Eyeworld

I WHAT OPHTHALMOLOGISTS SHOULD BE DOING TODAY N FOCUS 50 | EYEWORLD | OCTOBER 2019 by Liz Hillman EyeWorld Senior Staff Writer on paper," Ms. Simerson said. "The longer one waits, the more difficult it is to catch up." Choosing what to document When Richard Davis, MD, started his practice 20 years ago, his record system was digital out of the gate. At this time, going with an EHR was "much more difficult than today," he said. Overall, Dr. Davis thinks EHRs bolster efficien- cy, save space, help with regulatory compliance, automate pattern tracking (such as assessing trends charted out over time), and allow the physician to see the entire record easily in one place. "I think electronic documentation has the potential to be a better solution but also has the potential to create vast records that are mean- ingless," Dr. Davis cautioned. "Using the 'all normal' button to start a patient chart and mod- ifying it to illustrate the patient's condition is a usual tactic, but it may create misinformation. "On the other hand, if you have a great first examination outlined, pulling that forward and modifying it as appropriate saves a lot of time on subsequent exams. All too often, though, I see vast examinations documented for trivial problems, and it makes me wonder what was actually done," Dr. Davis said. Mr. Koch said paper records may have resulted in too little documentation but EHRs, as Dr. Davis expressed, tend toward "too much documentation due to automated functions, such as copy forward and auto-populating." In terms of what needs to be documented for insurance reimbursement, Mr. Koch said this is a complicated question. "It differs based on multiple factors. The exam, for example, should be coded based on the documentation after the exam rather than documenting to reach a certain level of ser- vice," he said. Ms. Simerson said documentation for insurance reimbursement includes the patient complaint, testing, diagnosis, assessment, and plan. "Be sure to use your Medicare LCD (local carrier determinations), as well as specific payer websites, for required documentation. Certain W ith electronic health records (EHRs) being used by 85.9% of office-based physicians 1 and be- ing incentivized through federal regulations, it's clear the paper- less record system is here to stay. As such, there are ways to maximize its potential and minimize its impact on practice flow. Physicians are not required to use a certified EHR, though choosing not to runs the risk of not meeting requirements in the Merit-based In- centive Payment System (MIPS) program. MIPS payment adjustments, William Koch, COA, pointed out, only apply to Medicare fee-for- service patients, but the MIPS program requires reaching a threshold (60%) of reporting quality data on all patients. In addition, small practices of 15 or fewer Medicare-eligible clinicians have the option of submitting a hardship request that would exempt them from the EHR-focused Promoting Interoperability category of MIPS and potentially limit the penalties for small prac- tices without EHR. "Some physicians make a conscious deci- sion not to implement an EHR because they think the cost of the system outweighs the po- tential penalties," Mr. Koch said. "However, the potential penalties are rising, which may cause a change in this philosophy. Not implementing an EHR may be advantageous to a physician who is retiring in the next couple years before the penalties increase beyond the point of dimin- ishing returns." Candy Simerson, FASOA, also said that at some point, it will be difficult to remain profitable on a paper system. In addition, as the market moves to value-based payments, practices will need to produce data that validate patient outcomes. Metric tracking and report generation will also be difficult with paper files, she said. "Many practices still on paper have senior physicians who want to hold out for retirement. However, if they want to sell their practice in the future, these physicians will take a hit to the valuation due to the fact that the practice is still Making the most of an EHR At a glance • While EHRs are not required, it could be difficult to achieve MIPS positive payment adjustments without them. • Auto-populating EHRs can lead to overdocumentation. Be conscious of what you choose to automate with these systems. • Use of scribes is a personal choice. Some doctors find they increase efficiency, while others wonder if efficiencies are offset by the cost.

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