-: Hello everyone and welcome to today's webinar,
Quality and the IRIS Registry.
I am Joy Woodke, the Academy's Coding
and Practice Management Executive.
I'm pleased to introduce our speaker today, Dr. Flora Lum.
Dr. Lum is the Academy's Vice President
of Quality and Data Science and oversees the IRIS Registry.
The goal today is to discuss how to monitor
your quality measures using the IRIS Registry,
and what steps to take
to improve your scores when necessary.
Dr. Lum and I have no financial interests
or relationships to disclose.
Throughout the presentation, we'd like to encourage you
to submit questions using the Q&A function.
You can find this feature at the bottom of your screen.
You can also promote a posted question
to prioritize at the top of the queue.
We will be taking questions at the end of the presentation.
And now I'd like to turn it over to Dr. Lum
to start our discussion.
-: Thank you so much Joy, may you go to the next slide.
Thank you for everyone for participating
and being part of the IRIS Registry.
These are the latest statistics for the IRIS Registry
which involves the large majority of ophthalmic practices
in the United States, a total of 18,155 physicians,
which are the ophthalmologists and the eligible clinicians
in their practices from 4,171 practices.
Of those, 15,920 physicians from 3,014 practices
are contracted for EHR integration.
And since 2014, the total number of patient visits
is 412.77 million representing 70.81 million
unique patients, next slide please.
As you know, the Iris Registry,
which stands for Intelligent Research in Sight
is the nation's first comprehensive
eye disease clinical database.
The number one goal was to help ophthalmologist
improve care delivery and patient outcomes.
It does this by providing individual feedback
on performance and comparison to national benchmarks,
and it helps practices meet
the merit based incentive payment system requirements.
Last Wednesday, in fact we held a webinar
on how to use the IRIS Registry
to optimize your MIPS reporting.
Next slide please.
The IRIS Registry has been the main MIPS reporting tool
for ophthalmology in the past four years.
This has yielded ophthalmologists
a higher average score than the average MIPS participant
in CMS and a total of $102,963 per ophthalmologist
in avoided penalties over this four year period.
The majority of ophthalmologists
and certainly the EHR integrated practices
have earned an exceptional performance bonus
which really hasn't amounted to a lot of money,
but it counts to, amounts to 0.1% to 1.79%,
is the highest we've seen of the Medicare fee schedule,
which translates to about $402 up to $7,191 bonus
per ophthalmologist per year.
And that could be a total of over the four-year period
of about $1,608 up to $28,764.
Next slide please.
This is the 2019 preliminary score performance
for those ophthalmologists
reporting through the IRIS Registry.
This is the score prior to CMSs finalizing the score
and adjusting for cost hardship and small practice
and complex patient score.
The average MIPS score was 74.82
out of the maximum of 85 points at this time,
this is before adding the cost category.
For quality 88% of those with EHRs,
scored items at the maximum or within five points
of the quality score and 78%
of EHR integrated participants qualified
for this exceptional performance bonus, which as we said,
really amounted to about 400 to 7,191 tops.
Next slide please.
And this is the 2020 preliminary MIPS performance.
83% of our ophthalmologists submitted
earned a score of 85 points or more.
That means these 5,450 ophthalmologists
would have earned an exceptional performance bonus,
and that's in the payment in two years, which is 2022.
3,004 or 36.7% had the top score of 100 points,
and so are eligible to earn the highest bonus.
Another 912 ophthalmologists didn't reach
the exceptional performance bonus threshold,
but still could have earned a very small bonus for 2022.
And then all of these 7,262 ophthalmologists
avoided the 9% penalty.
And of course this was the automatic hardship
as well for COVID.
So, normally we would have
more ophthalmologists reporting otherwise.
Next slide please.
So, altogether the IRIS Registry has permitted
all the ophthalmologists recording through it
to avoid $1.05 billion in accumulated penalties from MIPS,
which averages to, as I noted earlier
about $102,963 per ophthalmologist.
So when you do put in the time
to review your quality performance in the IRIS Registry,
there is a tangible return on investment.
Next slide please.
Now I'm going to talk about how to monitor your quality
and improve quality and the benefits of participation,
and some tips for success.
Next slide please.
As I noted as one of the initial goals of the IRIS Registry
is that it allows you to evaluate your own data,
and you can compare and benchmark against your colleagues
across the country.
You can look at your patients,
not just on a single one by one anecdotally,
but you can look at them more on a population level.
Specifically, you can look at a group of patients
based on condition, say all your diabetic patients,
or all your age-related macular degeneration patients.
And see, you can look at the trends
that might be happening or the occasional poor outcomes.
Say you started a new way of performing a procedure,
or you might note that a group of patients
had a systemic drug that affected their outcomes,
and you can answer some specific clinical questions
about the outcome of your patients.
Next slide, please.
There is a quality cycle at the academy
of how we utilize our quality measures and registry
to improve eye care.
It starts with guidelines,
which are known as our preferred practice patterns,
which are based on the best available evidence
in the literature and best practices.
From this evidence basis we develop the quality measures
that account for risk factors that would affect
for quality outcomes that are outside
of the clinician's control.
These quality measures are then integrated
into the clinical data registry,
the IRIS Registry for calculation and reporting.
Based on review of the quality measure performance
the individual clinicians can evaluate,
feedback to the appropriate people in the practice,
and think of how to improve upon their processes
to affect the patient outcome.
These steps get incorporated into the clinical practice,
such as having a telephone call back program
to make sure that patients with diabetes are seen every year
to prevent blindness in these patients.
And then these interventions and or learnings
about factors that affect patient outcome,
can make it in their way into scientific literature
or best practices and into our guidelines again,
and this cycle starts all over again.
Next slide please.
So quality improvement
is founded upon the principle of measurement.
It's been attributed to Lord Kelvin in 1880, this quote,
"If you can't measure it, you can't improve it."
Quality improvement is a method
of continually examining processes
and making them more effective.
What's relevant here is that it's continuous
and always making it better,
and that it's a team process because medical care
is highly complex and involves many different subsystems,
and multiple members of the team can help
because they understand the subsystems and how they relate.
Often there is a quality improvement cycle
which is repeating, plan, do, check, and act.
Plan, you analyze the process,
determine what changes would most improve that process,
and then establish a plan for making the improvement.
Do is the second step,
put your change into motion on a small scale
or a trial basis.
Study is the third step, check to see whether the change
is working, and that you can use the IRIS Registry
to look at your outcomes over time,
and then act is the fourth step.
If the change is working,
then you can implement it on a larger scale.
If the change is not working,
then you refine it or reject it and begin the cycle again.
Next slide please.
The academy initiated measure development in 2006,
and we've worked with subject matter experts
in the subspecialty societies for all these measures.
We created six measures,
which were the first eye care measures
in the physician quality reporting system in 2007.
We then created two cataract surgery outcome measures
that were accepted in 2008,
and they were among the first outcome measures
that CMS approved.
We created the cataracts measures group,
which was accepted in 2012
which included patient reported outcome surveys
that patients finish and complete, and tell them
about their subjective visual function or satisfaction.
And then there are 30 subspecialty outcome
and resource use measures available
in the CMS approved qualified clinical data registry,
which the IRIS Registry is in 2020, and in 2021.
In 2022, we have 26 subspecialty outcome measures
and I'll be reviewing those later on today.
In total, we have had 58 eye care
and noneye care related measures in the Iris Registry.
And we've created and copyrighted 43 measures,
which means that the academy does have the measure
development expertise and the full understanding
for measure implementation and interpretation purposes.
Next slide please.
In the literature we've been shown over and over again
that quality does improve with Actionable Feedback
and Targeted Education.
Actionable Feedback means that you are given information
that you can actually use and make changes for.
And Targeted Education is specific to the quality measure.
So we have demonstrated improvement on quality measure
over three years in this publication,
performance rates measured in the American Academy
of Ophthalmology IRIS Registry.
Next slide things.
So, we have shown that measurement does lead to improvement
and here are three retina measures.
The feeding back of these results to the commissions
allowed them to see which patients met
and which patients did not meet the measure.
And then we provided targeted education
about the measure specifications,
what were the results that attribute or attributed
to patient outcome success?
The three retina measures
are documenting the diabetic retinopathy severity
and macular edema status, diabetic retinopathy communication
with the primary care physician
who takes care of the patient's diabetes,
and an annual eye examination for patients with diabetes.
Next slide please.
Again we see that measurement can lead to improvement
on these quality measures, primary open-angle glaucoma,
and optic nerve evaluation, and a cap to this ratio
are required for success in these patients,
cataracts we're looking for 2040 visual acuity
resulting within 90 days after the cataract surgery,
tobacco cessation counseling
for those patients who are known to be tobacco users,
and then documentation of current medications,
both ophthalmic and systemic.
Next slide please.
Here we see the improvement over three years
on inverse measures.
An inverse measure just means
that a 0% performance rate means better performance
rather than 100%.
So this is complications within 30 days,
and then the prescription of high-risk medications
in the elderly populations.
And again, here you see that the performance has gone down,
which is in the right direction.
Next slide please.
And these are public health-related measures
designed to address concerns,
screening for the risk of falls in the elderly,
controlling high blood pressure
in those patients with hypertension,
completing the referral loop with a specialist
by receiving a report, and screening for BMI and follow up
if the BMI is abnormal.
In all, there are, these are a combination
of process and outcome measures,
and some are more eye related and others are not,
but CMS considers all of these measures as contributing
to the overall health and wellbeing
of the patient and improving public health.
Even improved and complete documentation
contributes to improve care
because it helps in transition of care and referral
to other settings with more precise
and up-to-date documentation.
Next slide please.
And these are the quality measures
for the EHR integrated practices for 2022.
Primary open-angle glaucoma, optic nerve evaluation
that we saw the improvement on, diabetic retinopathy,
which is communication with the physician
managing the ongoing diabetes care,
and we have the influenza immunization measure
as well as the pneumonia vaccination status,
and that is inquiring of the patient vaccination status,
the annual eye exam for patients with diabetes
that we saw the improvement on as well as the BMI screening
and follow up and documentation
of current medications in medical record.
Next slide please.
And then we talked about the 20/40 or better visual acuity
within 90 days.
And the important thing there is that we see
that patients who are co-managed and they don't come back
to the ophthalmologist office,
it's really good to have that documentation
of the final visual acuity or in the surgeons records
so that you can fulfill this measure.
Tobacco, the next one is tobacco use as we said,
what counts is not just that you screen every patient
for tobacco use,
but that you provide cessation intervention
which can just be simple advice to the patient
to stop smoking, and a lot of practices
provide those cessation intervention
as handouts to the patients,
controlling high blood pressure,
that's in patients with hypertension
and their blood pressure is measured in the office,
which shown the use of high-risk medications in the elderly
that this is minimized course in this high-risk population,
screening for future fall risk in the elderly,
and then closing the referral loop.
Again, that's important that your EHR system
has a place that shows the receipt
of the specialist report after referral.
Next slide please.
And these are the qualified clinical data registry measures
in IRIS Registry.
These are available only in the IRIS registry
and have been created and copyrighted by the academy.
So we have three for cataract complications
after cataract surgery.
There, we did have an original complications
after cataract surgery in the general program,
in the general MIPS program,
but because ophthalmologists do so well,
we have this issue of talked out
that everybody's getting 90%, 95%.
So CMS decides that the measure is no longer appropriate
for their program unfortunately,
so we do have a complications after cataract surgery
in our QCDR, we have visual acuity improvement
following cataract surgery with MIGS,
and then regaining vision after cataract surgery.
So this measure differs from the 2040 post-operative vision
because it includes patients with comorbidities
and there are just different visual acuity targets
for patients with different, with co-- ocular comorbidities.
And that includes many more
of the cataract surgery population.
And that it helps I think the practices to see,
you know, how are they doing in patients
with, at more high risk, more risk for visual acuity loss.
In cornea, we have two measures,
one for endothelial keratoplasty post-operative improvement
for visual acuity as well as dislocation
requiring surgical intervention.
Next slide please.
For glaucoma we have a total of five measures.
So, our most common measure that's being used
is glaucoma interocular pressure reduction,
and then we have other measures that look at IOP reduction,
following trabeculectomy or aqueous shunt procedure,
a measure looking at IOP reduction
following laser trabeculoplasty, and then IRIS 44,
we really are, do want to move toward parameters
such as visual field progression,
so this would be great if you can document mean deviation
in your EHR record, and then this really gives us
actually a more accurate measurement of disease progression.
And so I do like to emphasize IRIS 44.
And then IRIS 60 is visual acuity improvement
following cataract surgery combined with trabeculectomy
or an aqueous shunt procedure.
So we're trying to look at different cataract patients
with glaucoma procedures.
Next slide please.
For neuro ophthalmology we have, they have two measures,
one that deals with diplopia in adults,
so the improvement of ocular deviation
or absence of diplopia or functional improvement.
So there's three ways in order to meet
that measure successfully,
and then idiopathic intracranial hypertension improvement
in mean deviation or stability of mean deviation.
And again, this measure does depend
on your practice inputting the mean deviation
into the electronic health record,
and that is the way to meet this measure successfully.
And then we have one oculoplastic measure
acquired involutional and entropion.
So a normalized lid position after surgical repair.
Unfortunately CMS did not approve our other measure
this year because it was topped out.
So the oculoplastic we have one QCDR measure.
The next slide please.
And for pediatric ophthalmology and strabismus,
we have three measures to on esotropia,
one for adults, and one for children,
both looking at the post-operative alignment,
and then IRIS 50, which is on amblyopia
and we're looking at the visual acuity after treatment
between the two eyes.
And then refractive surgery do have two,
one is post-operative improvement,
in uncorrected visual acuity we are expecting a 20/20
or better within 30 days,
and then post-operative correction within five diopters
of intended correction.
And again, here it's important to document
the target correction in the EHR
so that we know what to compare
to be within that plus or minus 0.5 diopters.
Next slide please.
And then for retina we have four measures,
we did lose one measure on a neovascular AMD
because ophthalmologist had such good outcomes
on that they were achieving the visual acuity
CMS did not approve it unfortunately for this year.
And we also had a measure on antibiotic use
with intravitreal injections and that again,
because it was close to 0%
CMS said there wasn't enough variation
to keep it as a measure.
But we do still have a measure on diabetic macular edema,
loss of visual acuity, visual acuity
after epiretinal membrane treatment,
anatomic closure of macular hole within 90 days
as documented by OCT.
So this measure does depend on,
again no documentation in the EHR
that there is anatomic closure.
The OCT does not have to be documented in the record,
but we are assuming that the closure
is verified by OCT evidence.
And then improve visual acuity after vitrectomy
for complications of diabetic retinopathy.
So that covers several of the retina conditions.
Next slide please.
And then finally we have four uveitis measures.
So, we are fortunate to have acute anterior uveitis,
two measures and anterior cells
and post-treatment visual acuity,
one for chronic anterior uveitis,
and then improvement of macular edema
in patients with uveitis.
And again, on the first measure,
the grade zero anterior cells,
we are looking for that documentation
the EHR about cells in the anterior chamber.
Next slide please.
So, I'm going to talk a little bit
about how to use the IRIS Registry,
and the IRIS Registry dashboard does provide
views of performance by physicians,
by location, and by the practice as a whole.
And as we talked about,
it allows comparison to national benchmarks,
both in the CMS for ophthalmologists and everybody else
who does report to CMS on MIPS on those measures,
as well as an Iris registry benchmark.
And then this is important for the targeted feedback.
You can look, drill down and see which patients
did or did not meet the measure criteria.
Next slide please.
And this is the EHR dashboard that you have
for your practice and that you can see
it's by, a practice as a whole right now,
and then you can do it by clinicians,
here there's 67 clinicians I think we,
some, but there was a few of our practices
that have over 100 and then even by location.
So you can look at your ASC or different local offices.
Next slide please.
And the dashboard is usually refreshed on a monthly basis
if the data is available from the EHR.
So you can look at it on a monthly recurring basis.
And this is important because the timeliness of the feedback
helps you to take steps to improve performance
during the year.
If you submitted directly to CMS without a registry,
then you get your feedback on your quality performance
in about 18 months after the first patient in January.
So, obviously you can't really do anything 18 months later
to improve the care of that patient
for the reporting period.
So we do feel like timeliness of feedback
is really important.
Next slide please.
And then this is the key to the actionable feedback.
You can drill down to these individual patients,
as you see down below we call it Mickey Mouse,
and then you can see if they met the measure,
and then you can look into your EHR
to see the details of that patient's care
and what was documented and what wasn't documented.
So, say there was a letter to the primary care physician
that is in your record,
but somehow we might've missed it in mapping
or else it's in a new place because you have a new clinician
or there's a new field in your EHR.
All of those things would be information that would be good
to feed back to the registry vendor and put in the ticket,
and then you could set up a meeting and show the screenshot
of where that documentation actually is.
And then now Joy is going to be providing information
about setting up a meeting and tips for success, thank you.
-: Thank you Dr. Lum, you know,
when patients are not meeting measures,
you know, first of all, we want to quickly drill down
to look at that patient list and to quickly identify
hopefully where we are not documenting appropriately.
And we can do this by looking
at the entire reporting period,
or we can drill down by quarter,
but the key here has to do with the workflow.
But when we identify that patients
are not meeting the measures,
the first step is to schedule a meeting
with the IRIS Registry vendor.
And this meeting will help you understand
the measure specifications and identify steps
to be successful.
You will also review the IRIS Registry mapping.
And this really is key to success in MIPS reporting
because the data from your EHR system must flow correctly
to the IRIS Registry dashboard.
Sometimes there's a glitch in this process.
Also, if you've recently had a software upgrade,
this could potentially affect the mapping.
So during this meeting you will demonstrate the workflow
for documenting a specific measure.
And the client account manager will document this process.
And as Dr Lum mentioned, sometimes screenshots will be taken
to identify potential mapping solutions.
You will also review the not met charts
with the client account manager.
And this will include taking a look
at the patient's chart notes and reviewing documentation
to confirm why the measure was not met.
Corrective action will then depend on the actual root cause.
Sometimes the practice hardware may need an upgrade
to improve the interface with the IRIS Registry
or your internal workflow may need to be revised
or additional training maybe necessary
for the clinical team.
This may include a review of the measures
your practice reports,
and then how to appropriately document
within the EHR system.
And finally, IRIS Registry may need to reload your data,
especially if the mapping was recently updated.
Here are some of the tips we have received
from IRIS registry practices.
BIPS reporting is a team effort.
So it's really crucial to involve all staff members.
That starts at check-in and continues to the exam lane
with contributions from the technicians,
scribes, and the ophthalmologists.
It is also important to explain what MIPS reporting
is and how it impacts the practice and the patient.
Practices have identified that clarifying
each person's roles and responsibilities
as it relates to MIPS reporting
contributes to an improved process.
Providing practice reports per clinician
will demonstrate the progress and identify any areas
that need to improve.
And creating these reports will also involve the clinicians
in the MIPS reporting process throughout the year.
And some have recommended focusing
on one measure at a time.
So if you see that there is improvement that's needed,
set goals and then communicate the progress
with the entire team.
And many EHR systems have the functionality
to add prompts with any EHR templates
to ensure that the clinician
is capturing all the necessary information
or executing appropriate functions.
For example, providing patient electronic access
to their health information,
or printing a patient educational materials as appropriate.
Others find that checklists have provided guidance
and ensure that all the tasks are completed
during the encounter.
So, how does the IRIS Registry benefit a practice?
Well, primarily the IRIS Registry supports practices
with monitoring MIPS measures within a dashboard.
But in addition, the dashboard provides data
that can identify areas for practice improvement.
For example, if a report identifies
that some of the practices diabetic patients
are not returning for their annual dilated exam,
this will show in the dashboard as not met patients.
And then this provides the opportunity
to find these patients lost to follow up
and then reach out and schedule their exam.
Quality measures can be presented as a comparative report
amongst partners and prompt discussion on improving.
And some practices have used the data
to showcase excellent quality care to a hospital system
or insurance carriers without quality programs.
Also refining the EHR templates to improve quality,
not only increases your measure scores,
but it is also a benefit to both the practice
and patient overall,
and it oftentimes can improve your efficiency
within the practice.
And finally, the IRIS Registry quality performance dashboard
provides quarterly tracking of your measure of success.
It also compares to the IRIS and CMS benchmarks
and prepares your practice for MIPS attestation, Dr. Lum.
-: Thank you so much Joy
for all those great tips and guidance.
So in conclusion, as we look at IRIS Registry
providing your practice benefits,
the targeted feedback from the quality measurement
helps you to think about documenting in manner
that conforms to CMS guidelines,
it decreases the risk of incurring reimbursement penalties
associated with MIPS,
and permits demonstration of quality, not just to CMS,
but to hospitals, health plans, third party payers,
and the American Board of Ophthalmology.
Many practices download their quarter measure reports,
as Joy said, and supply them to their hospitals
and payers for credentialing and panel purposes.
And this avoids a separate documentation process for them.
And it balances out cost of care concerns.
Also the MIPS quality measure results are available publicly
on the care compare website that CMS runs,
and they are accessible
by the public health plans et cetera,
to compare your practice performance to other practices
on the same measures.
Just wanted to summarize again your benefits
as an IRIS registry participant.
Again it's, it is a free academy member benefit,
you can evaluate your practice patterns
and improve quality of care,
you receive actionable feedback that allows you
to make changes to patient followup, screening,
education, and outcomes, you can easily compare
and identify the discrepancies
between EHR documentation and billing,
you benchmark your practice against other practices
in the country, you can evaluate your processes
against most of the ophthalmology practices
that do participate in the IRIS Registry
and compare your practice, your locations,
and your clinicians within your practice
for internal quality improvement purposes.
Third, you demonstrate your quality of care
to third-party payers,
you can produce these patient outcomes
for panel selection and contract negotiation purposes,
we have heard that from many practices in the IRIS Registry.
And again, it balances that cost of care concern
with CMS approved quality measures.
Fourth, and we haven't touched on this yet,
but you are contributing to scientific advancement.
This is the world's largest single specialty
clinical data registry
and we are working to accelerate innovation
and enhance clinical knowledge.
We have 45 publications in the scientific literature today.
And in 2022, we are switching to a new technology vendor
Verana Health, and they have a trial connect tool
for any practice that has their EHR integrated,
and it facilitates patient recruitment for clinical trials
to identify suitable candidates for trials more easily.
And then also with our new partner, Verana Health
we anticipate that by the end of 2022,
you can receive future practice management tools
at no additional fee.
That includes a CPT code utilization tool
that might identify coding outliers
that could potentially improve your performance
during any kind of audit
and identify over and under coding issues with their tool.
So, next slide please.
In ending we have these academy member resources,
aao.org/medicare to find resources for 2022 MIPS.
MIPS help you can email mips@aao.org,
for IRIS Registry you can email irisregistry@aao.org,
and then for help with your dashboard as joy mentioned
in terms of meetings and tickets and confirming measures,
it's aaocams@figmd.com for 2021 MIPS, thank you.
-: Thank you Dr. Lum for an excellent presentation.
And we'd like to encourage the audience
to submit your questions using the Q&A function
at the bottom of your screen,
and we'd like to the discussion part of the webinar.
Dr. Lum, I want to start with one of the common questions
that we hear about the cataract measures,
and when it comes to the eligible population totals,
are we supposed to enter the number of patients
or the number of eyes?
-: So for the cataract surgery yeah,
it will be the number of eyes for that measure, thank you.
-: Excellent, and here's just another
frequently asked question regarding those inverse measures.
So, you know, the question
is regarding QPP one diabetes A1c Poor Control,
and sometimes none of my patients are meeting this measure,
what's going wrong?
So, can you talk a little bit more
about that inverse measure?
What that means. -: Sure.
Yeah, so that, that measure is looking to see
how many patients have a high, what we consider
a high hemoglobin A1c level.
So actually it's very good
if none of your patients meet that measure.
So that's what we call an inverse measure, 0% actually
is kind of equal to 100% success.
-: And another question,
some quality measures are broken into strata.
What does this actually mean?
-: Right, so it depends on the measures sometimes
like the tobacco screening, there's three strata.
So one is how many patients are screened,
second is how many patients are screened
and shown to be a tobacco user,
and the third one is how many of those screened
who are shown to be a tobacco user
and receive cessation counseling.
And that third strata is the one that counts,
that's the one that will be measured for performance
that will, that's the one that will be, you know,
graded by CMS and that will be the performance rate.
So yeah, sometimes a measure is more complicated
and you see it's one of the three strata
that is the actual performance rate.
But there are different obviously different factors
that go into that kind of measure.
In, for our measure on cataract surgery,
say the visual acuity,
we do have three strata and those are additive.
So it's like, the first strata I think
is patients without any co-morbidities,
the second strata is patient with certain co-morbidities
and baseline visual acuity, and a third one
even more severe comorbidities.
And those are added up to a total of performance rate
of patients meeting of visual acuity threshold.
So it can depend on what the measure is.
-: Very good, Dr. Lum you talked
about the IRIS Registry QCDR measures,
and are these eligible
for the end-to-end electronic reporting
bonus achievement point?
-: These are not currently eligible
for the end-to-end reporting bonus
because they have to be in electronic clinical measure
and those are approved and maintained by CMS.
So those are the first, I think, 14 measures
that we showed at the beginning,
those are considered electronic clinical quality measures
by CMS, and they are eligible
for that end-to-end reporting bonus.
Unfortunately though for 2022,
CMS has abolished the end-to-end reporting bonus.
And that is how a lot of our practices gained extra points.
Was that bonus point as well as one bonus point
for any outcome measure and all of our QCDR measures,
our outcome measures are high priority measures.
So unfortunately for 2022,
we have lost those two bonus point that really contributed
I think to practices scores.
-: And Dr. Lum,
for those that weren't on our webinar last week,
will you talk a little bit about the extreme
and uncontrollable hardship exception for 2021?
-: Sure, in early November,
CMS announced an automatic exception.
That means for any individual eligible clinician,
they do not have to report for MIPS
and will not receive a penalty.
Now the caveat is you have to be sure
that you did not submit earlier in the year say by claims
or entered anything even if you put data
for a performance period on the CMS portal
for an improvement activity or promoting interoperability,
CMS would consider that as submission
and they would consider that for the score.
So if you have done something like that,
say you did claims as an individual or a group,
then I would urge you to submit a formal application
and that application deadline is December 31st of this year.
But we are thinking that most of our practices,
especially the manual practices who have had issues
or have had problems this year, staffing difficulties,
patient, you know, volume being lower,
financial difficulties, you know,
a lot of that can be probably associated
with the ongoing pandemic that they, you know,
they can take advantage of this automatic exception.
Or if you think you might have submitted any claims
as a group or you can submit a formal application,
but that's due at the end of this year.
-: Thank you so much for that, Dr. Lum,
and on Thursday you're going to be presenting
another webinar on what to, how to report
2022 MIPS reporting with Dr. Repka and our Director,
Kayla Amodeo, Health Policy Director from DC.
But with that, practices that are still on paper charts
and thinking about 2022 reporting,
what's going to happen in the future,
and is it going to get harder and harder to report
if you're on paper charts?
-: Yes, that is kind of been the guidance and wisdom
that the academy has been talking to non-EHR practices
over the past couple of years,
we've seen CMS raise the threshold.
So, the year before it was 45 points,
this year was 60 points to avoid a penalty,
next year it's 75 points.
So you can see that CMS has continually upbeat,
I think the odds for needing an easier way to submit MIPS.
We know that doing it without an EHR is very time consuming,
it's a manual process and, you know, it's difficult.
But for every practice of course
you have to weigh the trade-offs, right?
The cost of an EHR versus the costs of not having an EHR,
the benefits, there's certainly a lot of benefits
and I think double AOE has a lot of information
about EHR benefits and help for your practice.
But, you know, if the practice clinicians
are going to retire soon then, you know,
an investment in an EHR may or, you know,
may or may not make sense.
But we have been advising practices that if their goal
is to avoid MIPS without the penalty with MIPS,
then they are going to go into several years
of this that they would consider an EHR
and not just for the MIPS benefits,
but for other benefits as well.
-: Thank you, and Dr. Lum in closing,
can you provide a few pearls and for practices
as they close out this year,
getting ready to report 2021 MIPS,
and then what should practices be thinking
for the first quarter of 2022
to prepare again for MIPS reporting?
-: Yeah, so, hopefully, and we talked
about our IRIS Registry "Prep Kit".
So, we do want to emphasize
that it's not just a one and done kind of deal.
You know, it is, we're trying to automate the process
with your EHR, but you know,
we hope that you kind of check your dashboard,
that you look at your quality measures on a regular basis,
and I really love the ideas
that Joy had in terms of a team-based approach, right?
It goes from the front desk to the technician in the office,
to the ophthalmologist to the practice manager,
that everybody could have a role in it.
You know, like handing out smoking cessation materials
to the patient, to looking at patients with diabetes
who haven't come back in the office,
and to get them back in for a follow-up appointment.
All of those things, you know,
working on the promoting interoperability
which we hadn't talked about, but, you know,
getting patients to view or at least invite them
to view their information online.
All of that is, you know, a team,
I think team-based approach really works best.
You know, it shouldn't really fall on one person
that we do recommend that there's a lead,
there's a team lead, and that, and certainly
in the quality aspects that, you know,
it really helps to have a physician and ophthalmologist
involved in looking at the performance rates
and understanding in terms of the quality outcomes
and processes, you know, where there could be improvement.
We are nearing the end,
so there are specific steps that have to be done.
If you want to report MIPS,
you have to sign the data release consent form,
you have to choose your measures in the EHR portal,
and then you do have to actually click and submit to CMS.
We don't do that on your behalf because we want,
you know, want you to be conscious exactly of which measures
you're submitting, of what score you'll be receiving.
So that is not done automatically.
So we do follow up with a lot of practices
in January through March
to make sure they go through with the final step
of clicking and submitting everything to CMS.
Because otherwise, you know,
it wouldn't go to CMS otherwise.
So, we want to make sure you do that.
And then in January, we are switching over to a new vendor
for MIPS reporting for 2022.
So hopefully if you're with one of the large EHR
you have already been contacted by Verana Health,
and you've already started that integration process.
We certainly want everybody to try to be integrated
by the first quarter of next year,
by the second quarter of next year
so that you're in good shape for 2022 MIPS reporting.
We won't be unveiling that dashboard with Verana too soon
because we don't want to confuse things
with the existing 2021 MIPS dashboard.
But I think if you contact your Verana Health representative
and get that integration process going,
and kind of keep in touch with them
then right after the MIPS submission period,
you'll be able to see your dashboard
for the first quarter of 2022.
-: Excellent, excellent advice, Dr. Lum
and wonderful presentation.
We thank you so much for your time today.
And audience we thank you so much for attending
and the American Academy of Ophthalmology and IRIS Registry
continues to be committed to support ophthalmologists
in their MIPS reporting.
And as you have questions with MIPS,
please submit them to mips@aao.org,
and if you have questions
regarding IRIS Registry reporting or your dashboard,
please send your questions to irisregistry@aao.org.
And again, thank you for attending,
and we wish you a very wonderful holiday season.