Eyeworld

EW ASCRS NEWS 10 September 2017 factor specified under the [Medicare Access and CHIP Reauthorization Act (MACRA)]." The alert also noted key policy changes, including the proposal to modify 2016 Physician Quality Reporting System (PQRS) require- ments, by reducing the required nine measures to six, to help practic- es avoid a 2% PQRS penalty in 2018. On the Value-Based Payment Modifier (VBPM) front, CMS is proposing a reduction from –4% to –2% of the automatic downward payment adjustment for practices of 10 or more clinicians not meeting minimum quality reporting require- ments under PQRS; solo practices up to nine clinicians could see a reduc- tion from –2% to –1% in 2018. The proposed rule would not penalize groups or solo practitioners with downward payment adjust- ments if they met minimum quality reporting requirements for perfor- mance under quality tiering, and the maximum upward adjustment would be two times the adjustment factor. In June, CMS released its 2018 Quality Payment Program (QPP) year 2 proposed rule. According to the alert issued by ASCRS, this rule, which proposes changes to the Mer- it-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model to impact 2020 Medicare physician payments, is a "continuation of transition flexibil- ity for the performance period and scoring, continuation of 0% weight- ing of the Cost category, continued use of 2014-certified EHR (CEHRT) technology, and further accom- modations for physicians in small practices of 15 or fewer providers." The QPP proposed rule and the MPFS proposed rule reflect the advocacy work of ASCRS focused on regulatory relief. ASCRS•ASOA issued regulatory alerts with the FDA recall of un- expired sterile drug products from Cantrell Drug Company (Little Rock, Arkansas) due to a lack of steril- ity assurance and a recall of ICU Medical (San Clemente, California) 0.9% Sodium Chloride Injection USP 1000 mL due to particulate matter. ASCRS•ASOA also reported the FDA recall of drug products intended to be sterile that were produced and distributed by Atlantic Pharma- cy and Compounding (Pompano Beach, Florida) due to a lack of steril- ity assurance. Alerts such as these, Dr. Bakewell said, keep membership in- formed and help with patient safety. Outside of government re- lations, ASCRS releases clinical advisories, such as that regarding the moxifloxacin triamcinolone injection compounded by Guardian Pharmacy Services (Dallas), which had been implicated in several retina toxicity cases. ASCRS clarified that this compounded injection is not the proprietary Tri-Moxi, which is produced by Imprimis Pharmaceuti- cals (San Diego). EW Editors' note: Dr. Bakewell has no financial interests related to his comments. Contact information Bakewell: eyemanaz@gmail.com ASCRS•ASOA continued from page 3 One such alert was issued on July 13 when CMS released its proposed 2018 Medicare Physician Fee Schedule (MPFS), starting the proposed rule's 60-day comment period. The proposed CY 2018 MPFS conversion factor is $35.99, which the alert explains "reflects a budget neutrality adjustment of –0.03%, a misvalued code recapture amount of –0.019%, and the 0.5% update LenSx® Laser Important Product Information for Cataract and Corneal Flap Treatments: Caution: United States Federal Law restricts this device to sale and use by or on the order of a physician or licensed eye care practitioner. Indication: Cataract Surgery Indication: The LenSx® Laser is indicated for use in patients undergoing cataract surgery for removal of the crystalline lens. Intended uses in cataract surgery include anterior capsulotomy, phacofragmentation, and the creation of single plane and multi-plane arc cuts/incisions in the cornea, each of which may be performed either individually or consecutively during the same procedure. Corneal Flap Indication: The LenSx® Laser is indicated for use in the creation of a corneal flap in patients undergoing LASIK surgery or other treatment requiring initial lamellar resection of the cornea. Restrictions: • Patients must be able to lie flat and motionless in a supine position. • Patient must be able to understand and give an informed consent. • Patients must be able to tolerate local or topical anesthesia. • Patients with elevated IOP should use topical steroids only under close medical supervision. Contraindications: Cataract Surgery Contraindications: • Corneal disease that precludes applanation of the cornea or transmission of laser light at 1030 nm wavelength • Descemetocele with impending corneal rupture • Presence of blood or other material in the anterior chamber • Poorly dilating pupil, such that the iris is not peripheral to the intended diameter for the capsulotomy • Conditions which would cause inadequate clearance between the intended capsulotomy depth and the endothelium (applicable to capsulotomy only) • Previous corneal incisions that might provide a potential space into which the gas produced by the procedure can escape • Corneal thickness requirements that are beyond the range of the system • Corneal opacity that would interfere with the laser beam • Hypotony, glaucoma* or the presence of a corneal implant • Residual, recurrent, active ocular or eyelid disease, including any corneal abnormality (for example, recurrent corneal erosion, severe basement membrane disease) • History of lens or zonular instability • Any contraindication to cataract or keratoplasty • This device is not intended for use in pediatric surgery. * Glaucoma is not a contraindication when these procedures are performed using the LenSx® Laser SoftFit™ Patient Interface Accessory Corneal Flap Contraindications: • Corneal lesions • Corneal edema • Hypotony • Glaucoma • Existing corneal implant • Keratoconus • This device is not intended for use in pediatric surgery. Warnings: The LenSx® Laser System should only be operated by a physician trained in its use. The LenSx® Laser delivery system employs one sterile disposable Patient Interface consisting of an applanation lens and suction ring. The Patient Interface is intended for single use only. The disposables used in conjunction with ALCON® instrument products constitute a complete surgical system. Use of disposables other than those manufactured by Alcon may affect system performance and create potential hazards. The physician should base patient selection criteria on professional experience, published literature, and educational courses. Adult patients should be scheduled to undergo cataract extraction. Precautions: • Do not use cell phones or pagers of any kind in the same room as the LenSx® Laser. • Discard used Patient Interfaces as medical waste. Complications: Cataract Surgery AEs/Complications: • Capsulotomy, phacofragmentation, or cut or incision decentration • Incomplete or interrupted capsulotomy, fragmentation, or corneal incision procedure • Capsular tear • Corneal abrasion or defect • Pain • Infection • Bleeding • Damage to intraocular structures • Anterior chamber fluid leakage, anterior chamber collapse • Elevated pressure to the eye Corneal Flap AEs/Complications: • Corneal edema • Corneal pain • Epithelial in-growth • Epithelial defect • Infection • Flap decentration • Incomplete flap creation • Flap tearing or incomplete lift-off • Free cap Attention: Refer to the LenSx® Laser Operator's Manual for a complete listing of indications, warnings and precautions. © 2017 Novartis 8/17 US-LSX-17-E-2076a 98700 US-LSX-17-E-2076a_PI EW.indd 1 8/21/17 7:14 AM EWAR spread Page: 12 and 13 Central herpes corneal scar with divot Page: 42 CSU Page: 59 Best of ASCRS: Cornea Page: 89 Tips and Tricks for Successful DMEK Transitioning Page: 90 ROCK the Endothelium Page: 96 EWrePlay.org: Elizabeth Yeu, MD Page: 98 EWAR app Page: 102 EWrePlay.org: Sumit "Sam" Garg, MD Page: 104 Education Hub: Page: 107 EWrePlay.org: Davinder Grover, MD Page: 109 EWrePlay.org: Sumitra Khandelwal, MD Page: 118 EWrePlay.org: Douglas Koch, MD Page: 120 EWrePlay.org: Elizabeth Yeu, MD Page: 121 EWrePlay.org: Cynthia Matossian, MD Page: 123 EyeWorld Augmented Reality (EWAR) Index

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