Eyeworld

This analysis revealed Dr. Cremers had the lowest phaco CDE. Her partner asked what she did during surgery and that conversation revealed Dr. Cremers was using a different technique—one she calls "phaco smash," which she developed at Harvard Medical School to help residents decrease their phaco CDEs. Dr. Cremers said she educated this surgeon on the technique and he saw a marked decrease in his phaco energy scores. Formal results will be presented at the 2016 ASCRS•ASOA Symposium & Congress. "We were very excited about this outcome," Dr. Cremers said of the analysis. "It's an example of how it is important to check your outcomes in order to become a better surgeon and help future patients." OB References 1. Cremers SL, et al. Objective surgical assess- ments for residents and experienced sur- geons in the Yelp Era. J Cataract Refract Surg. 2015;41(11)2593–2595. 2. Khalifa YM. Reply. J Cataract Refract Surg. 2015;41(11):2595–2596. Contact information Cremers: cremersmd@gmail.com Khalifa: yousuf.khalifa@emoryhealthcare.org Dr. Khalifa also said that he doesn't think risk associated with certain conditions or procedures should be the only additional factor to take into account when evaluating surgeons. "I would also argue that surgeons in academic environments who are actively teaching residents and fellows should have a risk adjustment," Dr. Khalifa wrote, and later said that those teaching residents "take on more risk in allowing a trainee to do [surgeries] but that gets billed in our names." On a smaller scale, data analysis can also be applied at the practice level as well. Dr. Cremers said that her practice hired a research fellow to keep tabs on various data points. "We're creating our own database to look at ourselves," she said. "We try to do that risk adjustment within our practice to better understand how to improve things." This practice has already put its data analysis to good use. Dr. Cremers said they com- pared the phaco time/energy scores (cumulative dissipated energy or CDE) and times among the surgeons in the practice, controlling for lens density. from public websites such as Yelp, IRIS would first have to develop risk-ad- justed metrics for the various ocular surgeries and use tools in tracking and benchmarking performance in these surgeries." "The Yelp Era is certainly upon us, and we are in an excellent position to provide accurate information to the public and drive continuous quality improvement in eye care," Dr. Khalifa wrote in his reply. If reviews and assessments do not take into account the risk factor, both Dr. Cremers and Dr. Khalifa noted that physicians might be dissuaded from taking more complex, risky cases, fear- ing negative and misinformed reviews. "Surgeons are getting paid the same amount for the average cataract surgery, so it's going to be harder and harder to find doctors who are going to want to do high-risk surgeries—that's a big issue," Dr. Cremers said. "A preliminary analysis in IRIS of the return to the operating room after cataract surgery cases has shown that 30% had comorbidities—giving surgeons credit for taking on these complex cases is in the public interest," Dr. Khalifa wrote in his reply letter. continued from page 7

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