid- ered how consecutive phacoemulsification patients fared when treated by residents versus staff surgeons. Of the 8,738 cases included, 3,845 involved resident participation, with 82% of these performed entirely by the trainees themselves. The staff surgeons meanwhile completed 56% of cases without any trainee involvement. Approximately 1/3 of the cases were categorized as complex. When simple and complex cases were compared, investigators found that there was no difference in over- all complication rates, posterior capsular rupture rates, or vitreous loss rates. Investigators concluded that in terms of complication rates both groups fared the same. Surgical options for enhancement after SMILE: the advantages and disadvantages Majid Moshirfar, MD, Tirth Shah, BS, Maliha Masud, BS, Steven Linn, OD, Yasmyne Ronquillo, MD, Phillip Hoopes Sr., MD Does the fact that the SMILE procedure lacks a standard enhancement approach hinder acceptance of the technique? Investigators pointed out that not only have more than 1 million patients undergone SMILE worldwide, but visual results were nearly equivalent to LASIK, which has had 20 years to improve outcomes. Still, inevitably some require retreatment. Investigators reviewed advantages and disadvantages of the retreatment options, which include surface ablation, thin-flap LASIK, CIRCLE, and re-SMILE, and also considered the literature to compare visual outcomes. Based on this, investigators provided retreatment deci- sion-making guidance, offering an algorithmic approach. Precision of intraocular lens power prediction in eyes shorter than 22 mm: an analysis of six formulas Ankur Shrivastava, MS, Pranayee Behera, MS, Binod Kumar, BSc (Optometry), Siddhartha Nanda, MD The aim of investigators in this retrospective study, involving eyes with an axial length of less than 22 mm, was to compare the precision of six different lens power formulas in such eyes. Included here were 50 eyes that met the axial length requirement. Investigators analyzed outcomes with each of the six formulas, the Barrett Universal II, Haigis, Hoffer Q, Holladay 2, Hill-RBF, and SRK/T, and compared the median absolute error. They found that there was no significant statistical difference with these with either post hoc analysis or Bonferroni correction for multiple comparisons. Investigators concluded that in eyes shorter than 22 mm, all six of the formulas offered equally accurate results for predicting intraocular lens power. EW November 2018

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