Eyeworld

EW MEETING REPORTER 100 EyeWorld/ASCRS reports from the 2019 Surgical Summit, January 31–February 2, Park City, Utah original surgeon was too anterior and asymmetric in their tunnel length. Dr. Fram exposed and cut the original flange on the side that was overlapping the iris and said cutting the flange on a bevel makes it easier to redock. She brought the haptic back into the anterior cham- ber, repositioned the IOL, and pro- ceeded with the Yamane technique. Dr. Fram also highlighted in a surgical video the importance of making sure your cautery is not near the patient's eyelid because it's not comfortable for the patient if you accidentally hit the eyelid. Yamane-fixated lenses, Dr. Fram said, are subject to tilt, pupillary capture, and CME. Thus, she said it is important to counsel patients that they might need to be on a nonste- roidal or there might be other issues that need to be addressed. One way she has reduced tilt in these cases is by using a modified marking system. It's important to be 180 degrees apart but you also need to have a 20-degree angle and 5-degree entry. Dr. Fram reminds herself to make the 20-degree angle by marking 180 degrees apart, then she goes over 2 mm and marks and goes down by 2.5 mm and marks. EW Editors' note: Dr. Fram has no financial interests related to her comments. or two but not all three criteria may opt into MIPS for 2019. Practices in areas with high participation in Medicare Advantage may be exclud- ed from MIPS. Finally, Ms. McCann highlight- ed key changes in quality reporting, noting quality reporting via Medi- care Part B claims is no longer an op- tion for large practices of 16 or more Medicare-eligible clinicians. Small practices of 15 or fewer may now report as a group through claims but must submit the other categories of MIPS as a group for CMS to score claims data collectively. Editors' note: Ms. McCann has no related financial interests. Yamane 'bloopers' Though the sutureless, double-nee- dle, flanged IOL fixation technique pioneered by Shin Yamane, MD, PhD, has become increasingly popular in the last few years, it is not without its nuances and compli- cations. Nicole Fram, MD, Los Angeles, presented several Yamane "bloop- ers." One video she showed was pulling too small of a flange back into the sclera. If this happens, you can retrieve it with a 30-gauge needle, but she emphasized that a bigger flange leads to safer surgery. Another case was refixation after pupillary capture. In this case, the Dr. Raviv said that with night- time visual phenomenon, it's important to explain halos and starbursts to the patient. In addition, there may be a need for additional procedures like laser vision correc- tion, an IOL exchange, or toric IOL rotation. Editors' note: Dr. Raviv has financial interests with a number of ophthalmic companies. Legislative and regulatory update Nancey McCann, ASCRS director of government relations, Fairfax, Vir- ginia, shared some of the key MIPS changes for 2019. The 2019 MIPS performance threshold is 30 points, which increased from 15 points in 2018. Physicians and practices must score at least 30 total points to avoid a 7% penalty in 2021. The cost category will count for 15% of a physician's final MIPS score in 2019, which is up from 10% in 2018. Additionally, the category now includes several episode-based cost measures, including one for cataract surgery. For 2019, five Medi- care Part B drugs are included, with one pass-through drug. These will be updated on a yearly basis. ASCRS is addressing the pass-through issue di- rectly with the contractor and CMS. Including pass-through drugs in the cost episode defeats the purpose of pass-through. Physicians and groups do not need to submit any data for this category, Ms. McCann said, because CMS will calculate the score based on administrative claims. In the promoting interoperabil- ity category, there were also some changes, namely streamlining and simplification of the requirements and scoring. Participants must report on a single set of required measures, measures requiring patient action have been removed, and health in- formation exchange measures have been modified. Additionally, all par- ticipants must use only 2015 edition certified EHR technology in 2019. She discussed the low-volume threshold. CMS maintained the threshold of $90,000 in allowed Part B charges or 200 patients and added 200 or fewer Medicare professional services. Physicians who exceed one March 2019 View videos from the 2019 Surgical Summit: EWrePlay.org Nicole Fram, MD, argues that DMEK is worthwhile even in complex cases.

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