Eyeworld

N EWS 22 | EYEWORLD | JUNE 2019 Contact information Parekh: parag2020@gmail.com Nancey McCann: nmaccann@ascrs.org by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor cataract surgeons with 10 cases that meet the at- tribution criteria. ASCRS served on a technical expert panel (TEP) convened by CMS and the contractor developing the measure, Acumen, to provide input on the development. Episode-based measures were developed in addition to existing population-based mea- sures, which were first used in the Value-Based Modifier Program and continued into MIPS. Population-based measures seek to measure the total cost of care for a patient in a year and may hold physicians responsible for the cost of care they did not provide. ASCRS, ASOA, and others in the medical community have long advocated for the devel- opment of episode-based measures to ensure that physicians are only evaluated on the costs of care that they can influence. Costs included in the cataract episode measure The cataract surgery measure new in 2019 mea- sures the costs 60 days prior to the surgery and 90 days following, including preoperative care, I n 2019, the Merit-Based Incentive Payment System (MIPS) includes a new cataract surgery episode-based cost measure in the Cost category. Following the MACRA technical corrections enacted in early 2018, CMS is continuing the MIPS transition period by keeping the weight of the Cost category low, at 15% of the final MIPS score. 2019 performance in MIPS impacts 2021 pay- ments. MIPS episode-based cost measures and the cataract episode measure In addition to the existing population-based cost measures in the Cost category—total per capita costs and Medicare spending per beneficiary—CMS has included several new episode-based cost measures that seek to mea- sure the total costs of patient care related to a specific "episode," such as a surgical proce- dure or inpatient hospital stay for a particular condition. Cataract surgery is included as a procedural measure and will be attributed to How the new 2019 MIPS cataract episode-based cost measure will impact you About the doctor Parag Parekh, MD Chair ASCRS Government Relations Committee Part B drugs included in the cataract episode measure *The cost of these drugs will not count against the measure score if used on a patient who is otherwise excluded from the measure because of complex surgery or ocular comorbidities. HCPCS code Included diagnoses C9447, Injection, phenylephrine and ketorolac, 4 ml vial Included regardless of diagnosis (currently on pass-through) J0278, Injection, amikacin sulfate, 100 mg H44.021, H44.022, unspecified purulent endophthalmitis J0713, Injection, ceftazidime, per 500 mg H44.021, H44.022, unspecified purulent endophthalmitis J3370, Injection, vancomycin hcl, 500 mg H25.11, H25.12, age-related nuclear cataract; H25.811, H25.812, combined forms of age-related cataract; H26.8 other specified cataract; H26.9 unspecified cataract; H44.021, H44.022, unspecified purulent endophthalmitis J3465, Injection, voriconazole, 10 mg H44.021, H44.022, unspecified purulent endophthalmitis; H44.011, H44.012 panophthalmitis (acute)

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