Eyeworld

JUN 2019

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/1123870

Contents of this Issue

Navigation

Page 26 of 70

N EWS This includes only surgeries billed with CPT code 66984. No other cataract surgeries, such as 66982 complex cataract surgery, will be included in the measure. In addition, ASCRS was successful in advo- cating for excluding any patients with significant ocular comorbidities from this measure. "Sicker patients are typically more expensive to care for, and if CMS attributes that added cost to a given ophthalmologist, we will have a system that penalizes doctors for treating the sickest among us," Dr. Parekh said. These comorbidity exclu- sions are identical to the exclusionary criteria for the cataract quality measure 191, 20/40 or Better Visual Acuity 90 Days following cataract surgery. Using the current pass-through drug on a patient otherwise excluded from the measure, such as through complex surgery or because of an exclusionary comorbidity, will not be includ- ed and therefore will not impact the episode measure score. Cataract surgery episode sub-groups Because the cost of cataract surgery varies greatly depending on whether it is performed in an ASC or an HOPD, the cataract episode separates surgeries into sub-groups to compare the cost of similar surgeries in similar contexts. "ASCRS insisted that the cost measure be a fair, apples-to-apples comparison," Dr. Parekh said. To further sub-divide the episodes, there are sub-groups for whether one surgery was performed within the 90-day window of the measure (unilateral) or if the second eye was operated on within the 90-day global of the first surgery (bilateral). Cataract Awareness Month continued from page 23 Therefore, the measure assigns each ep- isode to one of four sub-groups: ASC, uni- lateral; ASC, bilateral; HOPD, unilateral; and HOPD, bilateral. Cataract episode measure score To calculate the total measure score, CMS will evaluate each surgery, or episode, and calcu- late an "observed" cost and compare it to the national average "expected" cost for its sub- group. This is done by dividing the observed cost of the episode by its expected cost, which expresses the observed cost's deviation from the expected cost as a ratio. CMS will add all the episodes' ratios together, across all sub- groups, and divide that sum by the total number of episodes to determine the total average of the surgeon's episodes' deviations from the expected costs. That figure is then multiplied by a national average total cost to represent the surgeon's average deviation from expected costs as a dollar figure. If the surgeon is reporting MIPS as part of a group, the group's combined average cost is calculated. CMS then compares the physician's or group's average cost to a benchmark and as- signs the measure a score of 1 to 10 points. The benchmark will be determined based on cost data from the performance period. The lower the average cost of the cataract episode, the higher the measure score will be. Once the cataract episode measure is scored, CMS then determines the Cost category MIPS score for the physician or group. Several vision health organizations recognize June as Cataract Awareness Month. The nonprofit Prevent Blindness estimates that the number of cataract cases—already the leading cause of blindness in the world—will in- crease 78% by 2050. During this month, inform patients about the risk factors that can lead to cataracts (age, certain diseases, exposure to UV sunlight, etc.), the symptoms of cataracts (blur- ry/cloudy vision, glare, poor night vision), and about the safety and efficacy of cataract sur- gery. The National Eye Institute reports better vision after cataract surgery in 90% of cases. 24 | EYEWORLD | JUNE 2019 Online resources from ASCRS Members-Only Guide on the Cataract Surgery Episode-Based Cost Measure ascrs.org/media/8265 MACRA Center ascrs.org/macracenter MIPS Category: Cost ascrs.org/ mipsresourceuse

Articles in this issue

Links on this page

Archives of this issue

view archives of Eyeworld - JUN 2019