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New AOA course helps practices benefit under health care reform

April 3, 2012

The successful practice of optometry under emerging “value-oriented” payment systems will be the subject of a first-of-its-kind continuing education course offered this year at Optometry’s Meeting®, according to the AOA Clinical and Practice Advancement Group (AOA-CPAG).

“Health Care Reform: A Clinical Approach on How to Adopt and Integrate Incentive Programs, Quality Reporting, and Coding Changes into Your Practice” will outline a method for improving patient care while enhancing practice revenues through participation in public- and private-sector quality improvement programs, according to course co-presenters Greg Caldwell, O.D., and Phil Gross, O.D.

“Primary care will be the central focus of the reformed health care system, and optometrists, as American’s primary eye and vision care providers, are excellently positioned to play a key role,” Dr. Gross noted. “However, the reformed system will also be centered around a transition from the traditional fee-for-service reimbursement system to new value-oriented, or outcomes-based, payment systems under which practitioner reimbursement will be based – not just on the volume of services provided – but on patient outcomes, meeting recognized care standards, and taking extra measures to ensure excellent care or to proactively prevent health problems.”

“This will require a fundamental shift in the way health care practitioners think about day-to-day patient care and a new style of practice management,” Dr. Caldwell said.

“This course will benefit AOA members no matter what the outcome of the Supreme Court challenge to the Accountable Care Act,” Dr. Gross added.

The reformed health care system will involve a number of interrelated components including certification programs, quality reporting systems, advanced health information technology, new health care coding systems, and pay-for-performance programs, Drs. Caldwell and Gross noted.

“Optometrists must understand these components and how they will each help to enhance the quality of patient care as well as how each will be a factor in the reimbursement a practitioner receives,” Dr. Gross said.

Examples of programs already in place include Medicare’s

  • Physician Quality Reporting System (PQRS)
  • Electronic Health Records Incentive Program
  • e-Prescribing Incentive Program, and
  • Maintenance of Certification program

Through such programs, health care practitioners can already substantially enhance their income by earning bonuses totaling up to 2.5 percent of their total Medicare allowed charges for the year, or $18,000 plus 1.5 percent of their total Medicare allowed charges.

Under value-oriented reimbursement, such incentives will increasingly become a major part of the total reimbursement a practitioner receives, Drs. Caldwell and Gross noted.

Conversely, health care practitioners who fail to participate in such programs will increasingly be subject to financial penalties, they add.

Full participation in quality reporting and other incentive programs could become an important means of protecting practice revenues against potential across-the-board insurance plan pay cuts – such as the planned 27 percent Medicare fee reduction that was forestalled until the end of this year, according to the AOA Advocacy Group.

Eventually, participation in such programs will be strongly encouraged or required of practitioners on most health plan provider panels, the AOA Advocacy Group said.

Participation in emerging value-oriented reimbursement systems will require practitioners to become familiar with accepted clinical quality measures and the coding systems – such as the National Quality Forum codes – used to report them on claims.

Health care practitioners will also be required to master the new International Classification of Disease -10th Edition coding system that will be introduced to the U.S. health care system over the next decade to provide greater specificity in the reporting of diagnoses and treatment, the AOA Advocacy Group noted.

The new “Health Care Reform: A Clinical Approach” course will provide practical strategies for incorporating quality reporting and incentive programs into optometric practice.

The course will cover the integration of quality care measures into daily practice, the use of health information technology to facilitate care and participation in incentive program, and the proper reporting of incentive program participation on claims. 

Case-by-case examples in patient care will be provided.

“Health Care Reform: A Clinical Approach on How to Adopt and Integrate Incentive Programs, Quality Reporting, and Coding Changes into Your Practice” will be offered at Optometry’s Meeting®, Thursday, June 28, 10 a.m. to noon. Seating is limited.

Optometry’s Meeting will be held June 27-July 1 in Chicago.

While Optometry’s Meeting® is open to all optometrists, AOA members can register for the meeting and continuing education courses at discounted rates.

AOA members can register for the meeting and the course on the Optometry’s Meeting® website (www.optometrysmeeting.org).

One comment

  1. Outstanding course content.



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