ATLANTA – Value-based medicine will affect optometry in the near and distant future, Douglas C. Morrow, OD, said here at SECO.
He explained that the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) combines Physician Quality Reporting System (PQRS), electronic records, meaningful use and value-based modifier (VBM) into a merit-based incentive payment system (MIPS).
Morrow explained that a VBM is a database that looks at the quality and cost of care a provider is delivering to patients and compares it to benchmark outcomes to arrive at a quality figure for that provider.
Douglas C. Morrow
“You will be rated as low, average or high quality, which relates to low, average and high cost,” he said. “As we move forward, we’ll either get increased reimbursement, stay the same or receive a reimbursement penalty. This is a Centers for Medicare and Medicaid Services (CMS) system.”
Morrow said the only way to maintain or increase your reimbursement from CMS is to participate in the MIPS in by 2017.
“What can you do as a provider in 2016 to avoid a penalty in 2018?” Morrow queried the audience. “Participate in PQRS. If you don’t, that’s a 2% penalty in 2018. If you couple that with a penalty for VBM, the percentages add up.
“We have a penalty for poor performance with PQRS, failure to participate in meaningful use, and with VBM you can get a bonus or a penalty,” he continued. “You can have anywhere from 9% to 11% reduction in your CMS reimbursement if you include the 2% reduction from sequestration.”
While some optometrists may not see many Medicare patients, know that private payers are already adopting some of these models, Morrow said.
The AOA has introduced the AOA MORE registry as a way to “recognize that we’re moving into this health care payment reimbursement paradigm,” he said.
“The registry will assist ODs in quality improvement, to track outcomes and create some patient advocacy for us,” Morrow said. “Because of HR2, which kicks in in 2019, it’s a game changer for all of us. PQRS, meaningful use and VBM will determine what we’ll be paid in the future. It will require a registry for you to achieve the highest level of reimbursement.”
Morrow noted that in 2013, 62% of optometrists did not participate in PQRS and were penalized in 2015.
He said the registry is a database that pulls data from your electronic health records system and automatically submits it to CMS, showing your patient outcomes. Optometrists will realize immediate benefits by PQRS claims being submitted and automatically qualifying for meaningful use. – by Nancy Hemphill, ELS, FAAO
Morrow DC. Thriving in the new era: Tackling access, coding and payments head on. Presented at: SECO. Feb. 24-28; Atlanta.
Disclosure: Morrow reported no relevant financial disclosures.