Eyeworld

If we don't pay attention to it, those patients are not going to like that." Currently, of the three ways to correct astigmatism (excimer laser, toric lenses, and corneal incisional surgery), most surgeons use toric lenses, Dr. Kim said. "The excimer laser is extremely effective at treat- ing astigmatism," he said. "Unfortu- nately, it's a separate surgery." Limitations of toric IOLs include the possibility of IOL calculation error and post-op rotation. "Torics rely on accurate alignment," Dr. Kim said. "Even if you place the lens perfectly on the axis, there have been cases where the lens can rotate post-oper- atively … then you have to go back, inflate the bag, and reposition the lens." Good alignment is also needed with peripheral corneal relaxing in- cisions in order to get the best result. The fact that the femtosecond laser is automated is intriguing, Dr. Kim said. "All of this is automated—the depth of the incision, the length of the incision," he said. "That's an amazing component to this technol- ogy. It's an easy procedure to per- form, and it's forgiving. It's repeatable. There's a fairly quick re- covery. It's a great technology that can alleviate the astigmatism, but again, it's another surgery." SATURDAY Day 2 of the ASCRS/EyeWorld Town Hall Meeting on Laser-Assisted Cataract Surgery opened on Satur- day, July 16, with a lively discussion on the controversial matters of com- pliance and Medicare payment sur- rounding the new technology. This was followed by a panel dealing with questions regarding the cost ef- fectiveness of femtosecond cataract surgery—both for the patient and the practice. The third session of the day gave physicians who have im- plemented laser-assisted cataract surgery a chance to share their work- flow practices. The day closed with an open discussion on who's operat- ing the laser and related implica- tions. How do I stay in compliance and still get paid? ASCRS Government Relations Direc- tor Nancey K. McCann discussed Medicare reimbursement realities, carefully laying out the well-defined coverage and payment parameters set up by the U.S. government. The procedure on a medically necessary cataract, no matter how it is per- formed, is covered under Medicare. The covered procedure includes making an opening in the eye to permit entrance of the surgical in- struments, capsulorrhexis of the an- terior capsule, and fragmentation of the lens nucleus. Pre-op, intraopera- tive, and post-op care is covered, Ms. McCann said. Ms. McCann empha- sized that surgeons cannot charge more for cataract surgery just be- cause they are using a femtosecond laser. "You cannot bill the patient extra for anything that is part of the covered service," she said. "Medicare doesn't care what you use to do the procedure." However, non-covered services, such as astigmatism correc- tion, which is also performed by the femtosecond laser, could be billed to the patient. Long-term Medicare payments will be based on quality, outcomes, and efficiencies. "We have to look at the long-term reim- bursements because the way you are getting paid today is not the way you will be getting paid tomorrow," she said. Medicare will become a value-based budget neutral payment system by 2017 based on outcomes and efficiencies. "That means no more money is going to be coming into the system," Ms. McCann said, clarifying that the new system will be one of penalties and bonuses, meaning if one surgeon gets a bonus, another will be penalized in order to keep the system balanced. "There are no floors and ceilings. You're going to be compared to other physicians in your geographi- cal area," she said about future Medicare payment parameters. Sur- geons employing the technology should be cautious when touting the potential benefits of the surgery. "I'm very concerned when I hear physicians use words like quicker, safer, easier, and better outcomes, particularly when there isn't any data to back that up." Kevin J. Corcoran, C.O.E., C.P.C., F.N.A.O., president, Corcoran September 2011 C E R T I F I E D O P H T H A L M I C E X E C U T I V E www.ASOA.org Leaders in Managing the Business of Ophthalmology C E R O F T I F I E D O E E ober R IC S Y H P E Y E "G COE designation oing for the COE "G OE designation d a goal lik and professionalism. W also newfound c in running an ophthalmolo administr "G d a goal like that, it sp When y ofessionalism. Wh also newfound condenc in running an ophthalmolo r istr tor not only gr ator not only gr through ASOA gav OA ga "G e that, it speaks miles for hen you work ondence, asser e, asser e tiv s, eness, in running an ophthalmology practice but or not only gr ter exp eater expertise e ave our e but were able t gr w. A ew. A mo e ve f your desir your de to toward a goal lik e able to grow much mor . And because of her leadership e forward in the futur our desire and your det d a goal like that, it sp uch more proac e tively p, w er leadership, we d in the future We gr . We gr w. She ew. She termination as y termination as you e that, it speaks miles for y. y." ou eaks miles for mer he A T est the fast thalmic pr oph our sta up f Sign y thalmic A y of Oph ociet ican S mer cur , and ac eliable , most r est . e sta . tic ac thalmic pr ee trial memb or a fr r sta up f o ors— t a dministr thalmic A or e f c esour e r t a cur ership! ee trial memb our sta up f Sign y all Susan a C or email s g ee trial memb or a fr r sta up f o t 703-591-2220 all Susan a g @ usan@asoa.or . g A.or .ASO w w w ership! ee trial memb continued on page 86

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