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Registries are the Wave of the Future
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Everywhere you turn, more and more functions are being done online. Whether it is research, contacting friends, maintaining your calendar, or even meeting your future spouse, it seems that we all turn to the Internet to manage our lives. And now, the business of medicine has jumped on board, using the Internet to make the profession, and compensation, flow a bit more smoothly with the use of online registries.

Clinical data registries have been around since the 1980s, according to Academy CEO/EVP David W. Parke II, MD. The Academy’s own National Eyecare Outcomes Network project was the first attempt. However, it was before its time and never caught on, in part because there was no incentive to use it.

Fast-forward to the 21st century, and you’ll see that clinical data registries have now come to the forefront of quality of care. And the Academy has answered with the Ophthalmic Patient Outcomes Database, commonly referred to as the outcomes registry, created in partnership with the American Society of Cataract and Refractive Surgery (ASCRS).

What is the Outcomes Database?
Increasing requests for this type of service were the impetus for the database, according to Flora Lum, MD, executive director of the H. Dunbar Hoskins MD Center for Quality Eye Care and the Academy’s policy director for quality of care and knowledge base development. “The demand is great now,” says Dr. Lum. “That’s why we are working with ASCRS and, likely other ophthalmic subspecialty societies and organizations, to create one united ophthalmic registry.” Such collaboration means the database could grow to accommodate more and more pieces of data over time, rather than ophthalmologists having to report to a growing number of specialized registries. Physicians in some other specialties have wound up having to report to multiple registries, due to a lack of collaboration among organizations.

The outcomes database is a CMS-qualified Physician Quality Reporting Initiative (PQRI) registry managed by a vendor with extensive experience in operating data registries. “There needed to be a registry option for ophthalmologists to report on the cataract PQRI measures in 2010,” says Lum, “so the Academy took the lead in funding the start-up of the Ophthalmic Patient Outcomes Database in January 2010.” A significant figure in the project has been Anne Coleman, MD, PhD, director of the Hoskins Center and the Academy’s secretary for quality of care.

As you likely know, the 2010 PQRI program offers a 2 percent incentive bonus on all Medicare Part B allowable charges (less durable medical equipment and injected solutions) for physicians who volunteer and successfully participate in 2010. In order to qualify for the incentive, a physician must report on three or more measures 80 percent of the time. For more on the 2010 PQRI, visit the Academy’s PQRI page.

Two measures, new to this year’s PQRI, are registry reporting only:
  • Measure 191: Cataracts: 20/40 or better visual acuity within 90 days following cataract surgery
  • Measure 192: Cataracts: complications within 30 days following cataract surgery requiring additional surgical procedures
Why Use the Database?
In the past, PQRI incentive payments have been difficult to predict. According to Lum, you have about a 50 percent chance of getting reimbursed using a traditional claim submission. “With the outcomes database, you have an 80 to 90 percent success rate of getting paid,” says Lum.

Dr. Parke agrees. “Historically, physicians have had a tough time using the current Medicare reimbursement system. You send in your data and, way off in the future, you may or may not get your money,” says Parke.

With the outcomes database, you don’t have to wonder. “This is a marked improvement over the paper method,” Parke says. “In the past, you didn’t know if the government had accepted your claim or not, and you never knew where you stood at any point in time. With outcomes, you can check online any time to see what data you will be submitting. It allows you more control in the process.”

Specifically, the outcomes database does this by removing the middlemen (regional carriers) from the process. It separates the reporting of PQRI data from the claims-reporting process, allowing for retrospectively entering PQRI data — thereby preventing the PQRI process from delaying claims processing. It also removes the need for additional CPT III and G codes, and provides built-in quality checks that reduce errors and allow practices the opportunity to preview their data and correct errors or omissions before transmission to CMS. 

How to Use the Database
If you can fill in a form and hit enter, you can use the outcomes database. Once you’ve registered to use the database, data submission is as simple as logging into the online database and filling in the data on the screen. After you’ve used the system several times, you’ll also be able to automatically fill in patient demographic information from your billing system by importing a compatible file. You then check off measurement information, if you have performed the quality measure or not, etc., and submit. It’s that easy.

You can also import data from your practice’s electronic health records (EHR) system into the outcomes database. All the data will upload automatically, which means you don’t have to re-enter it. (You may need to populate the quality measures, however, if they are not already in your EHR system.) This saves you time and effort.

Use of the database isn’t free — it costs $405 to participate, plus $199 to transmit CMS — but the increased likelihood of reimbursement for claims makes it well worth it. According to CMS, the average incentive payment for ophthalmologists participating in the 2008 PQRI was $5,399.

PQRI is Just the Beginning
In the past five to 10 years, these types of clinical data registries have started to become the norm for medicine. Specialties such as general surgery, neurosurgery and plastic surgery have all used the same vendor as the Academy and ASCRS worked with to develop the outcomes database — with good success.

Cardiologists, in particular, have been using a data registry for the past 20 years, Dr. Parke says. This has helped hospitals and physicians alike benchmark outcomes of care and manage complex diseases more efficiently. “Registries emerged in cardiology first because, in part, outcomes are so tremendously varied and an awful lot of money is at stake,” says Dr. Parke. “Anything that can be done to improve morbidity and mortality is incredibly desirable.”

While the outcomes database is currently set up for PQRI reimbursements only, Dr. Parke sees it playing a larger role in the future. “I see us using Outcomes for performance improvement, and anticipate its use in maintenance of licensure and maintenance of certification in the very near future,” says Parke.

“When you have a big pool of clinical outcomes data, different groups can mine that data for different measures,” explains Dr. Parke. “It’s like a clinical trial on steroids! There are lots of physicians imputing important data that can be aggregated, analyzed and compared across a wide range of metrics. One key issue is that if ophthalmology owns the database, we control who has access to the data and for what purpose."

You can then compare and contrast your personal performance to your peers, as it relates to your particular specialty. What types of outcomes are common in your region? What do you need to improve? This type of feedback then allows you to create a personalized education plan to improve your performance.

Easy Adaptation for YOs
This new technology should benefit young ophthalmologists the most. Like HER systems, data registries should feel like home to YOs. Most YOs are very comfortable with the Web and using the Internet to aggregate information. Outcomes fits in perfectly with this system.

Plus, as all state boards move toward accepting maintenance of certification as a mechanism for determining maintenance of licensure, YOs will have a vehicle to get recertified, keep their license, and get paid.

It doesn’t get any better — or easier — than that!

Editor’s note: For more information, contact Dr. Lum at flum@aao.org; you can contact the vendor, Outcome Sciences Inc., at ophthalmicdatabase@outcome.com.

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About the author: Kimberly Day is a freelance health writer and medical editor and a frequent contributor to YO Info. She is the co-author of Hormone Revolution and ghost writer of Eat Papayas Naked.

 
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