Thanks to factors such as advocacy, the IRIS registry, and allowing physicians to choose between two reimbursement plans, penalties have been reduced in the shift from volume-to-value based payments.
Advocacy also played a part in a provision of the American Taxpayer Relief Act of 2012 allowing submission of data to a qualified clinical data registry to meet the requirement for providing data on quality measures. The AAO’s Intelligent Research in Sight (IRIS) Registry, launched in 2013, is a means for ophthalmologists to comply with this regulation. The registry is free to academy members.
“It’s an easy way to see if you’re doing well,” Dr. Peterson said.
“It helps you see real-time dynamic data on your patients, and it helps you report or attest to all of the program categories,” she added.
The registry has saved participants more than $185 million in estimated penalties avoided since 2014. The penalty in 2019 (based on 2017 data) will be 4%, an estimated $18,600 for the average ophthalmologist.
The current payment system under MACRA gives physicians a choice of two new reimbursement plans: MIPS (Merit-based Incentive Payment System) and A-APMs (Advanced Alternate Payment Models).
Most ophthalmology practices fit best into MIPS, the fee-for-service arm of MACRA, in which payment adjustment is tied to performance in four categories: quality, advancing care information (ACI), improvement activities (IA), and cost. Each category is weighted as part of the total score; in the 2018 performance year, quality is weighted at 50%; ACI 25%, IA 15%, and cost 10%. In 2019, the weight for quality was scheduled to decrease to 30% and cost was to rise to 30%; IA and ACI will remain stable.
However, recently enacted language in the budget bill now gives flexibility to the Secretary of HHS in re-weighting the cost and quality portions, and CMS will announce its decision by early summer.
Jessica Peterson, MD, MPH
e: [email protected]
This article was adapted from Dr. Peterson’s presentation at the 2017 meeting of the American Academy of Ophthalmology. Dr. Peterson did not report any relevant financial or commercial relationships.