House Bill 157

By Executive Director Keith Kerns Esq.

This Bill would change Ohio’s medical liability system.

House Bill 157, introduced by State Representative Jim Butler (R-Oakwood), would dramatically alter Ohio’s medical injury compensation program and make other changes to how Ohio administers the Medicaid program. Rep. Butler hopes to accomplish three primary goals with the legislation: lowering Medicaid spending, lowering overall healthcare spending and applying Medicaid savings to care for needy populations.

To accomplish this mission, his bill would create hospital ER diversion programs, institute price transparency for healthcare services, promote small business health coverage through Multiple Employer Welfare Arrangements (MEWAs), incentivize Medicaid recipients to utilize preventative services and reduce defensive medicine by establishing a new Medical Injury Compensation System.  The 386 page bill is aggressive and would impact nearly every stakeholder in the healthcare industry.  For optometry, one provision in the bill stood out as a cause for concern.

HB 157 calls for the creation of a new Health Care Professional Standards Board.  This board would be comprised of three members appointed by the state medical board, one member appointed by the state dental board, one member appointed by the state chiropractic board, one member appointed by the state board of pharmacy, two members appointed by the state board of nursing, and one member appointed by the state board of optometry.  The new board would have immense authority.  It would be charged with investigating malpractice claims brought against providers, imposing discipline against providers, maintaining a database of claims and complaints and establishing the standard of care for health professionals.

While important functions, all of these activities are currently being performed within state or federal government.  State regulatory boards, including the Ohio State Board of Optometry, maintain access to the National Practitioners Data Bank (NPDB) in order to review and investigate malpractice awards.  The boards also establish the standard of care for a profession and impose discipline when warranted.  Finally, the Ohio Licensure System provides public information on formal actions taken against health care providers and the NPDB tracks similar information for use by government entities and insurers.  Simply stated, the functions delegated to the Health Care Professional Standards Board are duplicative and would only serve to create another costly level of bureaucracy within health care system.

The OOA has communicated these concerns to Rep. Butler and other members of the House of Representatives.  At the same time, the OOA acknowledges that medical liability laws are a key component to establishing a cost-effective health care delivery system that keeps medical professionals in Ohio.  But recent tort reform efforts, including the establishment of caps on damages and the creation of a statute of repose, are already helping to achieve these goals.  For optometry, malpractice rates and the number of licensed optometrists are stable in Ohio.  So while there is always value in searching for ways to improve our medical liability system, the current structure appears to be working.  Dramatic changes, such as the creation of a Healthcare Professional Standards Board, could disrupt this stability.

The OOA will continue to monitor HB 157 and other bills impacting the practice of optometry.  Be sure to visit www.ooa.org to view the latest updates on these important legislative issues and to get involved in the OOA’s Key OD grassroots advocacy program.

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Reasons to Contribute to the OOPAC as an OOA Member

By Rebecca Brown, OD

As optometrists we care about our patients.  We have literally dedicated our lives to becoming better practitioners.  We work hard to become better doctors and to provide better services and a higher quality of care to our patients.  It is only logical that we also share a concern for the future of our profession.

The easiest way for us to protect the future of optometry in Ohio and allow us to continue offering excellent patient care is to annually contribute to the Ohio Optometric Political Action Committee (OOPAC).  Still less than one out of four Ohio optometrists contribute to OOPAC.

Unfortunately many of us do not understand the importance of giving money to OOPAC.  Money given to OOPAC is contributed to people seeking public office in order to assist with political campaign expenses.   Recipients of OOPAC contributions are candidates who are considered supporters of our profession.  Recipients of PAC money have often already demonstrated their commitment to optometry by creating or supporting laws that have directly benefitted optometry and our patients.

The reality is that every optometrist can make a difference by giving to OOPAC.  Sure large contributions are good, and the more money we give the more we can help friends of optometry, but even small contributions make a difference.  As stated earlier less that 25% of optometrists contribute to OOPAC.  A higher percentage of giving demonstrates that our profession is educated about and unified regarding our commitment to helping elect people that support optometry.  Your giving sends a message to lawmakers that as optometrists we are committed and willing to stand together to advocate for policies that help our profession and better serve our patients.

Straight Talk Regarding ‘Elephants in the Room’

By Charles B. Brownlow, OD

When I did my first presentation on medical record keeping after the release of the 1997 Documentation Guidelines for the Evaluation and Management Services (99000 codes), I was sure that the document would finally spur doctors and insurers to learn and follow the rules.  The ‘DGs’, as we refer to them, provide a very simple explanation of the logic of the delivery of health care services, followed by a very objective, detailed set of instructions for creating good medical records and for choosing 99000 codes accurately.

The word ‘objective’ in the previous sentence means that doctors and staff could choose codes exactly as insurers are required to choose them.  Doctors adhering to the definitions for services provided by the Current Procedural Terminology (CPT © American Medical Association) and the DGs would never have to worry about an audit by Medicare or any other insurer.  All a doctor would need to do for visits would be to provide the care the patient needs; no more, no less; keep an excellent record of all that happened during the visit, and then choose a code to represent the content of the record.

For the first time in history, the process of choosing visit codes can be accurate, objective, and repeatable, with those three characteristics ensuring appropriate reimbursement for services provided and ‘no hassle’ chart reviews or audits.  When I first read the DGs in July of 1997, I was ecstatic!  Our colleagues would no longer have to worry about choosing codes nor about being audited.  I was doubly ecstatic because the 1997 DGs were the first guidelines to provide guidelines customized for eye specialists.

The original guidelines required doctors to examine at least nine organs systems, actually doing at least two tests on each system for the physical examination portion of a visit to qualify as ‘comprehensive’. With the 1997 DGs, eye doctors could reach the previously acrophobic level of comprehensive physical examination (and thus the higher level codes that require comprehensive physical examinations) simply by doing twelve ophthalmic elements and two psychiatric elements (mood and affect and orientation to time, place and person.)

Furthermore, the required ophthalmic elements have traditionally been included in a typical eye examination; acuities, gross fields, examination of the adnexa, pupils and irises, motility and versions, corneas, anterior chambers, crystalline lenses, bulbar and palpebral conjunctiva, IOPs, and dilated ophthalmoscopy (discs and peripheral retina). Wow!  The 1997 DGs made it possible for eye doctors to appropriately choose the higher level 99000 codes; 99215, the 99204 and even the 99205 (albeit rarely); for the first time since CPT created the 99000 codes in 1992!

Being the eternal optimist that I am (or that I was in 1997), I assumed the 1997 DGs would be immediately embraced by ODs and OMDs, who would quickly learn of their simplicity and accuracy and objectiveness and repeatability, and would begin using them immediately.  Obviously, I could not have been more wrong.  Here we are, eighteen years after the introduction of the 1997 DGs, and the typical OD and OMD still don’t understand the power that the document provides them.

As a matter of fact, based on my experience with the hundreds of audiences I’ve faced during those years, I’m pretty confident in estimating that fewer than 30% of all eye doctors have ever read the 1997 DGs, even though a relatively high percentage of eye doctors use them in their practices every day!  Talk about self-destructive behavior.  Without understanding the DGs, it doesn’t matter whether the doctor, the doctor’s staff, or the doctor’s EHR software is choosing the codes, the audit will be ugly.  Even worse, without knowledge of the DGs, the doctor and staff will be helpless in attempting to defend themselves in an audit…Even though the auditor probably doesn’t know the DGs well, either.

As long as we’re getting depressed, let’s consider another ‘elephant in the room’, probably larger than the DG issues.  Thousands of eye doctors in the US are reporting their visits to insurers using the comprehensive ophthalmological services (CPT©AMA codes 92004/92014), without knowing the definition for those services.  Let’s do a little math.  If we assume that 40,000 eye doctors in the US are each using these codes 2,000 times per year, that would represent 80 million uses of that code per year.  If we generously assume 50% of those doctors actually have read the CPT definition, understand it, and appropriately apply it, that could mean up to 40 million potential incorrect choices of the code every year.   Imagine the potential impact on these two professions that a sweeping audit of those two codes would produce.  40 million incorrect claims, even at $100/claim would be $4 billion!

Will thoughts such as these get the attention of America’s eye doctors and staff?  Will thoughts such as these get the attention of American insurers? Sadly, I’d bet on the latter before the former, though it is clearly the former; America’s eye doctors; that I have devoted my professional life to.

What can be done about this?  What can the AOA and AAOphthalmology do?  What should the educational programs for tomorrow’s doctors of optometry and ophthalmologists do to correct these issues?  I believe it starts where it should have started back in 1997; with the practicing doctors.  It starts with downloading a FREE copy of the 1997 Documentation Guidelines for the Evaluation and Management Services from the CMS website; https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf  It starts with buying the 2015 American Medical Association Current Procedural Terminology from AMA ($114.95) amastore.com, 800-621-8335) or at a member discount (approximately $100) through the American Optometric Association (aoa.org/marketplace, 800-991-4100).  AMA is the only CPT that is the national standard for procedural coding, so don’t mess with substitutes…They cost more and you cannot defend yourself in an audit without the official AMA CPT.

In short, no more excuses.  Just reading the first few pages of the AMA CPT and the 1997 DGs will help docs and staff understand the key links between excellent patient care and excellent records.  In my opinion those two documents should be ‘required equipment’ for all eye doctors and all future eye doctors.  CPT is only good for twelve months, so new copies must be ordered each December for the coming year.  I know, I know, $100/year seems like a lot of money to some, but measured against the huge, looming expense of ugly audits, it’s ‘peanuts’!  Let’s face it, CPT and the DGs; though they’ve largely been ignored by health care providers for decades; are priceless.

Please don’t put it off another 18 years.  Act today!

ICD-10; Transition Tips from inside the Trenches

OOA President-Elect Dr. Jason Miller will be the featured speaker at each of the Zone President’s Nights in the fall. In addition, new OOA Executive Director Keith Kerns will provide a legislative update and looks forward to meeting the members in each Zone.

Dr. Miller will speak about ICD-10. A summary (one hour practice management ce)

ICD-10; Transition Tips from inside the Trenches

The conversion to ICD-10 will change many aspects of Optometric practice. It requires improved record documentation and plays a larger role in the delivery of health care. This course will discuss steps to help make the conversion a success. From the front office to the examination room to the billing office, it will uncover tips to help with that transition leading up to October 1, 2015 and into the future.

Mark your calendar and plan to attend your Zone’s President’s Night.

President’s Night Zone meeting dates are as follows:

Zone 1 (Mansfield) – September 14

Zone 2 (Cleveland) – September 9

Zone 3 (Canton-Akron)- September 2

Zone 4 (Youngstown)- August 24

Zone 5 (Zanesville)- September 24 

Zone 6 (Athens)- September 21

Zone 7 (Portsmouth)- September 3

Zone 8 (Cincinnati)- August 26

Zone 9 (Dayton)- August 27

Zone 10 (Lima)- September 16

Zone 11 (Toledo)- October 14

Zone 12 (Worthington)- September 23