Eyeworld

JUNE 2022 | EYEWORLD | 43 continued on page 44 Relations Committee session: "Same-Day Alternative Payment Model (APM): for You" About the speakers Steve Arshinoff, MD Associate Professor University of Toronto Toronto, Canada John Berdahl, MD Vance Thompson Vision Sioux Falls, South Dakota Arthur Cummings, MD Wellington Eye Clinic Dublin, Ireland Harold Miller President and CEO Center for Healthcare Quality and Payment Reform (CHQPR) Pittsburgh, Pennsylvania What would a good alternative payment model look like? Instead of paying every health- care provider separately, he suggested a single "bundled" payment to the full care team and let the team divide the payment based on costs. If the care team can reduce the cost of the proce- dure, it decides how to share the savings among the team members. The team could also offer a lower price to patients and payers. Mr. Miller discussed how a warranty might fit as part of this payment model, which is not an outcome guarantee. Offering a warranty on care does not imply that you are guaranteeing a cure or a good outcome. It merely means that you are agreeing to correct avoidable problems at no additional charge. Most warranties are "limited warranties," he added, in the sense that they agree to pay to correct some problems but not all. From a surgeon's perspective, with fee for service, if you have a lower-than-average rate of complications, your payment will be lower. The notion of a warranty, Mr. Miller said, flips this. Surgeons make more money for successful procedures and make less money when com- plications occur. Physician-designed APMs can help solve fee for service problems. Dr. Berdahl discussed the opportunities that were identified as priorities for a potential APM in cataract surgery by the ASCRS/ASOA task force, particularly: performing more proce- dures outside of HOPD (ASC or office), reduc- ing unnecessary non-ophthalmic preoperative testing, performing same-day, bilateral surgery, and using intraoperative medications to replace postoperative medications. The ASCRS draft APM includes a bundled payment for same-day, bilateral cataract surgery to appropriate patients. The surgeon, anesthesi- ologist, and facility establish a Cataract Surgery Team that accepts a single, bundled payment, which is then divided among team members. The model includes a warranty for complica- tions, whereby the payment covers the cost of surgery, including the anesthesia and facility fee, as well as complications that most common- ly occur. Since the payment is fixed, Medicare will not pay more if complications occur, and profits would be higher for a surgery team with low complications. The model excludes services, such as postoperative medications, intraoper- ative medications, anything beyond 90 days, and non-ophthalmic services. This is limited to uncomplicated cataract surgery, 66984, and includes a limitation on financial risk. Surgeons who have low rates of post-surgical complica- tions and good visual outcomes receive higher net payments than they currently receive, and if the model qualifies as an advanced alternative payment model, the team could receive a 5% bonus. Dr. Arshinoff discussed the history and evo- lution of immediate sequential bilateral cataract surgery (ISBCS). He noted that intracameral antibiotics dramatically reduce the incidence of postoperative endophthalmitis. Dr. Arshinoff did his first elective ISBCS in 1996. He cited a paper he and colleagues pub- lished in the Journal of Cataract & Refractive Surgery in December 2021 reviewing cases of bilateral simultaneous postoperative endoph- thalmitis over the past 50 years and said there have only been nine cases during this time. Dr. Berdahl gives an overview of the ASCRS draft alternative payment model for same-day, bilateral cataract surgery. Source: ASCRS

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