April 2015: Volume 2, Number 4

Farewell SGR:
Congress Sends SGR Repeal Bill to the President

Last night, the Senate voted overwhelmingly by a vote of 92-8 to repeal the Medicare sustainable growth rate (SGR) formula and chart a new path toward a physician payment system that rewards not for volume, but for value. The bill also reverses the Centers for Medicare & Medicaid Services (CMS) decision to unbundle the 10- and 90-day global surgery periods.

The vote ends a more than a dozen years of lobbying by the physician community to discard the flawed SGR. The SGR formula was enacted by Congress as part of the Balanced Budget Act of 1997. The formula limits growth in spending for physicians' services by linking updates to target rates of spending growth. When spending increases exceed the targeted rate of growth, payments are automatically reduced across the board. The SGR formula did not control volume and was undiscerning about the quality or efficiency of care provided by individual physicians.


ASRS Retina PractiCare Inaugural Report Demonstrates the Power of Retina-Specific Data

At the 2015 ASRS Practice Management Issues Seminar, John Thompson, MD presented data from the inaugural Retina PractiCare National-level Report. The report was based on 2014 claims data from over 100 retina specialists representing 27 practices across the country.

During the Washington Update, Dr. Thompson illustrated key retina practice-specific patterns and trends, including the top 30 procedures performed by retina specialists, examination code levels for new and return patients, and use of the -25 modifier.



Increase Practice Efficiency through Scribes

Scribes were an unusually hot topic at the 2015 ASRS Practice Management Issues Seminar. While often viewed as a costly employee for minimal services, ASRS members has started to realize the value of scribes and to consider new ways of integrating scribes and scribing into their offices.

During the Practice Management Issues Seminar session, How to Improve Efficiency In a Retina Clinic: Lean Process and the Toyota Production System, Dennis Han, MD and Aneesh Patel, Co-founder and President of FlowOne Lean Consulting, highlighted Dr. Han's implementation of scribing into his practice. Both Dr. Han and Mr. Patel noted that one of the primary reservations for hiring scribes is that they are restricted to scribing duties-that people perceive it as a function and not a person who can serve multiple purposes within the clinic.


Physicians have until May 20 to Review and Dispute Industry Reported Information

On April 6, the clock started on the 45-day review and dispute period for Open Payments. This means that physicians have until May 20 to review any payments attributed to them by industry. The law requires drug and medical device makers to report certain payments made to physicians and teaching hospitals on an annual basis. Physicians are not required to take any action, but they are encouraged to review and, if necessary, dispute payments before their information is made public on June 30, 2015.

This is the second reporting cycle for Open Payments covering payments made in 2014. Last year, the Centers for Medicare and Medicaid Services (CMS) published information about 4.45 million payments valued at $3.7 billion for the last five months of 2013.


Administration Launches New Phase of ACA Implementation

With millions of previously uninsured Americans now covered since enactment of the Affordable Care Act (ACA) five years ago, the Obama Administration is shifting gears toward making sure the health care delivery system is one that achieves better care, smarter spending, and healthier people.

While the ACA is mostly recognized for its insurance mandates, it is also responsible for a number of new payment models, including Accountable Care Organizations, and the Medicare physician value-based payment program.


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