• Academy Charts New Path Toward MIPS Success for Retina Specialists


    The Centers for Medicare & Medicaid Services is removing three quality measures used by ophthalmologists, including two widely used by retina specialists for Merit-Based Incentive Payment System reporting. CMS says that the following measures will no longer be available in 2019:

    • Measure 18 (Diabetic Retinopathy Documentation of Macular Edema and Severity of Diabetic Retinopathy)
    • Measure 140 (AMD Counseling on Anti-Oxidant Supplements)
    • Measure 224 (Melanoma Overutilization of Imaging Studies)

    This is a significant change, but one that that the Academy anticipated. That’s why we initially requested a delay. We have also been working to leverage the Academy’s IRIS® Registry as a solution to this issue to maintain ophthalmologists’ continued success. CMS is currently considering several new subspecialty eye-care measures that would be available for use in 2019. They were developed by the Academy with input from the Retina Society, Macula Society and the American Society of Retina Specialists.

    The Academy asked CMS this summer to delay these measures’ phaseout for two years. We are disappointed that CMS ignored this suggestion. However, the agency did opt to keep one glaucoma measure which was originally proposed for removal. CMS agreed to retain in ophthalmology’s most-reported MIPS measure, Measure 12 (POAG optic nerve evaluation), helping position our profession for another year of success in the program.

    The removal of the diabetic retinopathy measure in particular will have a significant impact on retina specialists and comprehensive ophthalmologists using electronic health records. This change leaves five eye-related electronic clinical quality measures. It means that ophthalmology practices need to add one or more general measures.

    That’s why the Academy continues to develop new ways to help ophthalmologists who use the IRIS Registry succeed in federal quality-payment programs, especially subspecialists. In October, we briefed CMS on several new and updated quality measures that we then submitted for formal review. 

    The new measures, if approved, would be available to ophthalmologists using the IRIS Registry for 2019 MIPS reporting and cover subspecialty areas including: retina, adult strabismus, glaucoma, oculoplastics, cataract and cornea. During the briefing, CMS staff remarked how impressed they were with our ongoing efforts to innovate and lead in this area.

    If approved, the new measures would give our members additional relevant/meaningful MIPS subspecialty outcome measures on which to report in 2019. CMS will make its decision in time for the 2019 performance year, which begins Jan. 1.

    The measures were developed and updated by the Academy along with physician volunteers from the subspecialty societies. This was done in order to give our members additional relevant and meaningful MIPS subspecialty outcome measures on which to report in 2019 

    This will be increasingly important as CMS removes quality measures from the program and limits the points available for topped out measures. Many of these measures won’t have benchmarks, though CMS could retroactively create these if enough physicians report the measures. Otherwise, the measures would only be worth three points each.

    Ophthalmology’s registry continues to be an asset to our profession. An overwhelming number of IRIS Registry participants performed exceptionally well in MIPS in 2017, with 99 percent qualifying for some kind of 2019 bonus. This CMS feedback is preliminary, since the agency still needs to confirm the size of a practice for small-practice scoring, along with evaluating whether a practice was already reported through an accountable care organization or advanced payment model.

    Still, because nearly 70 percent of all U.S. ophthalmologists participate in the IRIS Registry, these preliminary results are exciting. They verify the exceptional value that the IRIS Registry provides to ophthalmologists. They also reinforce why CMS consistently cites ophthalmology’s registry as an example for other medical specialties to follow.