The Impact of the Medicare Access and CHIP Reauthorization Act on the Field of Ophthalmology

Kinker, Brenton; Dobesh, Kaitlyn; Nassiri, Nariman; Juzych, Mark S; Wilson, M. Roy

doi:10.1016/j.ajo.2017.04.002

Cited by 2 publications

(6 citation statements)

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“…After its inception, MACRA's QPP was expected to result in lower reimbursement for ophthalmologists and disproportionately bur- den individual ophthalmologists in smaller, rural practices. 4 These concerns appear valid given the current disproportionate scores for PY 2019. Although proximity to a metropolitan core and subsequent commuting vary, at least 1299 participants here are not classified as within a metropolitan area core (Table 1).…”

Section: Discussionmentioning

confidence: 95%

“…Xiao et al similarly found higher MIPS scores for those reporting via APMs, driven largely by higher quality category scores and lower variance in other subcategory scores. After its inception, MACRA’s QPP was expected to result in lower reimbursement for ophthalmologists and disproportionately burden individual ophthalmologists in smaller, rural practices . These concerns appear valid given the current disproportionate scores for PY 2019.…”

Section: Discussionmentioning

confidence: 99%

“…After MACRA, ophthalmologists were predicted to participate in QPP primarily through MIPS with continued fee-for-service. This raised concerns among ophthalmologists about comparatively lower reimbursement and disproportionate difficulty with specialty agnostic measures for ophthalmologists . Given the QPP’s attempt to consolidate quality and value programs across physicians, specialists were concerned about the specific effect on their respective fields.…”

Section: Introductionmentioning

confidence: 99%

“…This raised concerns among ophthalmologists about comparatively lower reimbursement and disproportionate difficulty with specialty agnostic measures for ophthalmologists. 4 Given the QPP's attempt to consolidate quality and value programs across physicians, specialists were concerned about the specific effect on their respective fields. For example, QPP concerns were raised across multiple specialties, including among interventional pain medicine practitioners, 5 neurointerventional specialists, 6 gynecologic oncologists, 7 and dermatologists.…”

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confidence: 99%

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Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists

et al. 2022

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System (MIPS) is intended to promote high-value health care through quality-related Medicare payment adjustments. OBJECTIVE To assess the economic evaluation of MIPS scoring and reporting on ophthalmologists. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective, cross-sectional, multicenter economic evaluation conducted from October 10 to November 30, 2021, MIPS performance and related payment adjustments were evaluated using the US Centers for Medicare & Medicaid Service (CMS) public data files for ophthalmologists. Participants were stratified by reporting affiliation. Analysis of variance and summary statistics were used to characterize and compare total and subcategory MIPS scores and adjustments received by participants. Reported CMS methodology and performance year (PY) 2019 payment percentages were used to estimate payment adjustments for the following categories: positive MIPS adjustment plus potential additional adjustment for exceptional performance, positive MIPS adjustment, neutral payment adjustment, negative MIPS payment adjustment, and maximum negative MIPS payment adjustment. Study participants included ophthalmologists registered for Medicare Part B with participation in the Quality Payment Program (QPP) in PY 2019. MAIN OUTCOMES AND MEASURES Proportion of ophthalmologists qualifying for payment adjustments and payment adjustments.RESULTS For PY 2019, 76.5% of ophthalmologists (13 621) who registered for Medicare participated in the MIPS pathway of the QPP. Ophthalmologists practiced in a predominantly large metropolitan area (12 302; 90.3%). Roughly 99% of participants (11 182) received nonnegative reimbursement adjustments, and 92.6% (10 367) received positive adjustments. Ophthalmologists filing as individuals were less likely to achieve exceptional performance scores compared with those who had a filing category of advanced alternative payment model (APM; odds ratio [OR], 0.0003; 95% CI, 0.00002-0.00481) or group (OR, 0.21013; 95% CI, 0.19020-0.23215). When analyzing participating ophthalmologists with available Medicare payment data (11 193

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists

et al. 2022

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“…Of MACRA's 2 available paths for physician reimbursement, ophthalmologists will more likely use the Merit-Based Incentive Payment System (MIPS) owing to broader applicability and a paucity of alternative payment models. 5 A physician's composite MIPS score, which will have a positive or negative influence on fees beginning in 2019, will be based on the following 4 performance categories: quality, advancing care information, clinical practice improvement activities, and resource use. 6 As noted above, resource use may be negatively affected by presence of trainees in the clinic and the operative theater.…”

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confidence: 99%

Presence of Trainees and Appointment Times

Lindsey

Sternberg

2018

JAMA Ophthalmol

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The scenario is familiar to those of us in academic practice: a resident is pulled from a scheduled clinic with attending physician A to assist in a complex surgical case with attending physician B. A calls B in a fury, bemoaning the fact that the clinic will grind to a halt without a resident to refract, obtain consent, and perform surgical histories and physical examinations. Attending physician A's reaction represents a fundamental misconception of the role of trainees in a medical practice. Trainees join our clinics to learn and to be taught. Their presence in our clinics should slow us down, not speed us up. If we are using residents to facilitate patient flow, perhaps we really need additional technical help. Trainees are learners, not physician extenders. This point, among others, is addressed by the cohort study performed by Goldstein et al. 1

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The Impact of the Medicare Access and CHIP Reauthorization Act on the Field of Ophthalmology

Cited by 2 publications

References 3 publications

Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists

Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists

Presence of Trainees and Appointment Times

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