VIEWPOINTS
Serving Colorado Optometry since 1892
What is AOA
More?
And other
Medicare
Reimbursement
Questions
Page 16
The importance of
being HIPAA compliant
Page 19
NOVEMBER 2016
Colorado Optometric Association
Thank you to all our attendees for making our
Fall 2016 Symposium a success!
Your continued support is greatly appreciated!
Save the Date for our Spring 2017 Symposium
Sunday, March 12, 2017
Featuring
Dr. Prem Subramanian, Neuro Ophthalmologist
Page 2
November 2016
Colorado Optometric Association
Colorado Optometric Association
Serving Colorado Optometrists
for 122 Years
730 17th Street, Suite 350
Denver, Colorado 80202-3515
Tel: 303.863.9778
Fax: 303.863.9775
Toll Free: 877.691.2095
www.visioncare.org
E-mail: [email protected]
Officers and Trustees
President
Sean Claflin, O.D., F.A.A.O.
President-Elect
Jon Pederson, O.D.
Secretary-Treasurer
Heather Gitchell, O.D.
Immediate Past President
Michelle Chaney, O.D.
Trustee, District I
Kevin Pollard, O.D., F.A.A.O.
Trustee, District II
Kelley Jackson Condon, O.D.
Trustee, District III
Nathan Lohmeyer, O.D.
Trustee, District IV
Marcelo Saldivia, O.D.
Trustee, District V
Matt Buchanan, O.D.
Trustee, District VI
Diane Reddin, O.D.
Trustee, District VII
Teresa Carlson, O.D.
COA Administrative Staff
Executive Director
Sheryl Benjamin
Communications & Events Manager
Tara Weghorst
Expressed opinions and statements of
supposed fact published in the various
signed articles in this publication are those
of each individual author and do not
necessarily reflect the views and policies of
the editorial staff or the board of trustees
of the association. Advertising material
accepted by the publication is intended to
conform with ethical optometric standards.
However, advertising acceptance does
not imply endorsement by the Colorado
Optometric Association.
President’s Message
Sean Claflin, OD, FAAO
Action Required
All together now. Billy Joel’s song “We Didn’t
Start the Fire” comes to mind when thinking about
the new, highly impacting payment reform system
put in place in health care. Get the beat, tap your
toe, and here we go:
“MACRA, MIPS, MOC’s, National Registries…..
VPM, EHR, PQR, MU, and no more SGR…..
CMS, QPP, TPS, healthcare that is value based…..
ACA, ACO, ABO, APM…..We didn’t start the fire, dada dada, dada,
dada…..” You got it.
Just like Billy Joel’s song, health care payment reform has a fast paced beat
inundated with ongoing change of events and trends. And just as Joel’s song
was a significant turning point in his career and took us from one era into
another, value based health care will be taking us all into a new health care
delivery and payment era.
Conservative numbers from surveys say two out of three practitioners
have not even heard of MACRA/MIPS or Value Based Medicine. Many of
us are those that are unaware. That being said, it is time we become better
informed and start to understand the importance of Value Based Medicine
participation since it will directly affect how we get paid as providers.
Understanding the history and the implementation timeline of payment
reform is a good informed start.
The US Centers for Medicare and Medicaid Services (CMS) has been
transitioning to a payment system based on quality of care rather than volume
of care for the past several years. It all seems so recent, but really it is not.
Health care reimbursements were re-evaluated about ten years ago due
to health finance short-comings and the flawed fee-for-service Sustainable
Growth Rate (SGR) reimbursement model. Do you recall all the so-called
“doc fixes”? When the Affordable Care Act (ACA) in 2010 was signed into
law, health care reform was put into motion while CMS’s transition from
volume-based to value-based reimbursement was initiated. In April 2015,
the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was
enacted helping facilitate CMS’s ultimate goal, a Quality Payment Program
(QPP).
MACRA is health care delivery and payment system reform impacting how
hospitals, health systems, and physician groups get paid. MACRA replaces
the SGR formula with a determined implementation timeline. From 2015
through 2019 physician fee updates will be “fixed” at annual 0.5% increases
while year 2017 will be regarded as a performance period. How physicians
perform in 2017 will determine how 2019 physician fees are calculated and
continued on page 4
November 2016 Page 3
Colorado Optometric Association
Optometry on the MOVE
Bravo! Kudos!
Thank you to everyone who attended Top Golf with DMOS
on October 9th. It was a fun, family-friendly event!
COA welcomes Active members
Nathan Osterman, OD with Family Eye Center in Pueblo, CO
Jennifer Everett, OD with Associates in Family Eyecare in
Loveland, CO
COA welcomes Partial Practice
members
Harvey Thompson, OD with Advanced Eyecare in Fort
Collins, CO
COA welcomes Student members
Mary Chivetta (SCO, 2019)
Herbert Wentzien (OSU, 2018)
Did we miss your special event or big announcement (new
associate or office, marriage, baby, award, recognition….you
get the idea)!? Please let us know! We want to celebrate with
you! Email us at [email protected]
Membership Corner
We are currently collecting photos and information
for the 2017 directory! Please login to your MyCOA
profile on our website (Colorado.aoa.org) to make
sure your picture and information are up to date.
If you have any questions, please reach out to Tara
Weghorst [email protected]
All updates must be made no later than December
1, 2016. Changes will not be reflected in the 2017
directory after this date.
Page 4
President’s Message
continued from page 3
paid based on performance and quality. 2018 will be
used to see how practitioners will align for payment by
choosing from either path: the Merit-Based Incentive
Payment System (MIPS) (this is likely our path as eye
doctors) or Alternative Payment Models (APMs) (where
ACOs likely will align).
Officially in January 2017, MIPS will consolidate and
expand upon quality measures we are somewhat familiar
with currently: Physician Quality Reporting System
(PQRS), Medicare Electronic Health Record (EHR)
incentive program, Value-based Payment Modifier (VM)
and Meaningful Use (MU). Providers now will earn a
“MIPS score” based on their performance by reporting
in these reformed categories: Quality, Resource use,
Clinical Practice Improvement, and Advanced Care
Information (MU renamed). Practitioner scores will
determine whether they are paid a 4% fee increase or
a 4% fee reduction in 2019 with potential increases/
reductions of 5% in 2020, 7% in 2021, and 9% in 2022.
It is important we understand that health care delivery
and payment reform likely will not be a “CMS-only deal”.
As we know, many major medical insurers often adopt
and implement CMS programs and develop their own
fee schedules. If we choose not to actively participate
in these programs, we must be willing to accept that our
practices’ well-being could be at stake.
Some good news is the recent QPP final rules
released regarding reporting time periods and quality
measurement criteria this next year will be more
forgiving. More good news – AOA has a clinical
performance registry called “AOA More” that is included
with your membership to help with reporting and
meeting criteria for scores – sign up! Even better news COA is working on resources to better help members.
Read on. Stay tuned. MACRA/MIPS continues the fast
pace change just like Joel’s song. And just as he sings,
“It will still burn on and on and on and on…”
November 2016
Colorado Optometric Association
Happy November Birthday to:
Alison Loranger, OD
Eva Strube, OD
Leroy Popowski, OD
Amanda Walls, OD
Gail Saxerud, OD
Lilian Lahoud, OD
Anne Pence, OD
Garrett Moen, OD
Mark Bennett, OD
Bob Browder, OD
Gary Quarnberg, OD
Mary Freitag, OD
Brant Gehler, OD
Gordon Bashford, OD
Matthew Skrdla, OD
Christopher Ricke, OD
Greg Abel, OD
Michael Bell, OD
Corey Bernhardt, OD
J Macdonald, OD
Michael Bollenbacher, OD
Craig Asmussen, OD
Jeffrey Holland, OD
Michael Fukai, OD
Dale Lervick, OD
Josh Olson, OD
Michael Pharris Jr, OD
Dan Hock, OD
Kara Hanson, OD
Mike Luby, OD
Dave Baumgardner, OD
Kent Yount, OD
Ron Berggren, OD
David Hite, OD
Ketty Lee, OD
Shelly Toltz, OD
David Lewerenz, OD
Kyle Hughes, OD
Shira Pipkin, OD
Duke Underwood, OD
Lacey Brenner, OD
Stephen Bashford, OD
Ed Williams, OD
Laurel Rub
Tom Van Camp, OD
Emma Lundien, OD
Leeann Hoven, OD
Vicky Graham, OD
Did we miss your special day? Please call the COA office so we can correct our list.
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Page 6
November 2016
Colorado Optometric Association
Poppin’ In Visits
Tara Weghorst, Communications & Events Manager,
“popped” in on a few members in Boulder!
EnVision Boulder
has such an
awesome
location right off
of Pearl street!
Dr. Israelson & Dr.
Graham were in
the office to chat
with Tara when
she “popped”
by!
Dr. Beatty, pictured here with his
office manager, Kylie Sisson, just
opened his new practice Alpine
Eyecare Center in May!
Dr. Lozano & Dr. Elmont of Boulder Eye Care
Professionals in their newly renovated space! We also want to welcome Dr. Oneby and Dr. Alldredge
to Colorado! They have taken over Boulder Vision
Center, previously owned by Dr. Gurholt
Sheryl Benjamin, COA Executive Director, “popped” in on our
members on the Western Slope!
Sheryl and Dr. Jason Larsen with Eye Center of the
Rockies in Glenwood Springs, CO
Sheryl and Dr. Anne Pence of
Eagle Valley Vision in Eagle, CO
Sheryl and Michael Phillips, Chief
Operating Officer for 20/20 Eyecare
in Glenwood Springs, CO
Sheryl and Dr. Tod Smith of
The Eye Smith in Rifle, CO
November 2016 Page 7
Colorado Optometric Association
Meet a Member
BRENDAN MOFFAT TOBLER, OD
My first job was: Paperboy
I became an optometrist because: I wanted to
be able to improve other people’s daily lives in a
meaningful way
I earned my OD degree from: The Ohio State
University College of Optometry
My favorite thing about optometry: Helping people
see better and look better, which helps them feel
better about themselves
My favorite vacation spot is: Balboa Island, CA
Place of birth: Newport Beach, CA
Family: Wife Meg and 2-year old daughter Hazel
COA member since: October 2015
Lived in Colorado since: July 2016
My favorite way to spend free time is: Cooking with
my wife and going to the park with my daughter
Why am I a COA Member: I want all optometrists in
the state to be able to practice to the most of their
ability
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November 2016
Fort Collins: 1725 E. Prospect Rd., Fort Collins, CO 80525
Loveland at Centerra: 6125 Sky Pond Dr., Loveland, CO 80538
Loveland at Skyline: 2555 E. 13th Suite 225, Loveland, CO 80537
Colorado Optometric Association
We proudly work with optometrists, co-managing care of your patient.
ICON Eyecare Doctor Spotlight:
Dr. Michael Waggoner
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well as corneal transplants, dry eye, pterygium and anterior
segment disease. Based at ICON Eyecare in Grand Junction
as part of the Dr. Hoffman team, Dr. Waggoner provides
residents of Colorado’s Western Slope high-end, cornea
subspecialty care.
To learn more about Dr. Waggoner, visit our website.
OUR SERVICES INCLUDE:
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• Diabetic Eye Care
• LASIK and PRK
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Denver | Englewood | Lone Tree | Golden | Downtown Denver | Loveland | Grand Junction
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November 2016 Page 9
Colorado Optometric Association
On September 27th, our Young Professional’s put on a
panel discussion with members of the COA from each
mode of optometry. It was a program worth sharing
based on the expertise presented. This is a recap of the
panel’s comments:
Our moderator, Dr. Tom Cruse started off the panel
by asking each person to give their name, where they
work and if they thought that is where they would end
up after school.
Dr. Megan Borden: I thought I would end up in private
practice with an opportunity to buy in one day. Currently,
I am an independent contractor in a retail setting.
Dr. Alison Loranger: I also thought I would end up in
private practice, I wanted to associate and buy in or
purchase from someone retiring but I am happy where I
ended up, working for an OMD, because I wanted to be
immersed in the medical side.
Dr. Kristin O’Brien: I knew I wanted to own my own
practice so I started researching before I even left school.
Vision Source is a wide spread network and my partners
actually found me. I was able to run the office on my own
from the beginning but I didn’t actually own the office
until this past January.
Dr. Scott Middlemist: I initially worked in private practice
after school but I left to work for Kaiser. I practiced there
for 18 years and 2 years ago moved into an administrative
role running the optical division of Kaiser. I oversee 42
ODs that are spread across 12 eye care Kaiser buildings.
Cruse: Dr. Crockett and Dr. Jackson Condon are also
in attendance and have established private practices.
Would you two mind answering the question for us as
well?
Dr. David Crockett: I worked part time for Kaiser out of
school while trying to open my own practice. I now have
two offices and two associates.
Dr. Kelley Jackson Condon: Right out of school, I stayed
in Oklahoma and worked for a medical model. After 4
years, I moved back to Colorado and started my own
practice in Golden and have been there 18 years now!
Cruse: Can each person give us a pro and con about
the mode of practice you are currently in? Please feel
free to be as candid as you would like.
Borden: A pro is that I get to be my own boss with a little
Page 10
less responsibility than if I was in private practice, and I
appreciate the flexibility offered in this set up. I also don’t
have to worry about the employees since they are hired
by the corporation, which can sometimes be a con. A con
of my current situation is that they only have year leases
so you have to renegotiate every year. You are working
hard to build your practice with no guarantee that your
goals will align with the company’s after a year.
Loranger: Work/Life balance is a pro for me. Since I have
support staff, I am able to take lunch or leave at 5pm if
I want to go to the gym. A con would be that I am not
in charge of practice decisions which can be a bit of a
frustration.
O’Brien: A pro of having your own office is that I can
make it my own. Whether that be the way the office is run
or what products I decide to bring in. A con is that your
income is directly reflected by how well your practice is
doing. Staff can be both a pro and a con. I came right out
of optometry school to being someone’s boss. When it’s
your own practice, you want your staff to do everything
the way you envision it, which can sometimes be hard to
explain. However, it is very rewarding to help someone
advance in their career.
Tom Schoppet, ABO is the optical manager at Dr. Kristin
O’Brien’s practice and he chimed in on his thoughts as a
staff member.
Schoppet: Caring about the same goal will help keep
your staff members engaged as will teambuilding. A pro
to working in private practice is that you see the difference you’re making. A con for my role as an optical
manager is that you are competing with online retailers
on pricing. It is my role to get the patient to trust my
expertise. You want to feel that you are explaining to the
patient instead of selling.
Middlemist: A pro of practicing at Kaiser is that since it
is a non-profit, all of our ODs are union employees. They
are pretty strict on overtime so you are encouraged to
work no more than 40 hours a week. We also have great
benefits, and your CE and retirement are paid for. A con
is that there is not much flexibility in your schedule. You
can choose 8 hr days/5 days a week or 10 hour days/4
days a week to allow for a week day off. Every appointment is 20 minutes long so you’re seeing an average of
November 2016
continued on page 12
Colorado Optometric Association
Specialty Eye Care and InSight LASIK
are growing!
With this growth we have new locations and more doctors
to better serve your patients. We now have offices in:
Boulder
Denver
Fort Collins
Lakewood
Longmont
Parker
To encompass all locations, doctors, and services we
are changing our name to:
Services we provide:
Cataracts
Cornea
Glaucoma
Refractive IOLs
LASIK
Lipiflow
LenSx/ORA
PRK
Vision Rehabilitation
Research
ICL
Cross-Linking
We thank you for your trusting us
with your patient’s eye health!
November 2016 Page 11
Colorado Optometric Association
Young Professionals of COA
continued from page 10
22 patients a day. You can expect about 2 hours of charting time built in to your day so that you are sticking to
your 40 hour a week schedule. Since every Kaiser doctor
has access to all patient medical information, everything
has to stay in house and no computers are allowed at
home. You do get to practice in the full medical model.
Cruse: Tom Schoppet, do you have advice for our new
grads or ODs interested in private practice on treating
your staff members?
Schoppet: Listen to “understand” instead of listening to
“respond”. Have empathy with your staff and value their
feedback. They will feel like they are making a difference
in your practice.
Cruse: Can you each share a pearl of wisdom you’ve
learned since you’ve come out of school?
Borden: It is hard to be confident in your decision-making skills coming right out of school, especially if you are
the only OD in your office but just remember the patient
doesn’t know that you just started working. They are
looking to you as the expert.
Loranger: My advice for new grads would be to always
negotiate your contract and to not feel like you can’t.
Look out for yourself because no one else is going to and
if there are red flags with an employer, don’t ignore them.
If you do have issues with your employer, communication
is key.
O’Brien: When I came out of school, I thought the more
time I spent with each patient, the better the care. I now
realize it is about speed, accuracy and always making
sure the patient’s needs were exceeded.
Middlemist: For new grads, have an attorney look at your
contract. It won’t cost you as much as it could if you sign
a bad contract. If you don’t have a commitment upfront
from a doctor, that is a red flag so be careful. With patients, communication is key. And make sure they are well
taken care of.
Crockett: Don’t be afraid to ask for a second opinion.
It’s okay if you don’t know. You can refer your patient to
another OD, especially if it’s a vision therapy or low vision
case and you know of another optometrist who specializes in that area. Also, in my opinion, you will learn a lot
more if you commit to 8 hours of CE at a time in one
particular area.
Jackson Condon: You’re not going to make everyone
happy. Sometimes, patients just want to be listened to.
O’ Brien: Hire for personality, you can train someone but
it’s most important they work well with your staff.
Tom Schoppet: In our office, we gave everyone a personality test to see how we can work best together. It is a
great learning tool.
Meet a Member
NATHAN OSTERMAN
Place of birth:
Columbus, OH
I earned my OD degree from: Southern College of
Optometry
COA member since:
2016
My favorite thing about optometry: The people
Lived in Colorado
since: 2016
My favorite way to spend free time is: Hiking,
Snowboarding, Fly fishing, Beer, Sports
My first job was: Valet
Why am I a COA Member: To help increase the
scope of optometry
I became an
optometrist because:
Zoology was a bust
Page 12
My favorite vacation spot is: Colorado
November 2016
Colorado Optometric Association
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Brad Sheasby | 303.882.5119
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COA Viewpoints August 2016.indd 1
NORTHERN COLORADO
Dan Gleissner | 303.748.7905
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Kent Hildebrand | 719.440.0445
[email protected]
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November 2016 8/11/16 2:14 PM
Page 13
Colorado Optometric Association
You are invited...
2016-17 COA Lecture Series
with Dr. Robert Fante and Dr. Michael Hawes
Fante Eye & Face Centre
3900 E. Mexico Avenue, Suite 510
Denver 80210
Drinks & hors d’oeuvres from 5:30pm
Thursday, November 10, 2016
6:00-7:00 pm
Tuesday, January 10, 2017
6:00-7:15 pm
Tuesday, February 7, 2017
6:00-7:00pm
Pre-and Postoperative Care of Oculoplastic
Surgery Patients
What to Do for the Tearing Patient: Hands-on
Lab of Proven Techniques
Masses and Bumps of the Eyelids and
Surrounding Areas
This series is approved by COPE, the Council on Optometric Practitioner Education,
for 3.25 hours of CE. Please call 303.839.1616 to RSVP. We are happy to
welcome the first 25 respondents, as our space is limited.
Drs. Fante and Hawes look forward to seeing you.
Page 14
November 2016
Colorado Optometric Association
Ryan P. Ames, OD, MBA
[email protected]
888.456.2046
MIPS/MACRA
The AOA has sent out several warnings to members that they
need to participate in PQRS, MU, eventually MIPS, and all
the other quality reporting initiatives. The only way to avoid
penalties is to participate in a meaningful way. Simply register
for something will not help. The way the programs will work is
that some doctors will be paid less, and some more.... all based
on how well they can prove their quality of care. The largest
reduction at this time is up to 9%, but that is not until 2022. In
2019 it is 4%. But if a doctor participates and does well, they
can get bonuses up to that same amount above Medicare. For
every doctor who is paid 1% less, one will be paid 1% more.
This makes the possible spread of payments around 18% by
2022.
The percentage of value in each category will be adjusted in
each year of the program as it shifts its focus to different areas
of quality.
Although participation in these programs can be
overwhelming, this method of payment is likely to become the
norm across all payers. Ignoring quality reporting measures
will not be an option if you plan to continue to participate in the
healthcare landscape of third party payers.
Below is the actual breakdown of how Merit-Based Incentive
Payment System (MIPS) will affect doctors over the coming
years. The range will start in 2019 with a 4% spread and grow
to an 18% spread by 2022. The key to all of this is the doctors
need to participate successfully in MIPS and submit the quality
reporting data to CMS. •Up to +/- 4% in 2019
•Up to +/- 5% in 2020
Sign into www.visioncare.org and
click on the CCVIP Logo to:
•Up to +/- 7% in 2021
•Up to +/- 9% in 2022 The MIPS is the method OD’s will likely follow. These are the
areas that we will be compared against our colleagues and each
area has an assigned value. These values will shift as the years
go on. The nice thing, unlike MU, is this is not an all-or-nothing
program. With MU, you either passed or you didn’t. With MIPS,
you will earn points based on how you do in each category.
The best of the best will earn a full bonus, but if you fall short
in some areas, you will simply get less. So the best reporters will
get a 4% bonus in 2019 and the worst will get a 4% penalty. If
you participate and end up in the middle of the pack, you will be
at +/-0%.
In 2019 each provider will have a composite score of 0-100
that will be based on their performance across 4 categories:
•Advancing Care Information (formerly known as Meaningful
Use) - 25% of MIPS composite score
•Quality (formerly known as PQRS) - 50% of MIPS
composite score
View short early intervention
articles to assist you in continuing care
for patients with mild visual impairment
Download
a provider list
of Colorado ODs who provide referral
based low vison care in your area
Learn about driving guidelines
for patients with central and peripheral
visual impairments
Meet the Needs of the patients you care for and
their families
•Resource Use (formerly known as the Value-Based Payment
Modifier) - 10% of MIPS of composite score
•Clinical Practice Improvement Activities - 15% of MIPS
composite score
November 2016 Page 15
Colorado Optometric Association
Maximizing Medicare Reimbursement
By Kent G. Yount, O.D., Mountain Vista EyeCare and Dry Eye Center; Sheryl Benjamin, MA, Executive Director, COA
The CMS rules for the new reimbursement system are
changing. What you do now can make a difference in what you
are reimbursed by Centers for Medicare & Medicaid Services
(CMS) two years from now. CMS will be reimbursing different
amounts to doctors based on data collected now and next year.
If you implement certain quality measures now, it can make a
difference of up to 25% in what you receive in the future for
your Medicare patients.
The process in the development of this program has been in
transition. As late as Oct 14th, 2016, CMS modified reporting
that eases the burden for clinicians and triples the “low-volume”
threshold dollar amount for mandating participation, to practices
that bill more than $30,000 in a year or care for more than 100
patients.”
The changes are because Congress repealed the Sustainable
Growth Rate formula and passed what is now known as
MACRA “Medicare Access and Chip Reauthorization Act.”
Per CMS, the overarching concept of payment reform under
MACRA is to shift healthcare away from paying for volume
to paying for value -- improving care and outcomes through
efficient and smart use of resources -- through a Quality
Payment Program (QPP). Information about these changes was
announced in COA’s Viewpoints by Kent Yount, OD (reprinted
on Page 18). [Yount, K. (2015, December). Value Based Health
Care- What?! Viewpoints, 11]. Additional information has been
published by AOA as well. For recent changes, go to the CMA
information web site https://qpp.cms.gov/.
Part of MACRA is a new system called Merit-Based Incentive
Payment System “MIPS”. MIPS will be implemented as early as
2017. It includes components of the Physician Quality Reporting
System (“PQRS”), Meaningful Use (now called Advancing Care
Information-ACI), Clinical Practice Improvement (CPIA) and
one (1) remaining resource use category which does not have to
be submitted to the CMS. These components will be collected
and put into a total composite score which will then determine
reimbursement.
What is the best way to collect this data?
The best resource is a software program created by AOA that
is included in your membership and will help you maximize
your reimbursement… but YOU have to enroll and participate.
It’s called AOA MORE and here’s why you should enroll:
What is AOA MORE?
AOA MORE is a registry that will allow optometry, as a
continued on page 17
Colorado Re�na Associates
Consul�ng Physicians & Surgeons for Vitreo‐Re�nal Disorders
Nancy J. Christmas, MD
Robert J. Courtney, MD
Mark S. Dacey, MD
Cur�s L. Hagedorn, MD
Peter G. Hovland, MD, PhD
David W. Johnson, MD Loveland
1615 Foxtrail Drive Suite 100 Loveland, CO 80538
Lowry
8101 E. Lowry Blvd. Suite 210 Denver, CO 80230
303.261.1600
Page 16
Brian C. Joondeph, MD, MPS
Alan E. Kimura, MD, MPH
Mimi Liu, MD
Mark E. Patron, MD
Stephen T. Pe�y, MD
John D. Zilis, MD Boulder Valley
500 Discovery Pkwy. Ste. 100 Superior, CO 80027
Red Rocks
400 Indiana St. Suite 310 Golden, CO 80401 Harvard
850 E. Harvard Ave. Suite 155 Denver, CO 80210
Parker
11960 Lioness Way Suite 290 Parker, CO 80134
www.Re�naColorado.com
November 2016
Colorado Optometric Association
Maximizing Medicare Reimbursement
Continued from page 16
profession, to analyze clinical outcomes which will lead to
increased reimbursement and for the benefit of improving care
over time. This will apply to every aspect of what we do as
practitioners.
What role will AOA MORE play in the new MeritBased Incentive Payment System (“MIPS”) under
Medicare?
AOA MORE will seamlessly integrate data from your
EHR to report on the above MIPS criteria and also facilitate
benchmarking. Benchmarking is a privately-viewed comparison
of your care to the profession as a whole. For example, you
can view your performance rates on the PQRS measures or the
number (%) of glaucoma patients you diagnose as compared to
national registry averages in optometry. Additionally, you can see
the demographics of your patient population as compared to the
overall population numbers.
How easy is it to use AOA MORE?
AOA MORE is simple to use because it integrates with your
EHR. AOA MORE does not fetch data directly from your EHR;
your EHR will “push” information to AOA MORE on a weekly
basis. This will provide the data you view in your dashboard and
reports. There is no manual entry required for AOA MORE.
AOA MORE is set up to be intuitive. However, like most new
things, there is some learning that needs to occur. www.aoa.org/
MORE will have resources, including video education and screen
shots to provide you with step-by-step instructions on the use of
AOA MORE. Help is also available within AOA MORE. Most
measures have a “how is this measure calculated,” and a “HELP”
dashboard displays when you are logged into AOA MORE.
In other words… AOA MORE meets key standards that
are required. And it’s a new benefit with your membership in
COA/AOA.
How do I enroll?
COA members can go to www.AOA.org/MORE to register.
Follow the “ENROLL” prompt, using your AOA member
credentials to register.
What is the cost of AOA MORE?
AOA MORE is a member benefit to those who are current with
their dues. Non-AOA members will pay $1,800, per annum, to
use AOA MORE.
Your individual National Provider Identification (NPI) number
is what ties you to the registry, and it can be used with multiple
locations. This occurs automatically if you use the same EHR
installation in multiple locations under the same practice.
However, if you work in multiple practices, each practice will
need to sign-up for the registry and authorize its EHR vendor to
release data to the registry. The information is private for each
doctor. If you have multiple doctors in your practice, each doctor
can view only their own patients.
I am an associate in my practice (not an owner);
can I register with AOA MORE?
Yes; associates can register with AOA MORE, but they will
need their practice’s owner to sign an agreement to authorize the
associate OD to use AOA MORE. The owner is not required to
use AOA MORE.
Do my patients need to sign anything to be in AOA
MORE?
Patients do not need to sign additional forms, i.e., additional
HIPAA disclosures. Because your EHR has coordinated with the
registry to remove patient identifying information (patient name,
etc.), additional forms are not necessary.
Which EHRs are supported?
Currently, AOA MORE is supported by Compulink, Crystal
Practice Management, MaximEyes, Practice Director EHR,
and RevolutionEHR. Unfortunately, ExamWRITER by Eyefinity
for now will not be linked with AOA MORE.
AOA MORE will be expanding to add additional EHR vendors.
If your vendor is not currently integrated, please still sign up.
When you register for AOA MORE, the form will ask you what
EHR you are using, and we will track the demand of additional
vendors going forward. In addition, we encourage you to let your
vendor know your preference to participate in the registry.
It can take up to four (4) weeks for your registration and
verification to be finalized. Once finalized, your data will be
successfully “pushed” from your EHR to the registry, and you can
then view AOA MORE statistics. After that, data is pushed once
per week so you will not see updates instantaneously. You will see
them weekly.
Acknowledgement is given to AOA for much of the information
provided in this article about the AOA More program.
Who is eligible to use AOA MORE?
Any COA/AOA member OD, using a participating partner
EHR, can sign-up for AOA MORE.
What if I am in multiple practices or locations?
November 2016 Page 17
Colorado Optometric Association
REPRINT FROM VIEWPOINTS; DECEMBER 2015
Value Based Health Care- What?!
by Kent G Yount OD
We as practitioners have always felt we give value. Value to
our community, value to our patients, value to our staff in terms
of knowledge and education. What does it mean and why is
it being talked about so much now? We hear of MU’s, PQRS,
CPIA, MOC, ABO, Registries, TPS, MIPS, CMS, ABMS,
Physician’s compare, etc. Oh yeah and CRAZY… It is truly
the time to stay tuned as these terms are all becoming a part of
every conversation regarding what is appropriately called “Value
Based Medicine”. Your participation in Value Based Medicine
within the next few years will determine how you will be paid as
a Doctor in the very near future, so read on!
I will do my best to explain the terminology, what is in
store, and the reasons to stay alert. As it is said “If you’re not
changing, you’re standing still”.
Health care is in a state of flux with policies and regulations
that will soon become the norm. AOA’s involvement thank
heavens has kept us informed and in the game regarding
being recognized as players in all of health care including
reimbursement. I can’t imagine trying to negotiate all of this
without the AOA and the COA.
The Center for Medicare and Medicaid Services (CMS) sets
guidelines for not only how we deliver and are reimbursed for
care from Medicare, but they typically serve as the model for all
health insurers. Medicare payments to OD’s in 2016 is estimated
to be $1,178,000,000.
So what? Well that’s a big number. A number that not only
affects our lives, but the lives of many of our patients. How
approximately 1.2 billion dollars is going to be distributed
to OD’s is all about to change. It will change to the point to
where there will more than likely be a differential of about 30%
between the winners and the losers. The winners being those
who understand how the system works and comply with the new
payment system, and those who do not. It’s a zero sum game
meaning those who comply will be bonused and those who
do not will be penalized. The winners take from the losers.
This will be determined by something called a TPS (Threshold
Performance Score). There are a lot of details on the scoring and
actually still being work on to some degree currently.
So how do you play by the rules and keep yourself from
being penalized? First of all you need to get a handle and
understanding on a few of the terminologies, then apply what
you learn.
The first is “MIPS” (Merit-Based Incentive Payment System).
This is a new term and a payment mechanism encompassing
some of what we have been doing for some time now. It will
provide annual updates to physicians based on performance in
four categories. 1) PQRS (Physician Quality Reporting System),
2) MU (Meaningful Use), 3) EHR (Electronic Health Records),
Page 18
4) CPIA (Clinical Practice Improvement Activities). While it
is true that becoming board certified is completely voluntary,
there is some level of thought that MOC or Maintenance of
Certification may be a part of CPIA incentives. MOC comes
with being ABO certified. Matter of fact, as of October 30th
2015, CMS added ABO board certification to the Physicians
Compare website. (https://www.medicare.gov/Physician
Compare/search.html). This announcement came as part of a
final rule issued by CMS updating payment policies, payment
rates, and quality provisions for services furnished under
the Medicare Physician fee schedule. The ABO is the only
Optometry board certification program that is recognized by
CMS as “equivalent to ABMS (American Board of Medical
Specialties) as well as accredited by NCCA (National
Commission for Certifying Agencies) the same credentialing
agency that certifies the 24 ABMS boards for medicine.
The MIPS program will begin in 2019 but the data used
will be from prior years, so it is important to not delay in
complying with MU, PQRS, and the other criteria. Physician’s
whose composite performance scores, (mechanism which
may not be determined till next year) that are above a specific
threshold, will receive positive payments as mentioned earlier.
These adjustment can be up to 4% higher in 2019 and grow
over time to a maximum of 9% in 2022. Because of the zero
sum calculations, if the number of physicians attaining high
composite scores is low, incentives for complying doctors
could reach upwards to a factor of 3 times. The goal is budget
neutrality to help control cost by CMS. An additional incentive
payment funded with $500 million per year will be applied to
the top 75% of physicians above the threshold. Meaning that if
everyone meets the performance threshold that positive funds
will still be available. The point is that not performing well will
not be a good place to be.
There are a lot of other details that are impossible to include.
I’d recommend that you do a google search on “MIPS” and
or talk with your colleagues about what they are doing to
meet specific criteria. The AOA has an established clinical
performance registry called “AOA More” that will be key to
getting the merit-based milestones recorded. What is interesting
is that as an AOA member, this registry is free. Those that
are not members will pay $1,800, the equivalence of a 1 year
membership in AOA. So in summary, sign up for AOA More, be
sure you are utilizing EHR, reporting PQRS and MU data and
highly consider becoming ABO certified.
To enroll for AOA More today, please go to
aoa.org/more or for more information you can email
[email protected]
November 2016
Colorado Optometric Association
CordialTech guides Optometrist through the HIPAA Requirements
Rob Van Buskirk [email protected] www.cordialtech.com 720-810-3723
Why is Personal Health Information so valuable to a cybercriminal?
Not only is HIPAA compliance and data security a legal requirement but it is also the right way to handle
your patient’s personal health information.
The theft of credit cards and account data has a limited lifespan for the criminal. It is useful only until
the victim cancels the card numbers and accounts. In comparison, the information contained in medical
records has a much broader utility and can be used to commit multiple types of fraud or identity theft
and does not change, even if compromised. For example, a mortgage, bank account or new credit cards
could be taken out in your name.
The value of personal data to a cybercriminal is much higher than the credit card or bank account
number. For example, the average selling price for a U.S. credit card in the underground is $1 USD.
However, when that single card is sold as part of a “fullz”, or full identity profile, the value increases
dramatically to around $500, with health insurance credentials adding an additional $20 each. Health
insurance credentials are especially valuable in today’s economy where skyrocketing healthcare costs
are driving people to buy stolen health care credentials to receive free medical care.
To the individuals who believe paying fines after a breach makes more financial sense than paying for
the protection of HIPAA compliance beforehand, here are a few data breach costs, fines, and penalties
to consider:











HHS fines: up to $1.5 million/violation/year
Federal Trade Commission fines: $16,000/violation
Class action lawsuits: $1,000/record
State attorney generals: $150,000 - $6.8 million
Patient loss: 40%
Free credit monitoring for affected individuals: $10-$30/record
ID theft monitoring: $10-$30/record
Lawyer fees: $2,000+
Breach notification costs: $1,000+
Business associate changes: $5,000+
Technology repairs: $2,000+
So, what do you do? Here is a short list to get you started!
1. Go back to your last HIPAA Audit. Did you specifically address Breach Notifications?
2. Make sure you and your staff are properly trained to look for malicious emails and how to
properly handle PHI
3. Review your Privacy and Security plans to ensure your technology is secure and you know how
to handle a breach. This includes notifying the media if your breach exceeds 500 records
4. Make sure you have signed a current Business Associate Agreement with all your vendors that
potentially have access to PHI
5. Review your Disaster Recovery Plans and Cloud data storage plans. Make sure they are current
to today’s standards, including encryption and are retained for 7 years.
November 2016 Page 19
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