This isn’t what I signed up for!

Don’t worry, I am not about to go on a rant about my first month as POA president. The title of my editorial came to me as I was having an email discussion with a member about MIPS and PQRS. After some back and forth about the various measures we will have to be reporting, the response I received was, “Remind me why I went into medicine?” For me, that pretty much sums up what I think many of us in the healthcare community are feeling.

As the payment reform train continues hurdling down the tracks, many of us probably feel we are being left behind. We spent many years of training learning to care for our patients, diagnose and treat their problems, make sure they get to the correct provider to address their ailments. Now we feel we have to take away from our time caring for our patients, instead staring at a computer screen making sure we are clicking all the right boxes. It is a bit ironic that if you spend more of your time examining and listening to your patient, and less time clicking the boxes on your computer screen, you will be deemed as providing inferior care and thus penalized in your reimbursement. Huh? 

But this is the brave new world we are entering. Data collection is king, just look at ICD-10. We now have dozens of codes to specify how severe your glaucoma or macular degeneration is. I’m sure the day will come when we will be graded on the percentage of moderate glaucoma patients that convert to severe glaucoma. 

For those of us who have been doing this for many years, it is hard for us to comprehend anything but fee for service reimbursement. But I see the MIPS program as the first real step away from our traditional payment methodologies and towards a quality- and outcomes-based reimbursement system. If the thought of this scares you to the brink of early retirement, fear not, you are not alone. 

I truly believe optometrists in general provide some of the highest quality of care in the healthcare field. We spend a lot of time evaluating and listening to our patients. The challenge is to make sure we are communicating this into the electronic box that now takes up most of our desktop. But don’t worry, your professional associations are here to help. 
The AOA has developed an optometric-based registry, AOA MORE, that will allow you to link your electronic health records and be able to seamlessly report your quality data directly through the registry. The days of having to make sure you remember to add all the correct PQRS codes will be gone. The best part is that AOA MORE is a free member benefit, so if you have electronic records, make sure you register for AOA MORE. If you don’t have an EHR, the AOA just recently held a webinar on how you can participate in MIPS too. So, don’t think that if you are not electronic, you have to be left behind.

It is not just providers coming under more scrutiny for quality care, either. The insurance companies are subject to these measures, too, and are graded by HEDIS and STAR scores. 

Here at the POA, we have been able to utilize our Diabetic Eye Health Alliance to advance optometry’s role here, too. Our pilot program with Geisinger Health Plan (GHP) has seen our members partner with GHP to get 71% of their delinquent diabetics dilated retinal exams in 2015, and we’re seeing similar results for 2016. As we expand this program to Highmark and hopefully more health plans this coming year, this will help cement optometry’s role as the primary eye care provider in this new world, and allow us to work with the insurance companies to provide higher quality care to all of our patients. And isn’t that what we have all been trying to do, even before electronic health records, PQRS and HEDIS scores—provide better care to our patients?

Stay tuned; the ride is just beginning!

Steve Eiss, O.D.