November 18, 2019
2 min read

Appropriate use of new technologies will not jeopardize MIPS score

Cost is only 15% of total Merit-based Incentive Payment System points achievable.

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Welcome to another edition of CEDARS/ASPENS Debates. CEDARS/ASPENS is a joint society of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.

Recently, several new technologies have become available for intraoperative use during cataract surgery that may allow significant benefits to patients. Unfortunately, there has been some concern over how the use of these products will affect the individual surgeon’s Merit-based Incentive Payment System (MIPS) score.

This month, Jennifer Loh, MD, discusses the use of these products for cataract surgery and its impact on MIPS. We hope you enjoy the discussion.

Kenneth A. Beckman, MD, FACS

There has been concern among surgeons that we have many amazing technologies and new devices coming out in our field; however, one component of MIPS relates to cost. Medicare is looking at how much each surgeon is costing the health care system per patient during a surgery time period.

Jennifer Loh, MD
Jennifer Loh

MIPS is actually made up of four different categories, and cost is only 15% of the total points achievable. Many physicians fear that if we use things such as brand-name medications we will hurt our MIPS score position, but the three other measures are equal in weight to cost or more. Quality is worth 45 points out of 100, promoting interoperability is worth 25, improvement activities are worth 15, and cost is worth 15.

Medicare is looking at the total cost for the surgery period, which comprises 60 days before the patient’s surgery and 90 days after. So, it is not just about what we use during surgery, but it is also any costs associated with preoperative testing, the professional fee for the service, anesthesia, facility fee, drugs and technology.

With this point system, surgeons must get a minimum of 30 points to avoid a penalty. If they get between 30 and 70 points, they can achieve a bonus, and if they are above 75 points, they get a bigger bonus.

It is important to note that there are exclusion criteria. Any cataract case that is considered complex, for example, involving intraoperative floppy iris syndrome or miosis, would be excluded from being analyzed in the MIPS score. In addition, cases involving comorbidities, such as diabetes, glaucoma and age-related macular degeneration, would also be excluded. When you think about it, many of these newer technologies or devices or medications are usually used on patients with comorbidities or complex cases.


Some drugs physicians have expressed concern over due to costs are Omidria (phenylephrine 1% and ketorolac 0.3% intraocular solution, Omeros), Dexycu (dexamethasone intraocular suspension 9%, EyePoint Pharmaceuticals) and Dextenza (dexamethasone ophthalmic insert 0.4 mg, Ocular Therapeutix).

Overall, if a surgeon needs to use special devices or medications during surgery, they should not feel impeded by MIPS. Many of these new technologies are helpful at reducing postoperative complications, extra office visits and extra procedures, other factors that can lower someone’s MIPS score. And helping the patient is the most important part. New technologies can possibly reduce postoperative drops, pain medications, patient callbacks and surgical times. The longer you are in the OR, the higher the cost.

Costs are evaluated against the national average. Consistent, appropriate use of Omidria and other products should not be a concern because the costs should average out. Surgeons should not be avoiding these types of medications based on fear of MIPS alone; they should be using these technologies appropriately, when needed.

Disclosure: Loh reports she is an advisory board member for EyePoint, Ocular Therapeutix and Omeros.