Eyeworld

Reporting from the 2017 EyeWorld Surgical Summit, February 2–4 2017, Park City, Utah EW MEETING REPORTER 136 March 2017 Reporting from the 2017 EyeWorld Surgical Summit, February 2–4, 2017, Park City, Utah MIPS points by reporting more data for the potential to earn a bonus. A MIPS performance score of 70 or above qualifies as "exceptional performance" and is eligible for additional incentive payments, Ms. McCann said. Editors' note: Ms. McCann has no relevant financial interests. Optimizing the ocular surface Dr. Lane and Elizabeth Yeu, MD, Norfolk, Virginia, shared informa- tion about optimizing the ocular surface before refractive cataract surgery in a Saturday morning CME event with educational grants from Allergan, Shire (Lexington, Mas- sachusetts), TearLab (San Diego), and TearScience (Morrisville, North Carolina). Dr. Lane called the ocular sur- face a "key component for surgical success." He said some form of ocu- lar surface disease (OSD) is present in most cataract patients and its presence can reduce the accuracy of preoperative measurements and thus have an impact on IOL power selection and astigmatism correc- tion. What's more, cataract and laser vision correction surgery can worsen existing OSD symptoms. On the diagnostic front, the first step is issuing a simple questionnaire to patients before examinations, Dr. Lane said. Responses on this ques- tionnaire can clue the technician in as to whether they need to perform specific OSD testing. Traditional tests like a compre- hensive external exam and slit lamp exam can provide clues to OSD as well. Meibomian gland expression and meibography with a transillumi- nator can be helpful in assessing the gland's structure and function. In terms of tear production tests, Dr. Lane said he rarely con- ducts Schirmer's. However, he finds tests like lissamine green staining very valuable to identify damaged membranes. Tear breakup time (TBUT) is also easy to assess with fluorescein staining, Dr. Lane said. TearLab's Osmolarity Test, Dr. Lane said, can show a stronger correlation with dry eye severity comments on the proposed rule, she said. ASCRS requested a delay in implementation, reduced thresh- olds, Resource Use scored at 0% in the first year, and reinstatement of measure groups. The Quality Payment Program final rule included several options for the first performance period (2017) to avoid penalty in 2019, Ms. McCann said. "There is no reason anyone should be penalized in this first year," she added. To avoid the penalty, physicians can report one quality measure for one patient and not have to meet the measure benchmark; one im- provement activity; or the required base measures for Advancing Care Information (ACI). To be eligible for a small bonus and avoid a penalty, providers can choose to report for at least 90 days on two or more quality measures on one patient and not have to meet the measure benchmarks; on more than one improvement activity; or the required base measures and additional performance measures for ACI. Providers who report all the required measures and meet thresh- olds and benchmarks in each of the categories for at least 90 days—or up to a full year—have the greatest potential for a bonus (and avoiding penalty), Ms. McCann said, adding that the 90-day performance period can begin anytime between January 1 and October 2, 2017. If a MIPS-eligible clinician does not report even one measure or activity in 2017, he or she will receive the full negative 4% penalty in 2019, she said. MIPS-eligible cli- nicians who participate in Advanced APM entities that meet the required revenue or patient thresholds will receive a 5% bonus, she said. To avoid a penalty for 2019 payments, a provider must score at the 2017 MIPS performance bench- mark of 3 points, Ms. McCann said. Reporting one quality measure on one patient, one improvement ac- tivity, or the base measures for ACI on one patient will achieve a MIPS score of 3 and avoid the penalty, she said. Physicians can earn additional ly eliminates the sustainable growth rate (SGR). It also implements a new payment system that ties reimburse- ment to performance and offers two payment pathways: a modified fee-for-service model (MIPS) and ad- vanced alternative payment models (APMs). Ms. McCann then discussed these two payment pathways. The Merit-Based Incentive Payment Sys- tem (MIPS) consolidates the quality reporting programs (PQRS, VBPM, and Meaningful Use) and adds im- provement activities to create a new program, beginning in 2019, based on 2017 reporting. Meanwhile, APMs, or "advanced" alternative payment models, are based on par- ticipation in an advanced APM and meeting certain thresholds. Those choosing this option will be exempt from MIPS and will receive a 5% bonus payment for 6 years. The MIPS program assesses the performance of providers based on four categories: quality, cost, advancing care information, and improvement activities. It then gives providers a composite scored based on these categories. For the first year, quality will comprise 60% of the composite score, advancing care information will comprise 25%, and improvement activities will com- prise 15%. Cost will not be scored during the first year. The emphasis is on quality, Ms. McCann said, adding that ophthalmology is very well positioned for this component. In some cases, CMS may deter- mine a provider is excluded from one or more of the other MIPS cate- gories and will re-weight the individ- ual provider's quality performance score to make up the difference, she added. There will be positive, neg- ative, or neutral adjustment based on composite score. The negative is capped at 4% in 2019; 5% in 2020; 7% in 2021 and 9% in 2022. The MACRA final rule was released in October of 2016, Ms. McCann said, and was renamed the Quality Payment Program. The final rule incorporates the majority of the flexibility and reduced report- ing burdens advocated by ASCRS and the medical community in the Sponsored by

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