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Registry 101–Part 2: Clearing up confusion about the Optometric Registry coming in 2013

January 7, 2013

By Jeff Michaels, O.D., chair of the AOA Registry Committee, and Coby Ramsey, O.D., Registry Committee member

Last month, we presented the first in a four-part series addressing the optometric registry scheduled for release in 2013. In it, we discussed the questions “What is a registry, why do I need a registry and who is using registries?” To read the complete article, visit http://bit.ly/UyuC57.

1. How is doctor-patient confidentiality maintained in the registry?

The registry is hosted by Wellcentive—the largest private provider of Health Insurance Portability and Accountability Act (HIPAA)-compliant hosting services in the United States. Wellcentive uses information technology security systems that are used by the 10 largest banks in the United States. Wellcentive, as a “data center,” is defined as an American National Standards Institute (ANSI) Tier 3-4 data center (among the highest levels of security defined by ANSI for Data Centers).

Doctors who utilize the registry have access only to their own patient-identifying information. This is similar to how your electronic medical record (EMR) works. Your EMR shows you specific information only from your own patients—not from patients who visit the OD down the street.

The registry is designed to allow you to query information about your own patients better than your EMR inherently does.

For example, how many of your own diabetic patients between 40 and 64 years old did not have an eye exam within the last 12 months in your office? Running that query through the registry allows you (and only you) to see a list of your own patients who meet that criteria (and thus allow you to improve your recalls).

The registry also allows you to query information to benchmark yourself with your peers. By design, the registry does not share any doctor-specific information from your peers or other patient-identifying information from patients outside of your office.

For example, if you want to know how many diabetic patients are seen each year by ODs in your region, the registry would give you a numeric answer. A sample answer to that query might be something like this: on average, out of 25 ODs in your area, each OD sees 100 diabetic patients per year and you saw 10 this year. It would not tell you who the other doctors in your area are nor would it give information about who their patients are.

As a benchmark, you know you are seeing fewer diabetic patients than your peers in the area, reinforcing your consideration of improved ways of communicating to primary diabetic physicians that you provide diabetic eye care.

The AOA, its doctor members, other doctors, individual patients, insurance companies, licensing boards, regulatory agencies or other groups will not have access to or be able to obtain any information about specific doctors or patients from the registry, nor will they have the privilege of requesting this information.

2. Does insurance pay me to use a registry?

Effective July 1, 2007, the Centers for Medicare & Medicaid Services (CMS) started the Physician Quality Reporting Initiative (PQRI), which was later renamed the Physician Quality Reporting System (PQRS). Codes for PQRS can be submitted by traditional paper claims or directly from an EMR through a registry (known as registry-based).

Recently, the CMS discussed the success of registry-based PQRS submission compared to the limitations of claims-based PQRS. The CMS said registry-based reporting results in higher incentive payments to doctors. In 2015, doctors who do not submit PQRS data will be financially penalized.

3. What is the “registry” discussion in meaningful use?

Meaningful use (MU) requirements include Core Objectives, Menu Set Objectives and Clinical Quality Measures. The Menu Set Objectives in Meaningful Use Stage 1 (MU1) included two registry measures that were not applicable to most optometrists: reporting to immunization registries and reporting to syndromic surveillance registries (for tracking disease outbreaks such as SARS, bird flu, etc.).

Optometrists were required to use five out of 10 possible Menu Set items to qualify for MU1, and most often these two registry items were passed up for more applicable measures such as e-prescribing.

Meaningful Use Stage 2 (MU2) requirements were released in September 2012.

The MU2 Menu Set is more selective, including only six items for which the OD must select three applicable measures. Three of the six Menu Set Objectives are registry-based. The immunization and syndromic surveillance registry items were retained from MU1 (and still do not apply to ODs).

New to MU2 is the Objective for your EMR to report to “specialized” registries such as an eye care registry.

The CMS said reporting to registries is an integral part of improving population and public health, thus the role of registries in MU has expanded. The CMS expects health professions to increase their use of registries to improve health outcomes.

The AOA Clinical Resources Group and the Registry Committee are scheduled to begin a pilot beta test of the Optometric Registry, its features and capabilities this month. Part 3 of the Registry 101 series will appear in the February issue.

For more information, contact Danette Miller, AOA manager of Quality Improvement, at dmiller@aoa.org.

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