Eyeworld

EW FEATURE 46 Preparing for changes in ophthalmology • December 2017 AT A GLANCE • Healthcare is moving toward physicians being paid for outcomes rather than services. Documenting these outcomes will be crucial. • Veracity and MDbackline are systems that allow ophthalmologists to practice more efficiently. • Ophthalmologists are continuing to explore patient shared billing opportunities, and refractive cataract surgery has been an area of tremendous growth. by Michelle Stephenson EyeWorld Contributing Writer Physicians discuss how they're addressing practice today O phthalmologists are under increasing pressure to see more and more patients and provide optimal out- comes, while also navi- gating new and complex rules and regulations. "Ophthalmology is in an ex- traordinary state of flux right now, and our increasing caseloads are making it very hard to stay on top of practice management," said Eric Donnenfeld, MD, Rockville Centre, New York. "The rules and regula- tions that have gone into effect have made it almost impossible for ophthalmologists to fulfill all of the obligations that the government is asking of us while keeping up a good clinical practice." Ophthalmologists have tradi- tionally been paid a fee for services rather than outcomes, which incen- tivizes volume. However, recent fed- eral and private policies have turned to a "pay-for-performance" model. Pay for performance According to John Hovanesian, MD, Laguna Hills, California, healthcare is moving toward physi- cians being paid for outcomes rather than for services. "The push is to force doctors to assume the risk of caring for patients," he said. "Cur- rently, the risk of taking care of a complicated patient is on the health insurance company. They pay for Dr. Donnenfeld noted that Veracity and MDbackline allow ophthalmologists to practice in a smarter, more efficient way and increase patient satisfaction and patient outcomes. Additionally, they can help grow practices. "We view these changes in healthcare as some- times difficult but important, and they are something that we all need to embrace," he said. Patient shared billing opportunities In recent years, reimbursement rates have declined, making patient shared billing opportunities import- ant for practices. "We don't expect reimbursement rates to go in the opposite direction for the foresee- able future, but the opportunity to see patients for premium services is becoming more and more ro- bust," Dr. Donnenfeld said. "As the technologies that are associated with premium services, such as LASIK, multifocal IOLs, toric IOLs, and laser cataract surgery, become more and more effective, there's an increased whatever care the patient needs. To a small extent, we assume risk when we do surgery because there is a certain amount of postoperative care included, and complicated patients require more time. In general, there's going to be a shift toward more of that, so practices need to know the real costs of taking care of their patient population. If you're going to negotiate a contract that doesn't pay you a fee per service, you need to know what your outcomes are likely to be." Dr. Hovanesian noted that this has big implications for electronic health record (EHR) systems. "For the past 10 years, we have been working for the EHR system, and we need to change it around so that the EHR system works for us," he said. Dr. Donnenfeld agreed. "Out- comes will be crucial, and docu- menting those outcomes will be equally crucial. You must have a place where you can document that you are providing good outcomes, and that's where EHR systems are going to play a bigger role," he said. According to Drs. Donnenfeld and Hovanesian, MDbackline and Veracity (Temple, Texas) are two examples of new systems that work for ophthalmologists. For more information about these systems, see "Update on EHR" on page 18 of this issue of EyeWorld. EHR Electronic health records have become an important part of oph- thalmology practice, and they have advantages and disadvantages. "I was unhappy that I was forced to move into an area that I was uncom- fortable with," Dr. Donnenfeld said. "That said, EHR systems have be- come an important part of our prac- tice, and I now enjoy the freedom that they give me to provide patient care. They have become easier to use and allow us to mine data and ana- lyze results in a meaningful way. At first, they were more difficult to use, but now we have information in our EHR where we can bring findings to- gether, collate data, and create better spreadsheets for patient care." Facing changes in ophthalmology practice

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