JUN 2013

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

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62 EW MEETING REPORTER Reporting from the 2013 ASCRS•ASOA Symposium & Congress, San Francisco Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2013 ASCRS•ASOA Symposium & Congress, San Francisco. June 2013 Reporting continued from page 61 Case-based payment could be way of healthcare future Moving away from current fee-forservice care toward more personalized patient care using a case-based payment system could be the future of healthcare reform said Mark B. McClellan, MD, speaking at the Government Relations General session titled "Physician Leadership for HealthCare Reform." Dr. McClellan discussed healthcare reform for payments based on value. "If you look at what we're facing in the need for healthcare reform, there's a lot of talk about cutting costs. I know that a lot of you have felt a squeeze on the payment rates year after year because we haven't come up with a better approach to solving some of our healthcare policy problems," said Dr. McClellan, director of the Engelberg Center for Health Care Reform, and Leonard D. Schaeffer Chair in Health Policy Studies, Brookings Institution, Washington, D.C. In his talk, Dr. McClellan said expanded insurance coverage is likely insufficient and policy reform for more personalized healthcare at lower costs is key. He said effective healthcare reform needs more accountability and support for valuebased care. He touched briefly on 2013 issues including Affordable Care Act (ACA) implementation, Medicare physician/clinician payment reform and scope of practice regulation and reimbursement, focusing mainly on value-based healthcare reform, including measures of value and outcomes, payment reform such as accountable care organizations (ACO), and bundled payments. "The way that fee-for-service payment rates have gone in the past years, they're not keeping up with your costs of practice and don't permit … a culture change needed in investments to set up new relationships with ACOs and investments in ambulatory facilities that are cheaper than the outpatient hospital alternative," he said. Dr. McClellan said another problem with payment reform for physicians is that specialties some- Warren Hill, MD, speaks at an ASCRS symposium. Source: EyeWorld times create a "circle of wagons" around the topic. "[It's] focused on the cost of care and payments in Medicare for clinician services only," he said. "That's only about 17% of all Medicare payments. What really matters is physicians' decisions and with the physician payment system as a result, its impact on the rest of Medicare spending. So more than 80% of spending in total depends on what happens with physician decisions. Physicians work with things like what [kind] of care patients are using for treatment, whether complications can be prevented, whether [there are] more efficient ways of using hospitals, drugs, devices, imaging, everything else that Medicare pays for. Nothing in Medicare's current fee-for-service system does anything to help encourage progress on that front—that's the big opportunity for cost-savings and health improvements in our healthcare system." Science and Medicine Lecture looks at medical decision making The ASCRS Science and Medicine Lecture, given by Jerome Groopman, MD, Boston, and Pamela Hartzband, MD, Boston, focused on medical decision making, both from a patient and physician perspective. Dr. Groopman discussed medical decision analysis that is linked to economics and trying to calculate decision making through formulas. A formula from mathematician Daniel Bernoulli is often used and is calculated by looking at the probability of a certain outcome and multiplying it by the utility or impact that the outcome has. Dr. Groopman said this theory has been imported into medicine. "You can estimate the probability of an outcome." However, he said it's hard to put a number on how a patient's life will be affected. There are three methods that have been used for medical decision analysis. The first is a linear scale, he said, with numbers from zero to one. Zero is death and one is perfect health. The patient determines where he or she would classify life on the scale after developing a certain condition or complication. The second method is a time trade off, which asks the patient to determine how many years of life he or she would be willing to give up to avoid becoming incontinent or impotent. The third method is the standard gamble, he said, derived from game theory. In this method, patients are asked to imagine that they have a magic pill to prevent an outcome, however, in some cases there is instant death. Research shows that all three methods are flawed, Dr.

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