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Payment in Peril: Act Now to Save Your Financial Bottom Line

In addition to the ongoing threats to physician payments due to the sustainable growth rate, other changes and federal initiatives have significant financial implications for revenue.

  • HIPAA 5010: By Jan. 1, 2012, all practices must be compliant with new HIPAA 5010 standards in order to receive payment. If your practice is not compliant by the deadline, only workers’ compensation claims will be accepted; all others will be rejected. Standards are being upgraded in preparation for the move to ICD-10. The AMA estimates that the upgrade process will take several months. Vendors for practice management, electronic health record (EHR) systems and other services should be aware of the change, but you should contact your vendor(s) to find out what their plans are. For more information, including implementation guidelines, visit www.aao.org/hipaa5010.
  • E-prescribing: All practices face a 1 percent penalty on 2012 claims unless they begin e-prescribing this year. Only 25 e-prescriptions—or about two a month—must be submitted during 2011, but 10 of those must be submitted via claims (not registry) by June 30 to avoid the 2012 penalty. E-prescriptions during the global period do not qualify. Only the G8553 code should be used, but it must be linked to an exam code. For more information, including exemptions for practices with limited Medicare volume, visit www.aao.org/e-rx.
  • Physician Quality Reporting System (PQRS; formerly the Physician Quality Reporting Initiative, or PQRI): Only two options remain to qualify for the incentive bonus.
    1. Report for the six-month, July 1 to Dec. 31, period only (by claims or registry reporting).
    2. Report by registry only, in which case you can still report for the entire year.

You should also check remittance advice notices regularly to make sure that remark code N365 is shown for each PQRS measure submitted. For more information on PQRS, visit www.aao.org/pqri .

The Academy will continue to keep you updated to help you protect your practice’s payments.



Notice of Resignation During an Ethics Investigation

At its February 2011 meeting, the Academy’s board of trustees approved a recommendation to publish information about an Academy fellow’s resignation. Emil W. Chynn, MD, of 102 East 25th Street, New York, N.Y., resigned effective Feb. 10, 2011. A challenge pursuant to the Code of Ethics was pending at the time of the resignation.



Renew Your Academy Membership for 2011

By now you should have received your membership renewal packet in the mail. Respond immediately so you can continue to take full advantage of all the benefits of Academy membership. To ensure uninterrupted benefits, your Academy membership must be paid by June 1. To renew your membership online, visit www.aao.org/member/paydues. You also can renew by mail, fax or phone.

If you have questions, please contact Member Services by phone, 866-561-8558 (toll-free in the United States) or call 415-561-8581, by fax, 415-561-8575, or by e-mail, member_services@aao.org .


Connect With the Academy on Community Blogs

Academy leadership and other physicians are offering their takes on current events, clinical issues and other topics on the Community blogs.

Academy President Richard L. Abbott, MD, uses his blog to “let our members know exactly what the Academy is doing and what is on the front burner for the different divisions of the Academy.”

On the EyeNet blog, Chief Medical Editor Richard P. Mills, MD, MPH, is joined monthly by other ophthalmologists to discuss EyeNet’s clinical content from an international perspective.

Community blogs are excellent vehicles for sharing your thoughts and interacting with other members.

To get started, visit www.aao.org/community and click “Blogs.”


Visit the Academy Abroad

The Joint Congress of the Academy and the European Society of Ophthalmology (SOE) will be held June 4 to 7 in Geneva.

Stop by the Academy’s booth to learn more about new products, membership and the Annual Meeting in October.

For more information, visit www.aao.org/meetings/aao_exhibits.cfm.


Catch Up on Practice Management Tips

The AAOE now offers archived recordings of recent practice management webinars. Topics include PQRS (formerly PQRI), e-prescribing, 2011 coding updates, avoiding an EHR disaster and strategic planning.

For more information, visit www.aao.org/aaoecalendar.


Post Job Openings on Professional Choices

Is your practice currently hiring? Advertise your listing on Professional Choices, the Academy’s online career center. It is an effective way to connect hiring practices with ophthalmologists and office staff.

For more information, visit www.aao.org/professionalchoices.


Ask the Ethicist: Off-Label Meds

By the Ethics Committee

Q: Almost every week I hear about promising new treatments for various eye diseases. While I want to offer my patients the latest developments, I hesitate when learning that many of these treatments are considered “off-label.” What are the ethical issues with off-label treatments?

A: The FDA approves drugs and devices for specific indications. The use of any medication “prescribed to treat a condition for which it has not been approved by the FDA” is therefore defined as off-label. While a drug’s labeled use is specified by a regulatory body, its indications and incorporation into standard of care are determined by clinical trials and consensus practices. Thus, there is an inherent disconnect. An estimated 50 percent of medications used routinely in ophthalmic practice are used off-label. And many of these uses, ironically, have been validated by robust clinical trials.

The central tenet of the Academy’s Code of Ethics is that clinical practice should be guided by the best interest of the patient. Advisability of any treatment for an individual requires an objective appraisal of the disease’s natural history compared with known clinical effectiveness of available therapies. Physicians should discuss realistic treatment expectations, the reasonable odds of achieving these goals and incidence of potential complications with the patient. While one individual may choose a treatment with only a 10 percent chance of success, another may decline to use any treatment with less than a 90 percent chance of success. The decision to proceed should be made by the patient after appropriate informed consent.

Ophthalmologists must be aware of potential conflicts of interest with the use of off-label medications, including financial gain, notoriety or recognition, advancement of a personal research program or promotion of a third party interest, and carefully assess whether these interests are affecting treatment recommendations. Lastly, since the charge for unapproved medication is often discretionary, fees for drugs or services should be reasonable and not exploit patient vulnerability.

In sum, the off-label use of medications is not inherently unethical. In many instances, off-label treatments may be the best, or the only, available treatment, and withholding treatment would be unethical. An honest and complete discussion of the proposed treatment, its known and potential risks, realistic expectations of treatment, alternative treatments and potential financial burden is mandatory. Ultimately, the patient’s best interest remains the primary motivation for any treatment.

To submit a question for this column, contact the Ethics Committee staff at ethics@aao.org. To read the Code of Ethics, visit www.aao.org/about and click “Ethics” and “Code of Ethics.”



New BCSC Available for Advance Order

Starting on May 17, you can place an advance order for the 2011–2012 Basic and Clinical Science Course.

Four sections have undergone major revision:

  • Section 4: Ophthalmic Pathology and Intraocular Tumors (#02800041)
  • Section 7: Orbit, Eyelids, and Lacrimal System (#02800071)
  • Section 9: Intraocular Inflammation and Uveitis (#02800091)
  • Section 13: Refractive Surgery (#02800131)

Order the complete set. An order for the complete set (#02800951) of BCSC includes 13 print volumes plus the Master Index. It costs $790 for members and $1,065 for nonmembers. Individual print sections cost $83 for members and $115 for nonmembers.

DVD-ROM. The 2011–2012 BCSC series is also available on DVD-ROM (#02820001), which offers the same content as the 13 print sections and includes an interactive self-assessment program, search capabilities and thousands of images. It costs $720 for members and $1,045 for nonmembers.

BCSC Online. Complete BCSC content can also be accessed from any computer with an Internet connection (#02840001V). It costs $720 for members and $1,045 for nonmembers.

To find out more about pricing, visit www.aao.org/bcsc.



Who’s in the News

Jerald Bovino, MD, and Martin K. Schmid, MD, were quoted by The New York Times in a February story on eye damage caused by green laser pointers. Many doctors are warning that recent cases of teenagers suffering eye damage from these lasers are the first of many. “I am certain that this is a beginning of a trend,” Dr. Schmid said. Dr. Bovino noted that the way the eye focuses can intensify the laser: “It is going to the fovea, the center of the retina.”

Ivan R. Schwab, MD, FACS, was interviewed by U.S. News & World Report for a March story on computer vision syndrome. This syndrome “is a new diagnosis and a relatively trendy one at that,” said Dr. Schwab. “And the thought that focusing up close at technology will provoke a new set of symptoms different from those experienced during other forms of close-up work and attention has yet to be documented.”



Academy Advocates Against Regulations

In his January State of the Union address, President Obama ordered federal agencies to review government regulations to determine whether they hinder economic growth. In response, the Academy worked with the AMA on a list of burdensome regulations—with the AMA conducting an online survey for additional input. Survey results are being used to advocate that the administration reduce paperwork hassles, and its associated administrative complexity, which take time away from patient care and do nothing to advance quality.

There are several rules and programs the Academy believes have significant costs or burdens yet provide little or none of the benefits they were purported to provide. While there are other examples, the following are high priorities for the Academy:

  • New Medicare-enrollment rules whereby ophthalmologists who provide postcataract surgery eyeglasses and frames or contact lenses are put in either the moderate or high category of fraud risk—which entails a $500-plus enrollment fee, possible surprise inspections and fingerprinting.
  • The surety bond requirement (from $500 to $1,500 annually, depending on the practice location) faced by practices whose ophthalmologists provide postcataract glasses to individuals who aren’t patients at the practice.
  • CMS’s Physician Compare website that is plagued with erroneous information, which physicians must monitor and correct.
  • Penalties for noncompliance with e-prescribing requirements on physicians who do not write enough prescriptions to meet the threshold of 10 prescriptions in the first six months of 2011.

Jonathan Blum, deputy administrator of CMS and director of the Center for Medicare, said CMS will reexamine requirements that take the doctor away from patients and take another look at the importance of physician/patient face-to-face requirements. Face-to-face requirements remain for home-health encounters, but that requirement is being reconsidered for lab service encounters.

Mr. Blum said the proposed physician fee schedule rule that will be released this summer is a potential vehicle to introduce a number of the changes. Agencies must develop and submit a preliminary plan for review by the end of this month.

There are several programs the Academy believes have significant costs or burdens yet provide little or no benefit.



The online self assessments (1) on the Ophthalmic News & Education Network are a quick way to measure your clinical knowledge. These expert-developed quizzes are available in nine subspecialty areas. You will receive immediate, detailed feedback after each question, as well as a comparison of how you scored against your peers. Suggestions for remediation are also available so you can add resources to a customizable lesson plan.

“Diagnose This” quizzes (2) are published weekly. Vote for the best approach to management of a common clinical presentation and see how your colleagues responded. After taking the quiz, you will have options to recommend it to a peer or offer comments on the issue.

Both types of quiz are free member benefits. To get started, visit www.aao.org/one and click on “Self Assessments” under “Educational Content.”


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