American Academy of Ophthalmology Web Site: www.aao.org
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2011 Survey Results: Four Familiar Frustrations
Trend data from the biennial Academy membership survey1 show that, as in 2009, the top four practice problems in the United States are concerns about reimbursement levels, high practice costs, administrative problems with billing, and the challenges of the current economy. These problems are consistently identified as major concerns for ophthalmology.
When asked to rank the greatest threats to the practice of ophthalmology over the next five to 10 years, most U.S. members’ concerns remain constant: They considered changes in physician payment, reform of health care delivery, and the current regulatory environment to be the most threatening issues.
Q: I am the president of my state society. A society member contacted me for advice about this scenario: A neurologist consulted a cataract surgeon for evaluation and treatment of his cataracts with the principal complaint of decreased night vision. During the visit, the eye surgeon stated that the patient’s vision may not be completely corrected for distance because of his astigmatism but that he would have “the best uncorrected vision of his life.” The patient specifically asked for distance correction before the surgery and wrote this on the consent form. The surgery proceeded without complications; however, postoperatively, the patient’s uncorrected vision was better for near, and he claimed to now have “the worst uncorrected vision of my life.” The surgeon offered to perform a second surgery to replace the original lens. The patient refused, citing a lack of trust, but requested the surgeon’s personal contact information to engage in a discussion about the unplanned outcome. The surgeon declined the patient’s request, which further strained communication.
A: During your career, you might treat another physician, even an ophthalmologist. When caring for physician- patients, there may be a tendency to make assumptions or inferences about their understanding of the procedure or intended outcomes. Incorrect assumptions may result in a breakdown of the routine doctor-patient relationship and informed consent process.
Because there is no formal training on how to care for a doctor, unusual problems may come up. These could include providing incomplete explanations of treatments or potential complications; assuming a level of understanding that the patient may not have; and conducting less rigorous follow-up after surgery based on a presumption that the physician-patient knows when to contact the treating physician about problems. Alternatively, there may be VIP physician-patients who expect special attention or preferential treatment, such as special office hours, expedited clinic visits, off-the-record consults and testing, e-mail and cellphone contact information, or specific prescriptions.
There are two major guidelines in caring for the physician-patient: First, physicians should not take on the role of treating other physicians if they are not comfortable doing so; and second, the relationship needs to be clarified at the beginning and should be collaborative. The treating physician is in charge and should carry out his or her usual complete examination. In addition, the treating physician should comprehensively review the treatment plan with the patient and be sure that the informed consent process is thorough, regardless of what the physician-patient claims to understand.
In summary, when physician-patients seek care, it is necessary for the treating physician to be attentive to the special issues inherent in these relationships. A comprehensive examination with explanation and thorough informed consent process will help mitigate miscommunication and defuse tension if unexpected outcomes occur.
Registration Now Open for MOC Exam Review Course
This course offers an in-depth review of comprehensive clinical and specialty-specific knowledge. Sessions are taught by a faculty of instructors selected from among the physicians who created the Practicing Ophthalmologists Curriculum. Special study sessions are held for each practice emphasis area.
The course will be held July 20 to 22 at the InterContinental Chicago O’Hare Hotel in Rosemont, Ill. A two-day course costs $1,300 for members and $1,680 for nonmembers. A three-day course costs $1,950 for members and $2,250 for nonmembers.
To register, visit www.aao.org/moc. Registration closes July 2.
New Content on EyeSmart Website
The EyeSmart public education website is a reliable source of eye health information for your patients—and now it’s even more comprehensive. In recent weeks, physician-reviewed content on nearly 50 diseases, conditions, and treatments has been added. New topics include color blindness, HIV infection, and vitamin A deficiency.
Visit www.geteyesmart.org and click “Diseases and Conditions A to Z.”
Renew Your Academy Membership for 2012
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 dues must be paid by June 1. To renew your membership online, visit www.aao.org/member/paydues. You can also renew by mail, fax, or phone.
Questions? Contact Member Services by phone, 866-561-8558 (toll-free in the United States) or 415-561-8581, by fax, 415-561-8575, or by email, firstname.lastname@example.org.
New OTA on ROP Therapy
A new Ophthalmic Technology Assessment, entitled Current Role of Cryotherapy in Retinopathy of Prematurity, appeared in the April Ophthalmology. This OTA reviews the clinical evidence and concludes that for threshold ROP, laser therapy provides better structural and functional outcomes and fewer systemic complications than does cryotherapy.
To read OTAs, visit www.aao.org/one and select “Practice Guidelines” and “Ophthalmic Technology Assessments.” Full text is free to members and Ophthalmology subscribers.
Find the Perfect Job
The Academy’s Ophthalmology Job Center allows job seekers to search open positions and post resumes. The center also allows employers to post ads and search for candidates.
To get started, visit www.aao.org/ophthalmologyjobcenter.
Need Help in Implementing an EHR System?
Keys to EMR/EHR Success: Selecting and Implementing an Electronic Medical Record, 2nd Edition (#012198) helps practices achieve a smooth transition to a new electronic health record system. This step-by-step guide includes information on HIPAA and the EHR incentive program and tips for simplifying each stage of the selection and implementation process. It costs $139 for members and $188 for nonmembers.
New BCSC Available for Advance Order
Starting May 15, you can place an advance order for a print edition of the 2012-2013 Basic and Clinical Science Course.
Three sections have undergone major revision:
Order the complete print set. A full set (#02800952) of the BCSC includes 13 print volumes plus the Master Index. It costs $830 for members and $1,118 for nonmembers. Individual print sections cost $87 for members and $121 for nonmembers.
Coming soon—BCSC eBooks. The new eBooks format is different from any previous BCSC electronic product. It is not a Flash app or an Apple iBook and, therefore, can be used on any computer, tablet, or smartphone. The BCSC eBooks will be available to order this summer and may be purchased as individual volumes or as a complete set.
For more information, visit www.aao.org/bcsc.
Get Ready for the Joint Meeting
On June 1, the Virtual Advance Program will be available online at www.aao.org/2012. It contains the first look at Joint Meeting preregistration, housing, and program information for the Academy’s Joint Meeting with the Asia-Pacific Academy of Ophthalmology. You can also search, bookmark, and print course and session listings.
Complete registration information will also be available the same day at www.aao.org/registration.
Don’t Miss the Keynote Speaker
Abraham Verghese, MD, MACP, will present the keynote address during the Opening Session on Sunday, Nov. 10. Dr. Verghese is a physician and senior associate chairman for the theory and practice of medicine at Stanford, and has garnered many accolades for his advocacy efforts. His debut novel, Cutting for Stone, has spent more than 100 weeks on The New York Times bestseller list.
For more information, visit www.aao.org/2012.
This February, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule announcing its requirements for how physicians can successfully participate in the second stage of “meaningful use” in its Medicare Electronic Health Record Incentive Program. Physicians who meet the requirements, which are being released in stages, can qualify for up to $44,000 in Medicare incentive payments over five years. Each stage requires more-advanced use of EHR technology to earn the incentive payment.
Over the past year, the Academy has lobbied Department of Health and Human Services officials in charge of the program to ensure that ophthalmologists who choose to adopt an EHR system are able to qualify for the incentive. (Requirements included in an initial draft of the proposed rule for the second stage were focused toward primary care physicians.) As a result of this lobbying effort during the drafting process, CMS adopted changes advocated by the Academy and released a proposed rule that incorporates more flexibility so that the requirements better accommodate specialties. A key component in the rule is a new specialty-focused objective that will drive EHR vendors to include in their systems the capability to access diagnostic images. Under the rule, CMS also will continue to allow ophthalmologists to be exempted from requirements that are not applicable to their scope of practice, such as recording patient vital signs, reporting to immunization registries, documenting lab test results, and documenting a patient’s advance directive.
Even with these changes, some elements of the meaningful use requirements in the proposed rule may prove burdensome for ophthalmologists—especially considering that, beginning in 2015, physicians will be penalized if they do not successfully adopt an EHR system. Indeed, the rule proposes limited exemptions from the penalty for physicians who practice in an area without high-speed Internet, who are in the first two years of their careers, or who aren’t able to use an EHR system because of unforeseen circumstances (e.g., a natural disaster or the EHR vendor going out of business). But the Academy believes that these exemptions are inadequate to protect ophthalmologists whose circumstances make participating in meaningful use infeasible, such as those physicians who have a lower threshold of Medicare billing or who are over 65.
The Academy continues to lobby for sufficient opportunities under the rule for ophthalmologists to request an exemption from the EHR penalties and continues its advocacy efforts to ensure that meaningful use can be achieved by ophthalmologists.
The Academy continues to lobby for sufficient opportunities for ophthalmologists to request an exemption from the EHR penalties.