Becoming A Key Optometrist

Dr. David Anderson
Dr. David Anderson

By Dave Anderson, OD, Trustee, Ohio Optometric Association

After the November election, I volunteered to become a Key OD for Representative Niraj Antani, Ohio House 42nd district.  I first wondered how I would relate and what we would have in common, what issues we would discuss besides legislative agendas, or how we could support each other.  My partner, Dr.  Keith Basinger, is in the local Rotary club with Representative Antani.

Representative Niraj Antani
Representative Niraj Antani

Rep. Antani and I both grew up in a small town. His hometown is Miamisburg, where I live now and where my practice is located. We both went to Ohio State, and we both have a passion for helping the families in my community.  When I first called and spoke with Rep Antani, we agreed to meet the day after the Sugar Bowl.  I quickly found that we shared another passion: Buckeye football!

I approached the encounter with Rep. Antani much in the same way I do each new patient encounter – I wanted to find out what made him tick, his background, and how I might personally connect.

Over coffee we discussed his platform and agenda as well as mine as a constituent and Optometrist.  I explained some of the barriers to patient access, including insurance challenges like prior authorization, panel access and sales tax on optical goods.  He listened, took notes, asked questions and was able to relate to each of my issues.  He was interested in the challenges we have with other providers who are his friends and supporters.  He was surprised to hear that Ohio was one of only of eight states that charges sales tax on optical goods.  At this news, he stopped his note taking, looked at me, and said, “Wow – one in eight??  Ohio should be a leader on something like this.  Not only should we be in-line but we need to be forward thinking in ways to help with cost saving measures like this in healthcare.”

Since this meeting, we have discussed the sales tax issue and others, in person and via email.  We have, of course, discussed the Buckeyes at length, and at each time I feel that we are much more alike than we are different.  He believes in Ohio, he wants the best for Ohio and our community, and he uses a common sense approach to legislation.  He has proven this by voting against an increase in pay for legislators. “Why should we get a raise when the pay scale for Ohio has been stagnant?” he said.

Rep. Antani is one of the youngest representatives in the nation at age 23.  He is in Law School and increasing his debt load just as I did during Optometry school.  He is totally focused on moving Ohio forward, in higher education including skilled trades like Optician and Ophthalmic Technician.

I urge all OOA members to reach out to your state representative or senator.  They drink the same coffee, shop at the same grocery stores and cheer on the same football teams.  They have a desire to help those in your community.  Shortly after our first visit, Rep. Antani visited my office where I cleaned and adjusted his glasses at my suggestion.  He got a glimpse of what occurs in my busy practice, and he left with the ability to see our community and his constituents better than when he arrived.

Would you like to be a Key OD? Click on the link below:

2015 Key OD Listing

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State Innovation Model – 75 Million Reasons to Pay Attention

By Mark Ridenour

In December, the Center for Medicare and Medicaid Innovation (CMMI) awarded a $75 Million four year grant to the Ohio via its State Innovation Model (SIM) awards to implement a payment reform model which will broadly move reimbursement models to recognize outcomes over volumes.  Providers will get increased reimbursement for providing more efficient care while maintaining or improving quality.  Ohio budget projections suggest another $125 Million in state funds could be added over the life of this project.  The stated SIM goal is to have 80-90 percent of Ohio’s population in some value-based payment model within five years.

The Ohio Office of Health Transformation (OHT) led by Director Greg Moody will manage this project.  There are two primary vehicles designed to work together to implement this change: 1) Episodes of Care and 2) Medical Homes.  (see chart below) The state will require each of the managed Medicaid insurers (CareSource, Buckeye, Molina, Paramount, and United) to participate along with the four largest commercial insurers (Anthem, Aetna, Medical Mutual and United).  In 2015, these payers will share data with providers on selected Episodes and begin to change payments in 2016.  The initial Episodes are Perinatal, Asthma acute exacerbation, COPD exacerbation, Percutaneous Coronary Intervention (PCI), and total joint replacement.

Capture

There are now over 500 accredited Medical Homes in Ohio.  This project will initially work with the 75 Medical Homes in the Cincinnati-Dayton region already engaged with the Comprehensive Primary Care initiative (CPCi), additionally funded by CMS.  This will progress by region in Ohio most likely taking advantage of the significant work already accomplished by the health collaboratives, Better Health Greater Cleveland and the Healthcare Collaborative of Greater Columbus.  The OOA has been a supportive participant over the past few years, although optometry has yet to demonstrate an impactful relationship.

Capture 1This chart represents the variability in total costs across an episode and how the OHT envisions introducing risk and gain sharing.  While the initial episodes chosen do not directly involve optometric care, we are confident that as the list grows to the expected 50 episodes they will likely include diabetes, glaucoma and/or cataract care.  The OOA has been engaged with the OHT so will be part of the stakeholder groups helping to shape this effort.

What can you do now to prepare for the changes brought about by this significant investment in the State Innovation Model (SIM)?  1) affiliate with Medical Homes and 2) maintain an Electronic Health Record (EHR) which meets Meaningful Use standards.

The best position for optometry as the primary eye care provider is to solidify our standing as part of primary care team via alignment with Medical Homes.  You should survey your primary care referral sources to see if they are an accredited Medical Home or are in process.  Maps and lists of accredited practices are available on the Ohio Department of Health website.  In addition, even though the promise of electronic interconnectedness has yet to be realized, participating in risk-sharing, outcomes-based reimbursement vehicles will be largely dependent on providers having EHRs with the ability to send and receive data.

Medicare Update for 2015

Medicare Update for 2015

Dr Brownlow

10 and 90 day global periods will be eliminated for minor surgical procedures in 2017 and for major surgical procedures in 2018.  Current 0, 10, and 90 day post op periods are still in effect for 2015!  Lots of ODs and staff have been asking me about the potential impact of all global periods going to 0 days.  Actually, I think it will be an advantage, as doctors providing post op care will no longer be limited by the meager CMS payments for post op periods, and will be submit claims for whatever visits and procedures are necessary during the post op period, just as they are during any other time they are caring for the patient.  Another interesting thing I’ve noticed about this issue…I’ve been getting more questions regarding these changes; though they won’t go into effect for two or three years; than I get on issues that should be of concern to doctors and staff currently and/or should have been of concern to docs and staff for years…Go figure!

Medicare Fee Schedule

The 2015 Medicare Fee Schedule has been published and it does include some changes, resulting in small net increases across the board for services ODs provide most commonly. Medicare’s fees are calculated based on relative values assigned for each service and the Conversion Factor, set by Congress each year.  The formula for calculating the fee for each services is Relative Value x Conversion Factor = Fee.  The conversion factor will be slightly lower at the beginning of 2015, though some of the relative values have increased, so the net impact will be very small.  However, a very large decrease in the conversion factor is slated to go into effect April 1, 2015, unless Congress acts prior to that date.  For those of you who have watched this strange scenario play out in previous years, this is no surprise.  My prediction?  Congress will act in the 11th hour to avoid the big cuts and leave the fee schedule pretty much as it is in 2014.

Act Now to Avoid PQRS Penalties in the Future

AOA has been successful in convincing CMS that small group practices (1-9 doctors) should not be penalized for PQRS issues, but should be eligible for the PQRS bonus payments.  2017 PQRS bonuses will be earned by PQRS participation in 2015, so gear up now to be sure you qualify.  You can continue to report PQRS measures on your Medicare claims, although AOA will be providing members with an easier way to accomplish that reporting, referred to as ‘registry reporting’, early in 2015.  Watch for more PQRS information from AOA in December.  If you decide to begin (or continue) to use the traditional method of reporting PQRS measures on each Medicare claim, you may do that as well.  There are lots of PQRS changes for 2015, so please refer to all of the information that has been created by the AOA Third Party Center. It’s all available to AOA members at aoa.org/pqrs.  The major change for this year is that you must now report nine measures 50% of the time the related diagnoses appear on a claim.  Prior to his year you could have qualified by reporting only three PQRS measures 50% of the time the related diagnoses appear on a claim.  My advice at this point is to wait for AOA’s ‘Registry’ for PQRS reporting, which will make the process much more workable.

Medicare’s Impact on Optometry

CMS estimates that ODs provided services and were reimbursed over $1 billion in 2014 and predicts the total payments will rise in again for ODs in 2015.

Pretty amazing! And clear testimony of the value of your membership in the state association and AOA.  Without the hard work of organized optometry during the past thirty years and currently, we would not have been prepared to provide medical care to anyone, and we certainly would not have been granted full parity in Medicare, nor would we be providing full scope eye care services and being reimbursed by Medicare and other medical insurers today!

Charles B. Brownlow, OD, OS, OU