Eyeworld

AGBC 1347 Rev.C 3360 Scherer Drive, Suite B, St. Petersburg FL 33716 800-637-4346 • Tel: 727-209-2244 • Fax: 727-341-8123 Email: Info@RheinMedical.com • Website: www.RheinMedical.com 1 Developed In Coordination With Juan F. Batlle, M.D. 2 Developed In Coordination With Elie G. Khouri, M.D. 3 Developed In Coordination With Steven L. Maskin, M.D., Patent Pending. 4 Developed In Coordination With David R. Hardten, M.D. 5 Developed In Coordination With James Tearse, M.D. Background, Expressed Lid Image 08-01720 Tearse 5 Meib um Com pression Forceps 08-01718 Batlle 1 Eye lid C om p ression Forceps 08-01719 Khouri 2 Eyelid Squeegee 08-01 7 16 M askin 3 Mei bu m Expressor 08 -01717 H a rdten 4 Eyelid Compression Forceps Meibum Expressors Hardten 4 Tearse 5 Batlle 1 Khouri 2 Maskin 3 Come See Us At ESCRS Booth No. D10 of the Medicare Payment Adviso- ry Commission under President Clinton, predicted, "But as in so much of health care, the devil is in the details, and those have not been spelled out." 1 MACRA provides a grace period with 0.5% increases in reimburse- ment beginning on July 1 and extending through 2019. The cost of a practice will outstrip this aggregate 2.5% minim; proponents proclaim it the necessary expedient. Carrots and sticks of Meaningful Use (MU), PQRS (Physician Quality Reporting System), and the Value-Based Pay- ment Modifier remain intact until 2019; indifferent practitioners will suffer reductions in reimbursement. The aforementioned 3 reports will eventually become 1 system. And, don't fall behind to the IRS. MACRA intensifies the govern- ment's ability to collect overdue fed- eral taxes by expropriating Medicare payments. After 2019, it gets interesting. Ophthalmologists must choose among 3 alternatives. Behind curtain number 1 is MIPS, the fee-for-service option. Doctors will be graded against predetermined thresholds based on the new reporting system. Adding a fourth element, clinical practice improve- ment, the thresholds will incorpo- rate elements of MU, PQRS, and Value-Based Payment Modifiers … or not. Some wonder if these pro- duce metrics accurately measuring quality. Exceeding threshold value proxies, providers reap bonuses between 4 and 9%; the truly excep- tional may earn up to 3 times the amount of the penalty floor for that year. Conversely, those failing to meet thresholds are penalized on a sliding scale to 9%. According to the American Medical Association, performance will be judged on 4 parameters graded 0–100: quality, resource utilization, meaningful use, and clinical practice improvement activities. Maintenance of Certifi- cation helps meet the latter but is not yet mandatory. Contrary to FFS, increasing volume of services can lower remuneration. MIPS reporting is required of optometrists and other non-MD providers. Behind curtain number 2 are the APMs. Beyond some initial suc- cess, it is unsettled that these work. Favored by hospitals, ACOs are the progenitors. Their introduction to Medicare has been bumpy. Some pioneer ACOs have dropped out. ACOs can capture greater financial reward than MIPS providers but incur greater downside risk. The darling of the American Academy of Family Practitioners (AAFP), the medical home, is another contender. The PCMH incurs little downside risk as long as the model shows quality improvement without in- creasing cost. According to Medical Economics, one-third of AAFP mem- bers have transitioned to this model. Eye surgeons? Like the Cataract Demonstration Project of the 1990s, expect lots of bidding and bundling. Curtain number 3? Physicians retiring before 2020 can safely opt out. If not retiring and possess- ing a National Provider Identifier Standard (NPI), doctors choosing neither pathway incur Medicare reimbursement reductions of 4% in 2020 increasing to 9% by 2022; they are still required to submit reports. A final caveat to retiring physi- cians eligible for Medicare: To make sure all pay their "fair share," MACRA stipulates that if you are among the top 6% of Medicare income earners, i.e., above $85,000 per year for an individual, the stan- dard premium for Parts B and D will increase from $138 per month to as much as $440 per month (double for married couples). These thresholds are not adjusted for inflation any time soon. No one—not politicians, bu- reaucrats, the AMA, or 750 medical organizations and societies who supported MACRA—knows what will ultimately emerge. A best guess? Consolidation, financial risk, EHRs, gamesmanship, e.g., adverse selec- tion, unintended consequences and the end of private practice as we have known it. Unlike Gray's humble deceased, "knowledge to their eyes her ample page" has indeed unrolled. Best to pay attention. EW Reference 1. Wilensky G. Improving value in Medicare with an SGR fix. N Engl J Med 2014;370(1):1–3. Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for more than 30 years. Contact information Noreika: JCNMD@aol.com

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