EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78708
June 2012 Sink or swim: Future reimbursement and Medicare's value-based payment modifier by Jenny Liljeberg, M.P.P., ASCRS•ASOA Associate Director of Regulatory Affairs provided via claims through the Medicare Physician Quality Report- ing System (PQRS) and detail per capita cost and quality reporting information in 2010. Uncertain start A possible indicator of impending problems with this program is the widespread failure of the reports to reach their intended audience. Feed- back from the physician community revealed that the report link was not made available to individual physi- cians in a timely manner, and in the majority of cases there was no expla- nation given as to why the delay oc- curred. Several physicians received no report. Of the physicians who received reports, only 3,300 of 23,730 had downloaded the reports as of late March. The scattershot dissemination of Source: Donna Day/Workbook Stock/Getty Images I n March, the Centers for Medicare & Medicaid Services (CMS) sought to provide nearly 24,000 physicians in Kansas, Missouri, Iowa, and Nebraska with a preview of how quality re- porting data could be used to deter- mine Medicare payments in the very near future. In conjunction with contractor Washington Physician Services (WPS), CMS emailed physi- cians in those four states a link to an individualized report (Confidential 2010 Quality and Resource Use Report [QRUR]: Medicare Fee-For-Service). The report provided information about the quality of care provided to Medicare fee-for-service (FFS) pa- tients the physicians treated in 2010; the amount Medicare paid the provider for that care; and how the individual provider compared to other Medicare providers within the same specialty. Pay for performance The reports are part of the "value- based payment modifier" initiative, mandated by the Affordable Care Act (ACA), which is still under devel- opment but set to take effect in 2015. At that time, select physicians, whom CMS has yet to determine, will either receive bonuses or re- duced reimbursement based on the quality and cost of care they pro- vided to their patients in 2013. In 2017, the value-based modifier will apply to all physicians who treat Medicare patients. The initiative's premise is that patients would re- ceive better and more efficient care when their various physicians can compare their approach to treat- ment costs of other doctors treating similar patients in the same area. All doctors, regardless of specialty, treat- ing a given patient during a speci- fied period of time will be compared collectively with other groups of physicians. The reports rely on data the reports means physicians lack important data that will impact their finances as well as the ability to pro- vide vital feedback on improving the existing methodology. Measuring whether a provider is delivering or a patient is receiving quality medical care is much more complex than de- termining whether the treatments given improved the patient's condi- tion. Value-based payment centers on quality, and quality is not a con- cept that can be easily standardized. Especially problematic is comparing quality and outcomes measures and extending payments based on those results, given the wide range of prac- tice settings and conditions under which doctors deliver care. Quality reporting Value-based payment models are being implemented at the federal level through CMS programs, such as the PQRS.1 Reportable quality measures within the PQRS program change because of annual additions and deletions to the program, and many medical specialties have only recently begun reporting measures that are directly relevant to their scope of practice.2 The QRUR reports included only one eyecare measure in the list of quality measures evaluated. An oph- thalmologist would not have re- sponsibility for any of the other measures on the list; however, the current methodology would com- continued on page 8 © 2012 Novartis 1/12 ACR12838JAD-PI AcrySof® Statement IQ ReSTOR® IOL Brief CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Lens (IOL) is intended for primary implantation for the visual correc- tion of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. The lens is intended to be placed in the capsular bag. WARNING/PRECAUTION: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/ben- efit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery. Some patients may experience visual disturbances and/or discom- fort due to multifocality, especially under dim light conditions. Clinical studies with the AcrySof® ReSTOR® lens indicated that posterior cap- sule opacification (PCO), when present, developed earlier into clinically significant PCO. Prior to surgery, physicians should provide prospec- tive patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and ben- efits associated with the AcrySof® IQ ReSTOR® IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® vision. The effect on vision of the AcrySof® Natural IOL and normal color Natural IOL in subjects with hereditary color vision defects and acquired color vision defects sec- ondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® Solutions. or BSS PLUS® Sterile Intraocular Irrigating ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. AcrySof® IQ IOL Brief Statement CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof® IQ posterior chamber intraocular lens is intended for the replacement of the human lens to achieve visual cor- rection of aphakia in adult patients following cataract surgery. This lens is intended for placement in the capsular bag. WARNING/PRECAUTION: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/ben- efit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Caution should be used prior to lens encapsulation to avoid lens decentrations or dislocations. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® vision. The effect on vision of the AcrySof® Natural IOL and normal color Natural IOL in subjects with hereditary color vision defects and acquired color vision defects sec- ondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® Solutions. or BSS PLUS® Sterile Intraocular Irrigating ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. AcrySof® Statement IQ Toric IOL Brief CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof® IQ Toric posterior chamber intraocular lenses are intended for primary implantation in the capsular bag of the eye for visual correction of aphakia and pre-existing corneal astig- matism secondary to removal of a cataractous lens in adult patients with or without presbyopia, who desire improved uncorrected distance vision, reduction of residual refractive cylinder and increased spectacle independence for distance vision. WARNING/PRECAUTION: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/ benefit ratio before implanting a lens in a patient with any of the con- ditions described in the Directions for Use labeling. Toric IOLs should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens repositioning should occur as early as possible prior to lens encapsulation. All viscoelastics should be removed from both the anterior and posterior sides of the lens; residual viscoelastics may allow the lens to rotate. Optical theory suggests that high astigmatic patients (i.e. > 2.5 D) may experience spatial distortions. Possible toric IOL related factors may include residual cylindrical error or axis misalignments. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this prod- uct informing them of possible risks and benefits associated with the AcrySof® IQ Toric Cylinder Power IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® vision. The effect on vision of the AcrySof® Natural IOL and normal color Natural IOL in subjects with hereditary color vision defects and acquired color vision defects sec- ondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® Solutions. or BSS PLUS® Sterile Intraocular Irrigating ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions.