An Evolving Health Reform Landscape – Part 4 of 4

by Mark A. Ridenour of the Ridenour Group, Consultant to the Ohio Optometric Association

There are numerous other delivery and payment reform pilot projects currently happening or planned generally. The pilots are funded by state and/or federal grants.  As an illustrative example, note the following activity just in Ohio.  Innovation grants for coordinated pediatric care were awarded to University Hospitals of Cleveland and Nationwide Children’s (Columbus) earlier this year.  MetroHealth (Cleveland) was granted a waiver to deliver Medicaid-like benefits to a local uninsured population, although this project has yet to launch.  Governor Kasich submitted a grant application for a federal State Innovation Model (SIM) to extend Medical Homes and facilitate payment reform via episode-based modules (e.g. a single payment for the care and rehabilitation of knee replacement).

Each of these delivery and payment system changes (Medical Homes, ACOs, bundled payment models, and other initiatives) modifies the flow of patients and/or funds. If Optometry is not actively engaged and promoting its value, the results are likely to mean less of both.  The good news is that, as the primary eye care provider, your services align with the general shift of investment to primary/preventive care.  An efficient exchange of data inter-professionally will be key to each of these initiatives.  Therefore, your EHR capabilities and willingness to participate should provide the necessary advantage to avoid exclusion.

At least in the interim, and perhaps for the longer term, there will be variation in how these shifts manifest locally.   In Ohio, the Ohio Optometric Association has identified key relationships for each of these pilots and has engaged administration and key optometrists in the planning and design wherever possible.   While the scope of this is very broad, impacts are felt at a local level.  Be cognizant of change within your inter-professional community and, as always, contact Ohio Optometric Association for support.

“An Evolving Health Reform Landscape” is a four-part series.

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Personalized Cost of Health Care

The Health Benefits That Cut Your Pay

Health care, associated expenses, and our outcomes are at the very top of our national agenda. The enclosed link overviews a commentary on these issues. OOA leadership have read the New York Times commentary and have been weighing in as to their thoughts.

Accordingly, we are posting an example that you may find of value and interest.

Dr. Melvin Shipp, Dean, OSU College of Optometry:

  • We do pay a lot for health care, but there no evidence that employers would give a substantial portion to employees in wages via this scenario.
  • Also there is little evidence employers would create more jobs; business is currently sitting on over $2 trillion in reserves and is not creating jobs.  In some cases businesses are cutting health benefits to employees.
  • The catastrophic costs idea has been around for some time. The problem is it ignores the concept of primary care’s role in reducing costs.
  • If you only cover catastrophic care, people will not get adequate primary care and will get sicker, faster and at a higher cost.
  • If we keep the employer based system, we would simply shift the costs to the individual or Medicare with a catastrophic only plan. We would still have to pay for it but much more inefficiently.
  • By the way, as you know that is how it used to be with hospital only plans.

Google Docs: Forms & Spreadsheets

Greg Hopkins, OD

Google Documents has been around for quite awhile, and perhaps you have uploaded a word document or PDF to the service in the past. Similar to the free file syncing service Dropbox, Google Docs is a useful resource for maintaining accessibility to documents from any location (“in the cloud,” as it were), but one great and often under-utilized feature is the ability to create forms and surveys to populate spreadsheets automatically. Trying to get feedback from your patients about your office? Trying to plan a meeting or office party? You can create a form for that and either link directly to it, embed it in a website, or even an email. I’ve used one before to fill-out convergence insufficiency symptom surveys (CISS) on the fly. Once the answers are in a spreadsheet, it’s relatively simple to score the responses automatically to provide instant feedback and a more efficient exam flow.

Links and References:

Cincinnati Eye Institute Foundation Receives $50,000 Grant

The Cincinnati Eye Institute Foundation has received a $50,000 grant from the Jacob G. Schmidlapp Trusts, Fifth Third Bank, Trustee to support Onesight Vision Center at Oyler School for the 2012 – 2013 school years for student transportation and an office manager.

The grant will be used to provide students, throughout the 45 Cincinnati Public Schools (CPS) who have failed school vision screenings, transportation to the Onesight Vision Center at Oyler School for a complete eye exam with the center’s full time optometrist.  Then the Center will serve all CPS students in need of primary eye care.  The Center opened in October 2012 through the combined efforts of OneSight, The Cincinnati Eye Institute Foundation, Ohio Optometric Association, The Cincinnati Woman’s Club, Cincinnati Health Department and Cincinnati Public Schools.

The Onesight Vision Center at Oyler School sees students who do not have health insurance, as well as students who have Medicaid and other insurance coverage.  Many CPS students qualify for or have Medicaid coverage, however insurance coverage does not guarantee access to care.  The reasons include: a shortage of local eye care providers; unfavorable office hours for single and working parents; transportation concerns; illiteracy; and homelessness, among others.

“The grant also allows us to hire a fulltime office manager, which means we can provide more eye exams to CPS students. It also means we are able to provide follow-up services, and follow up with that student to make sure their parents are informed,” said Don Holmes, Executive Director, The Cincinnati Eye Institute Foundation, and Executive Member, Onesight Vision Center at Oyler School.

The Jacob G. Schmidlapp Trusts supports charitable or educational purposes; for relief in sickness, suffering and distress; for the care of young children, the aged or the helpless or afflicted; for the promotion of education, and to improve living conditions.  Jacob G. Schmidlapp was born in Piqua, Ohio in 1849 to German immigrants, and overcame poverty and great personal tragedy to become one of the most respected and successful men of his time.  He founded the Union Savings Bank in 1876, which merged with Fifth Third Bank in 1919. In 1903, he established a trust to help improve lives and a second Schmidlapp Trust was established in 1919. The Onesight Vision Center at Oyler School is now financially assisted by the Jacob G. Schmidlapp Trusts, Fifth Third Bank, Trustee.

The Cincinnati Eye Institute Foundation is a nonprofit organization serving the Greater Cincinnati region with programs and services that help preserve and improve sight.  The Cincinnati Eye Institute Foundation educates the public about vision-related issues, and provides access to eye care services to under served adults.

For more information about making a donation, or about any of the programs and services offered by The Cincinnati Eye Institute Foundation, please call (513) 878-2300, or visit www.CEIFoundation.org. The views expressed herein do not necessarily represent those of the Jacob G. Schmidlapp Trusts, Fifth Third Bank, Trustee.

An Evolving Health Reform Landscape – Part 3 of 4

by Mark A. Ridenour of the Ridenour Group, Consultant to the Ohio Optometric Association

Accountable Care Organizations (ACOs) are health systems, hospital or physician-led, which are charged with the management of the health of a defined population.  Medicare has led with various models, the most popular of which is the Medicare Shared Savings Program (MSSP). Medicare will continue to pay individual providers and suppliers for specific items and services as it currently does under the Fee-For-Service payment systems. Should the ACO achieve lower costs and better quality outcomes than projected, Medicare will share the financial savings with the ACO, which then shares it with its providers.

The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated high-quality care to the Medicare patients they serve. Selected participants will receive upfront and monthly payments, which they can use to make important investments in their care coordination infrastructure.

The Pioneer ACO Model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings. It will allow these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the MSSP.  A minimum of 15,000 Medicare beneficiaries must be managed in this model versus the  5,000 minimum for the MSSP.

Each of these models will eventually move to a population-based payment model. Population-based payment is a per-beneficiary-per-month payment amount intended to replace some or all of the ACO’s fee-for-service (FFS) payments with a prospective monthly payment.  Recent CMS notices have stated that 154 organizations now participate in all Medicare ACO programs.  Since there is no accreditation, there is no accounting of private ACOs however it is known that most major hospital systems and large physician organizations have these in development with plans to offer to multiple payers.

“An Evolving Health Reform Landscape” is a four-part series.

Amblyopia Treatment Today and Into the Future

OOA Member, Dr. Cara Frasco, featured in the Winter/Spring edition of Lazy Eye News, the bi-annual newsletter for the Ohio Amblyope Registry (OAR):

Today many children with amblyopia (commonly known as lazy eye) can successfully be treated with fewer hours of eye patching per day and for a shorter time period. A study of over 400 children found that after 2 months of patching most children had better vision. Their vision improved regardless if they did near activities such as coloring or distance activities like watching television, when wearing the eye patch. The most important factor is being consistent with wearing the patch for the prescribed number of hours every day.

Recently, several studies are trying to incorporate technology in the treatment of amblyopia to help children with a lazy eye improve their vision. In fact, a current study in the United Kingdom is investigating the I-BiT™ virtual reality system. This technology involves playing a computer game or watching a DVD displayed through virtual reality glasses. The lazy eye (weak eye) is shown the more interesting part of the game or DVD, while the good eye is shown the background. A small test study showed this technology worked very well for children who would not wear an eye patch but requires weekly trips to the doctor for treatment sessions. This large study testing the I-BiT™ system is currently underway and should be complete in late 2013.

Another new potential treatment for amblyopia could reside in the Amblyz electronic eyeglasses. These glasses use liquid crystal lenses to briefly block the vision in the good eye for fractions of a second. It is reported that the child has minimal awareness of this quick effect. These glasses can be made with prescriptive lenses for children that need to wear glasses as part of their treatment. The child would wear the Amblyz glasses all day and recharge them at night. As with most new technology this will likely be costly at first but may offer another treatment option in the future. These glasses are not yet available in the US.

Wearing virtual reality glasses, using game applications on an Apple iPod touch or playing action video games may be recommended by your eye doctor in the near future. Incorporating technology into the prescribed treatment plan will likely be a great motivator for the youngest and most active patients. Remember that amblyopia is a preventable form of blindness. Patching, wearing glasses,using eye drops or visual activities could be prescribed to improve vision. Develop a partnership with your child and his eye doctor to ensure the most successful visual outcome.

The entire newsletter can be downloaded here.

School Nurse Eye Kits

IMG_2021Thank you to Alcon for providing the solutions that are in the emergency eye kits Realeyes distributes to school nurses.  The kits include EYE-STREAM®, OPTI-FREE® PureMoist® MPDS contact lens solution, contact lens cases, penlight, eyeglass repair kit and an eye emergency instruction sheet.  School nurses from more than 2,000 schools have requested the popular kits supplied by the Ohio Optometric Association.

 

Don’t Risk 2015 Medicare Reimbursement Cuts!

Many optometrists may be aware that failure to report PQRS measures will result in penalties beginning in 2015. What they may not realize is that the determination of which practitioners are penalized is based on performance two years in advance of the penalty! For 2013 and 2014, there is still a 0.5% incentive payment in effect, but payment reductions for failure to report performance measures start with 1.5% in 2015 and 2.0% in 2016. While the incentives may not have motivated some practitioners to use the PQRS codes, the penalties can adversely affect your bottom line. According to the AOA, to secure exemption from the 2015 penalty, practitioners must report at least one PQRS quality measure on a Medicare claim in 2013. Just one time, on one claim! Obviously, it’s best to fully participate and get the 0.5% incentive, but submitting one claim is a simple way to secure full Medicare payment on your 2015 claims.